MARYLAND MEDICARE CARRIER - 12302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BALTIMORE/SURR. CNTYS
******
**A2001**1174.20*1115.49*1282.81
**A2002**180.18*171.17*196.85
**A2004**13.78*13.09*15.05
**A2005**267.80*254.41*292.57
**A2007**84.75*80.51*92.59
**A2008**92.91*88.26*101.50
**A2013**1313.25*1247.59*1434.73
**A2014**61.16*58.10*66.82
**A2015**1236.00*1174.20*1350.33
**A2019**580.92*551.87*634.65
**A2021**1387.93*1318.53*1516.31
**A2022**1339.00*1272.05*1462.86
**A2023**15.45*14.68*16.88
**A2024**2008.50*1908.08*2194.29
**A2025**257.50*244.63*281.32
**G0186**478.79*454.85*523.08
#**G0186**410.31*389.79*448.26
**G0339**3106.03*2950.73*3393.34
**G0340**2336.11*2219.30*2552.20
**G0398**142.78*135.64*155.99
**G0398*TC*103.22*98.06*112.77
**G0398*26*39.56*37.58*43.22
**G0399**98.51*93.58*107.62
**G0399*TC*54.86*52.12*59.94
**G0399*26*44.00*41.80*48.07
**G0400**101.83*96.74*111.25
**G0400*TC*60.86*57.82*66.49
**G0400*26*40.97*38.92*44.76
**G0460**842.86*800.72*920.83
#**G0460**125.95*119.65*137.60
**G0465**842.86*800.72*920.83
#**G0465**125.95*119.65*137.60
**G0498**156.15*148.34*170.59
**G6017**81.63*77.55*89.18
**0042T**237.97*226.07*259.98
**0054T**247.71*235.32*270.62
**0055T**247.71*235.32*270.62
**0071T**602.41*572.29*658.13
**0072T**602.41*572.29*658.13
**0075T**1028.32*976.90*1123.44
**0075T*TC*1028.32*976.90*1123.44
**0075T*26*1025.99*974.69*1120.89
**0076T**1116.34*1060.52*1219.60
**0076T*TC*893.06*848.41*975.67
**0076T*26*223.27*212.11*243.93
**0095T**677.97*644.07*740.68
**0098T**758.99*721.04*829.20
**0100T**1970.44*1871.92*2152.71
**0101T**327.87*311.48*358.20
#**0101T**234.33*222.61*256.00
**0102T**327.87*311.48*358.20
#**0102T**234.33*222.61*256.00
**0106T**35.71*33.92*39.01
**0107T**35.71*33.92*39.01
**0108T**35.71*33.92*39.01
**0109T**35.71*33.92*39.01
**0110T**35.71*33.92*39.01
**0164T**740.99*703.94*809.53
**0165T**759.25*721.29*829.48
**0174T**10.26*9.75*11.21
**0184T**866.86*823.52*947.05
**0198T**89.00*84.55*97.23
#**0198T**32.53*30.90*35.54
**0200T**1876.98*1783.13*2050.60
#**0200T**420.58*399.55*459.48
**0201T**2815.47*2674.70*3075.91
#**0201T**630.86*599.32*689.22
**0207T**121.70*115.62*132.96
**0208T**40.32*38.30*44.05
**0209T**48.79*46.35*53.30
**0210T**30.79*29.25*33.64
**0211T**47.73*45.34*52.14
**0212T**37.49*35.62*40.96
#**0212T**32.19*30.58*35.17
**0213T**202.28*192.17*221.00
#**0213T**108.74*103.30*118.80
**0214T**101.78*96.69*111.19
#**0214T**60.83*57.79*66.46
**0215T**102.13*97.02*111.57
#**0215T**61.89*58.80*67.62
**0216T**186.39*177.07*203.63
#**0216T**93.55*88.87*102.20
**0217T**95.22*90.46*104.03
#**0217T**52.16*49.55*56.98
**0218T**95.22*90.46*104.03
#**0218T**53.22*50.56*58.14
**0219T**1414.59*1343.86*1545.44
**0220T**1387.38*1318.01*1515.71
**0221T**1693.20*1608.54*1849.82
**0222T**416.51*395.68*455.03
**0232T**842.86*800.72*920.83
#**0232T**125.95*119.65*137.60
**0234T**9058.31*8605.39*9896.20
#**0234T**611.44*580.87*668.00
**0235T**9058.31*8605.39*9896.20
#**0235T**611.44*580.87*668.00
**0236T**9214.80*8754.06*10067.17
#**0236T**706.15*670.84*771.47
**0237T**9214.80*8754.06*10067.17
#**0237T**706.15*670.84*771.47
**0238T**9214.80*8754.06*10067.17
#**0238T**706.15*670.84*771.47
**0253T**968.10*919.70*1057.66
**0266T**945.14*897.88*1032.56
**0267T**165.58*157.30*180.90
**0268T**352.11*334.50*384.68
**0269T**895.79*851.00*978.65
**0270T**165.58*157.30*180.90
**0271T**352.11*334.50*384.68
**0272T**58.64*55.71*64.07
**0273T**74.77*71.03*81.68
**0274T**1187.63*1128.25*1297.49
**0278T**14.78*14.04*16.15
**0308T**1446.88*1374.54*1580.72
**0329T**89.00*84.55*97.23
#**0329T**32.53*30.90*35.54
**0330T**38.21*36.30*41.75
**0331T**193.15*183.49*211.01
**0332T**329.59*313.11*360.08
**0347T**148.62*141.19*162.37
**0348T**34.72*32.98*37.93
**0349T**36.87*35.03*40.28
**0350T**37.58*35.70*41.06
**0351T**178.45*169.53*194.96
**0352T**43.89*41.70*47.96
**0353T**178.45*169.53*194.96
**0354T**43.89*41.70*47.96
**0358T**28.67*27.24*31.33
**0362T**94.65*89.92*103.41
#**0362T**67.47*64.10*73.72
**0378T**25.44*24.17*27.80
**0394T**263.42*250.25*287.79
**0395T**636.19*604.38*695.04
**0397T**48.07*45.67*52.52
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**536.72*509.88*586.36
**0409T**371.66*353.08*406.04
**0410T**386.51*367.18*422.26
**0411T**386.51*367.18*422.26
**0412T**243.75*231.56*266.29
**0413T**502.60*477.47*549.09
**0414T**387.62*368.24*423.48
**0415T**322.89*306.75*352.76
**0416T**358.60*340.67*391.77
**0417T**86.93*82.58*94.97
**0418T**58.64*55.71*64.07
**0419T**471.09*447.54*514.67
#**0419T**376.49*357.67*411.32
**0420T**670.23*636.72*732.23
#**0420T**553.40*525.73*604.59
**0421T**1689.92*1605.42*1846.23
#**0421T**719.58*683.60*786.14
**0437T**223.29*212.13*243.95
**0439T**75.93*72.13*82.95
**0440T**261.15*248.09*285.30
#**0440T**123.49*117.32*134.92
**0441T**261.15*248.09*285.30
#**0441T**123.49*117.32*134.92
**0442T**261.15*248.09*285.30
#**0442T**123.49*117.32*134.92
**0449T**791.37*751.80*864.57
**0464T**70.79*67.25*77.34
**0472T**69.94*66.44*76.41
**0473T**58.64*55.71*64.07
**0479T**64.55*61.32*70.52
**0480T**81.52*77.44*89.06
#**0480T**32.28*30.67*35.27
**0483T**1247.22*1184.86*1362.59
**0484T**1616.44*1535.62*1765.96
**0485T**24.45*23.23*26.71
**0485T*TC*9.43*8.96*10.30
**0485T*26*15.45*14.68*16.88
**0486T**48.90*46.46*53.43
**0486T*TC*18.43*17.51*20.14
**0486T*26*30.47*28.95*33.29
**0488T**64.99*61.74*71.00
#**0488T**51.22*48.66*55.96
**0505T**11984.52*11385.29*13093.08
#**0505T**598.56*568.63*653.92
**0507T**24.77*23.53*27.06
**0507T*TC*21.61*20.53*23.61
**0507T*26*3.16*3.00*3.45
**0510T**635.95*604.15*694.77
#**0510T**445.34*423.07*486.53
**0512T**327.87*311.48*358.20
#**0512T**234.33*222.61*256.00
**0513T**98.36*93.44*107.46
#**0513T**70.30*66.79*76.81
**0515T**536.72*509.88*586.36
**0516T**495.57*470.79*541.41
**0517T**352.11*334.50*384.68
**0518T**243.75*231.56*266.29
**0519T**353.22*335.56*385.89
**0520T**495.57*470.79*541.41
**0521T**58.64*55.71*64.07
**0521T*TC*38.20*36.29*41.73
**0521T*26*20.44*19.42*22.33
**0522T**69.94*66.44*76.41
**0522T*TC*38.90*36.96*42.50
**0522T*26*31.04*29.49*33.91
**0523T**160.19*152.18*175.01
**0524T**1737.94*1651.04*1898.70
#**0524T**184.47*175.25*201.54
**0525T**495.93*471.13*541.80
**0526T**386.51*367.18*422.26
**0527T**336.28*319.47*367.39
**0528T**69.94*66.44*76.41
**0528T*TC*38.90*36.96*42.50
**0528T*26*31.04*29.49*33.91
**0529T**58.64*55.71*64.07
**0529T*TC*38.20*36.29*41.73
**0529T*26*20.44*19.42*22.33
**0530T**660.84*627.80*721.97
**0531T**502.60*477.47*549.09
**0532T**353.22*335.56*385.89
**0540T**182.54*173.41*199.42
**0543T**1616.44*1535.62*1765.96
**0544T**1860.04*1767.04*2032.10
**0545T**1860.04*1767.04*2032.10
**0546T**74.62*70.89*81.52
**0552T**7.02*6.67*7.67
**0553T**2597.87*2467.98*2838.18
#**0553T**409.03*388.58*446.87
**0565T**647.22*614.86*707.09
#**0565T**541.68*514.60*591.79
**0566T**104.59*99.36*114.26
#**0566T**61.17*58.11*66.83
**0569T**1860.04*1767.04*2032.10
**0570T**435.62*413.84*475.92
**0571T**580.72*551.68*634.43
**0572T**472.82*449.18*516.56
**0573T**361.25*343.19*394.67
**0574T**418.77*397.83*457.50
**0575T**69.94*66.44*76.41
**0576T**58.64*55.71*64.07
**0577T**195.83*186.04*213.95
**0578T**29.87*28.38*32.64
**0579T**22.67*21.54*24.77
**0580T**224.37*213.15*245.12
**0581T**2400.81*2280.77*2622.89
#**0581T**221.50*210.43*241.99
**0582T**1748.23*1660.82*1909.94
#**0582T**399.48*379.51*436.44
**0583T**1496.16*1421.35*1634.55
#**0583T**139.65*132.67*152.57
**0587T**464.24*441.03*507.18
#**0587T**307.52*292.14*335.96
**0588T**383.20*364.04*418.65
#**0588T**240.24*228.23*262.46
**0589T**49.88*47.39*54.50
#**0589T**39.64*37.66*43.31
**0590T**59.09*56.14*64.56
#**0590T**41.09*39.04*44.90
**0596T**2235.23*2123.47*2441.99
#**0596T**133.18*126.52*145.50
**0597T**672.69*639.06*734.92
#**0597T**133.18*126.52*145.50
**0598T**159.91*151.91*174.70
**0599T**106.20*100.89*116.02
**0600T**3769.26*3580.80*4117.92
#**0600T**742.79*705.65*811.50
**0601T**1529.52*1453.04*1671.00
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**205.50*195.23*224.51
**0611T**43.22*41.06*47.22
**0614T**386.88*367.54*422.67
**0615T**48.73*46.29*53.23
**0616T**684.08*649.88*747.36
**0617T**766.95*728.60*837.89
**0618T**928.91*882.46*1014.83
**0619T**683.35*649.18*746.56
#**0619T**495.29*470.53*541.11
**0620T**1414.22*1343.51*1545.04
**0623T**1600.00*1520.00*1748.00
**0624T**25.00*23.75*27.31
**0625T**1500.00*1425.00*1638.75
**0626T**75.00*71.25*81.94
**0627T**271.86*258.27*297.01
#**0627T**102.43*97.31*111.91
**0628T**81.56*77.48*89.10
#**0628T**30.73*29.19*33.57
**0629T**271.86*258.27*297.01
#**0629T**102.43*97.31*111.91
**0630T**81.56*77.48*89.10
#**0630T**30.73*29.19*33.57
**0631T**87.09*82.74*95.15
**0632T**598.17*568.26*653.50
**0633T**211.43*200.86*230.99
*C*0633T*TC*113.03*107.38*123.49
**0633T*26*59.85*56.86*65.39
**0634T**211.43*200.86*230.99
**0634T*TC*151.58*144.00*165.60
**0634T*26*59.85*56.86*65.39
**0635T**211.43*200.86*230.99
**0635T*TC*151.58*144.00*165.60
**0635T*26*59.85*56.86*65.39
**0636T**211.43*200.86*230.99
**0636T*TC*151.58*144.00*165.60
**0636T*26*59.85*56.86*65.39
**0637T**211.43*200.86*230.99
**0637T*TC*151.58*144.00*165.60
**0637T*26*59.85*56.86*65.39
**0638T**211.43*200.86*230.99
**0638T*TC*151.58*144.00*165.60
**0638T*26*59.85*56.86*65.39
**0639T**87.09*82.74*95.15
**0640T**24.77*23.53*27.06
**0640T*TC*21.61*20.53*23.61
**0640T*26*3.16*3.00*3.45
**0644T**1227.73*1166.34*1341.29
#**0644T**248.91*236.46*271.93
**0646T**1860.04*1767.04*2032.10
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**62.42*59.30*68.20
**0652T**302.62*287.49*330.61
#**0652T**126.13*119.82*137.79
**0653T**395.89*376.10*432.52
#**0653T**142.45*135.33*155.63
**0654T**146.37*139.05*159.91
**0655T**1689.92*1605.42*1846.23
#**0655T**719.58*683.60*786.14
**0658T**100.68*95.65*110.00
**0659T**2846.04*2703.74*3109.30
#**0659T**451.06*428.51*492.79
**0671T**1063.71*1010.52*1162.10
**0673T**3627.38*3446.01*3962.91
#**0673T**376.76*357.92*411.61
**0699T**117.05*111.20*127.88
#**0699T**93.76*89.07*102.43
**0707T**390.85*371.31*427.01
#**0707T**293.07*278.42*320.18
**0714T**1483.58*1409.40*1620.81
#**0714T**373.10*354.45*407.62
**0730T**284.26*270.05*310.56
#**0730T**254.30*241.59*277.83
**0738T**72.62*68.99*79.34
**0739T**1689.92*1605.42*1846.23
#**0739T**719.58*683.60*786.14
**0740T**21.33*20.26*23.30
**0741T**50.20*47.69*54.84
**0742T**98.88*93.94*108.03
**0742T*TC*79.53*75.55*86.88
**0742T*26*19.34*18.37*21.13
**0743T**56.13*53.32*61.32
**0744T**929.09*882.64*1015.04
**0745T**273.03*259.38*298.29
**0746T**229.71*218.22*250.95
**0747T**1055.54*1002.76*1153.17
**0748T**191.93*182.33*209.68
**0751T**9.43*8.96*10.30
**0752T**12.24*11.63*13.37
**0753T**20.66*19.63*22.57
**0754T**83.17*79.01*90.86
**0755T**455.22*432.46*497.33
**0756T**117.37*111.50*128.23
**0757T**85.82*81.53*93.76
**0758T**94.60*89.87*103.35
**0759T**141.83*134.74*154.95
**0760T**104.01*98.81*113.63
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**122.79*116.65*134.15
**0764T**4.50*4.28*4.92
**0765T**8.22*7.81*8.98
**0771T**27.20*25.84*29.72
**0772T**27.20*25.84*29.72
**0773T**24.44*23.22*26.70
**0774T**24.44*23.22*26.70
**0777T**325.00*308.75*355.06
#**0777T**25.00*23.75*27.31
**0777T*TC*276.25*262.44*301.81
#**0777T*TC*21.25*20.19*23.22
**0777T*26*45.75*43.46*49.98
#**0777T*26*3.75*3.56*4.09
**0779T**462.35*439.23*505.11
**0779T*TC*436.01*414.21*476.34
**0779T*26*26.34*25.02*28.77
**0780T**24.44*23.22*26.70
**0783T**15.25*14.49*16.66
**0784T**2240.84*2128.80*2448.12
#**0784T**335.44*318.67*366.47
**0785T**255.23*242.47*278.84
#**0785T**151.10*143.55*165.08
**0786T**771.83*733.24*843.23
#**0786T**315.07*299.32*344.22
**0787T**255.23*242.47*278.84
#**0787T**151.10*143.55*165.08
**0788T**19.33*18.36*21.11
#**0788T**18.62*17.69*20.34
**0789T**27.70*26.32*30.27
#**0789T**23.28*22.12*25.44
**0790T**1982.91*1883.76*2166.32
**0791T**9.39*8.92*10.26
**0793T**598.17*568.26*653.50
**0794T**130.35*123.83*142.40
**0795T**743.36*706.19*812.12
**0796T**495.57*470.79*541.41
**0797T**495.57*470.79*541.41
**0798T**785.96*746.66*858.66
**0799T**523.98*497.78*572.45
**0800T**523.98*497.78*572.45
**0801T**1019.55*968.57*1113.86
**0802T**509.78*484.29*556.93
**0803T**509.78*484.29*556.93
**0804T**81.72*77.63*89.27
**0804T*TC*44.90*42.66*49.06
**0804T*26*36.81*34.97*40.22
**0805T**3128.93*2972.48*3418.35
#**0805T**334.36*317.64*365.29
**0806T**4171.90*3963.31*4557.81
#**0806T**445.82*423.53*487.06
**0807T**44.91*42.66*49.06
**0807T*TC*29.73*28.24*32.48
**0807T*26*15.19*14.43*16.59
**0808T**44.91*42.66*49.06
**0808T*TC*29.73*28.24*32.48
**0808T*26*15.19*14.43*16.59
**0810T**1172.10*1113.50*1280.53
**0811T**21.33*20.26*23.30
**0813T**2752.58*2614.95*3007.19
#**0813T**189.22*179.76*206.72
**0814T**488.56*464.13*533.75
#**0814T**366.34*348.02*400.22
**0818T**383.20*364.04*418.65
#**0818T**240.24*228.23*262.46
**0820T**149.84*142.35*163.70
#**0820T**131.13*124.57*143.26
**0821T**149.84*142.35*163.70
#**0821T**131.13*124.57*143.26
**0822T**127.36*120.99*139.14
#**0822T**111.46*105.89*121.77
**0823T**743.36*706.19*812.12
**0824T**785.96*746.66*858.66
**0825T**1019.55*968.57*1113.86
**0826T**69.94*66.44*76.41
**0826T*TC*38.90*36.96*42.50
**0826T*26*31.04*29.49*33.91
**0827T**0.01*0.01*0.01
**0828T**0.01*0.01*0.01
**0829T**0.01*0.01*0.01
**0830T**0.01*0.01*0.01
**0831T**0.01*0.01*0.01
**0832T**0.01*0.01*0.01
**0833T**0.01*0.01*0.01
**0834T**0.01*0.01*0.01
**0835T**0.01*0.01*0.01
**0836T**0.01*0.01*0.01
**0837T**0.01*0.01*0.01
**0838T**0.01*0.01*0.01
**0839T**0.01*0.01*0.01
**0840T**0.01*0.01*0.01
**0841T**0.01*0.01*0.01
**0842T**0.01*0.01*0.01
**0843T**0.01*0.01*0.01
**0844T**0.01*0.01*0.01
**0845T**0.01*0.01*0.01
**0846T**0.01*0.01*0.01
**0847T**0.01*0.01*0.01
**0848T**0.01*0.01*0.01
**0849T**0.01*0.01*0.01
**0850T**0.01*0.01*0.01
**0851T**0.01*0.01*0.01
**0852T**0.01*0.01*0.01
**0853T**0.01*0.01*0.01
**0854T**0.01*0.01*0.01
**0855T**0.01*0.01*0.01
**0856T**0.01*0.01*0.01
**0859T**24.77*23.53*27.06
**0859T*TC*21.61*20.53*23.61
**0859T*26*3.16*3.00*3.45
**0864T**327.87*311.48*358.20
#**0864T**234.33*222.61*256.00
**10011**448.84*426.40*490.36
#**10011**110.33*104.81*120.53
**10012**247.31*234.94*270.18
#**10012**73.64*69.96*80.45
**15847**370.56*352.03*404.83
**21088**1834.61*1742.88*2004.31
**21742**1213.29*1152.63*1325.52
**21743**1399.63*1329.65*1529.10
**32855**449.60*427.12*491.19
**32856**475.03*451.28*518.97
**33928**3471.08*3297.53*3792.16
**33929**1299.72*1234.73*1419.94
**33933**582.62*553.49*636.51
**33944**509.55*484.07*556.68
**34841**2252.32*2139.70*2460.66
**34842**2478.11*2354.20*2707.33
**34843**2703.88*2568.69*2953.99
**34844**2929.67*2783.19*3200.67
**34845**2252.32*2139.70*2460.66
**34846**2478.11*2354.20*2707.33
**34847**2703.88*2568.69*2953.99
**34848**2929.67*2783.19*3200.67
**43496**2289.45*2174.98*2501.23
**43647**787.28*747.92*860.11
**43648**577.02*548.17*630.40
#**43648**257.74*244.85*281.58
**43881**749.94*712.44*819.31
#**43881**687.51*653.13*751.10
**43882**796.88*757.04*870.60
#**43882**729.68*693.20*797.18
**44137**1763.49*1675.32*1926.62
**44715**449.58*427.10*491.17
**47143**450.81*428.27*492.51
**47144**535.33*508.56*584.84
**47145**507.15*481.79*554.06
**48551**449.58*427.10*491.17
**49906**2212.16*2101.55*2416.78
**50323**604.25*574.04*660.15
**50325**301.33*286.26*329.20
**53451**787.20*747.84*860.02
**53452**393.60*373.92*430.01
**53453**669.13*635.67*731.02
**53454**59.13*56.17*64.60
#**53454**36.19*34.38*39.54
**54440**797.06*757.21*870.79
**63043**624.53*593.30*682.30
**63044**567.72*539.33*620.23
**64596**2240.84*2128.80*2448.12
#**64596**335.44*318.67*366.47
**64597**672.25*638.64*734.44
#**64597**100.63*95.60*109.94
**64598**255.23*242.47*278.84
#**64598**151.10*143.55*165.08
**65757**124.82*118.58*136.37
**66983**684.08*649.88*747.36
**66987**790.08*750.58*863.17
**66988**655.86*623.07*716.53
*C*70170**266.51*253.18*291.16
*C*70170*TC*251.75*239.16*275.03
**70555**233.47*221.80*255.07
**70555*TC*113.84*108.15*124.37
*C*70557**720.93*684.88*787.61
**70557*TC*556.61*528.78*608.10
*C*70558**358.98*341.03*392.18
*C*70558*TC*188.92*179.47*206.39
*C*70559**349.30*331.84*381.62
*C*70559*TC*188.92*179.47*206.39
*C*74190**588.87*559.43*643.34
*C*74190*TC*566.61*538.28*619.02
**74235**154.72*146.98*169.03
**74235*TC*97.58*92.70*106.61
**74300**89.67*85.19*97.97
**74300*TC*76.27*72.46*83.33
**74301**27.80*26.41*30.37
**74301*TC*17.89*17.00*19.55
**74328**175.06*166.31*191.26
**74328*TC*151.80*144.21*165.84
**74329**151.35*143.78*165.35
**74329*TC*127.74*121.35*139.55
**74330**262.59*249.46*286.88
**74330*TC*235.19*223.43*256.94
**74340**86.58*82.25*94.59
**74340*TC*60.90*57.86*66.54
**74355**86.58*82.25*94.59
**74355*TC*49.95*47.45*54.57
**74360**86.58*82.25*94.59
**74360*TC*58.99*56.04*64.45
**74363**175.06*166.31*191.26
**74363*TC*133.29*126.63*145.62
*C*74445**166.94*158.59*182.38
*C*74445*TC*113.03*107.38*123.49
*C*74450**267.44*254.07*292.18
*C*74450*TC*251.75*239.16*275.03
*C*74470**591.58*562.00*646.30
*C*74470*TC*566.61*538.28*619.02
**74742**233.47*221.80*255.07
**74742*TC*204.05*193.85*222.93
*C*74775**281.51*267.43*307.54
*C*74775*TC*251.75*239.16*275.03
*C*75801**689.25*654.79*753.01
*C*75801*TC*645.33*613.06*705.02
*C*75803**1701.45*1616.38*1858.84
*C*75803*TC*1644.97*1562.72*1797.13
*C*75805**3312.99*3147.34*3619.44
*C*75805*TC*3273.99*3110.29*3576.83
*C*75807**3327.08*3160.73*3634.84
*C*75807*TC*3273.99*3110.29*3576.83
*C*75810**3322.70*3156.57*3630.06
*C*75810*TC*3273.99*3110.29*3576.83
**75894**971.18*922.62*1061.01
**75894*TC*897.15*852.29*980.13
*C*75898**3368.53*3200.10*3680.12
*C*75898*TC*3273.99*3110.29*3576.83
**75970**473.55*449.87*517.35
**75970*TC*435.49*413.72*475.78
**76125**42.33*40.21*46.24
**76125*TC*28.93*27.48*31.60
**76390**217.51*206.63*237.62
**76390*TC*164.29*156.08*179.49
**76390*26*53.22*50.56*58.14
**76932**90.09*85.59*98.43
**76932*TC*53.27*50.61*58.20
**76940**169.37*160.90*185.04
**76940*TC*66.64*63.31*72.81
**76941**121.96*115.86*133.24
**76941*TC*57.56*54.68*62.88
**76945**88.95*84.50*97.18
**76945*TC*56.97*54.12*62.24
*C*76975**292.80*278.16*319.88
*C*76975*TC*251.75*239.16*275.03
**76998**175.06*166.31*191.26
**76998*TC*126.87*120.53*138.61
**77013**448.36*425.94*489.83
**77013*TC*264.50*251.28*288.97
**77022**498.65*473.72*544.78
**77022*TC*298.19*283.28*325.77
**77371**1354.89*1287.15*1480.22
**77520**980.87*931.83*1071.60
**77522**980.87*931.83*1071.60
**77523**1126.23*1069.92*1230.41
**77525**1271.59*1208.01*1389.21
*C*78282**438.89*416.95*479.49
*C*78282*TC*423.65*402.47*462.84
**78414**514.99*489.24*562.63
**78414*TC*493.88*469.19*539.57
*C*78429**1685.86*1601.57*1841.81
*C*78429*TC*1606.85*1526.51*1755.49
*C*78430**1682.07*1597.97*1837.67
*C*78430*TC*1606.85*1526.51*1755.49
*C*78431**2514.04*2388.34*2746.59
*C*78431*TC*2426.12*2304.81*2650.53
*C*78432**2088.80*1984.36*2282.01
*C*78432*TC*1994.78*1895.04*2179.30
*C*78433**2205.71*2095.42*2409.73
*C*78433*TC*2102.79*1997.65*2297.30
**78434**754.21*716.50*823.98
**78434*TC*725.25*688.99*792.34
*C*78459**1531.89*1455.30*1673.60
*C*78459*TC*1458.60*1385.67*1593.52
*C*78491**1678.75*1594.81*1834.03
*C*78491*TC*1606.85*1526.51*1755.49
*C*78492**1691.43*1606.86*1847.89
*C*78492*TC*1606.85*1526.51*1755.49
*C*78608**1676.11*1592.30*1831.15
*C*78608*TC*1606.85*1526.51*1755.49
*C*78811**1529.98*1453.48*1671.50
*C*78811*TC*1458.60*1385.67*1593.52
*C*78812**1697.05*1612.20*1854.03
*C*78812*TC*1606.85*1526.51*1755.49
*C*78813**1699.04*1614.09*1856.20
*C*78813*TC*1606.85*1526.51*1755.49
*C*78814**1708.97*1623.52*1867.05
*C*78814*TC*1606.85*1526.51*1755.49
*C*78815**1720.59*1634.56*1879.74
*C*78815*TC*1606.85*1526.51*1755.49
*C*78816**1721.46*1635.39*1880.70
*C*78816*TC*1606.85*1526.51*1755.49
**79300**237.04*225.19*258.97
**79300*TC*173.92*165.22*190.00
**79445**237.04*225.19*258.97
**79445*TC*127.23*120.87*139.00
**86485**5.81*5.52*6.35
**90867**315.90*300.11*345.13
#**90867**142.76*135.62*155.96
**90868**210.81*200.27*230.31
#**90868**107.15*101.79*117.06
**90869**289.11*274.65*315.85
#**90869**167.74*159.35*183.25
**90952**512.97*487.32*560.42
**90953**366.73*348.39*400.65
**92978**259.59*246.61*283.60
**92978*TC*163.01*154.86*178.09
**92979**157.03*149.18*171.56
**92979*TC*80.50*76.48*87.95
*C*93315**692.44*657.82*756.49
*C*93315*TC*566.61*538.28*619.02
**93317**226.35*215.03*247.28
**93317*TC*138.22*131.31*151.01
*C*93318**668.27*634.86*730.09
*C*93318*TC*566.61*538.28*619.02
**93571**258.53*245.60*282.44
**93571*TC*185.13*175.87*202.25
**93572**154.48*146.76*168.77
**93572*TC*100.94*95.89*110.27
**93600**3557.81*3379.92*3886.91
**93600*TC*3439.50*3267.53*3757.66
**93602**3557.81*3379.92*3886.91
**93602*TC*3441.77*3269.68*3760.13
**93603**3557.81*3379.92*3886.91
**93603*TC*3441.77*3269.68*3760.13
**93609**2134.69*2027.96*2332.15
**93609*TC*1857.14*1764.28*2028.92
**93610**3557.81*3379.92*3886.91
**93610*TC*3393.91*3224.21*3707.84
**93612**3557.81*3379.92*3886.91
**93612*TC*3396.61*3226.78*3710.80
**93619**7115.62*6759.84*7773.82
**93619*TC*6723.63*6387.45*7345.57
**93620**7115.62*6759.84*7773.82
**93620*TC*6486.55*6162.22*7086.55
**93621**7115.62*6759.84*7773.82
**93621*TC*7031.91*6680.31*7682.36
**93622**7115.62*6759.84*7773.82
**93622*TC*6943.02*6595.87*7585.25
**93623**2134.69*2027.96*2332.15
**93623*TC*2065.22*1961.96*2256.25
**93624**3557.81*3379.92*3886.91
**93624*TC*3313.77*3148.08*3620.29
**93631**7115.62*6759.84*7773.82
**93631*TC*6712.81*6377.17*7333.75
**93640**1133.95*1077.25*1238.84
**93640*TC*954.45*906.73*1042.74
**93641**1133.95*1077.25*1238.84
**93641*TC*819.77*778.78*895.60
**93662**452.04*429.44*493.86
**93662*TC*382.11*363.00*417.45
**93745**95.43*90.66*104.26
**93745*TC*71.59*68.01*78.21
**93745*26*23.80*22.61*26.00
**94642**32.38*30.76*35.37
**95700**259.12*246.16*283.08
**95705**103.65*98.47*113.24
**95706**431.17*409.61*471.05
**95707**538.96*512.01*588.81
**95708**155.47*147.70*169.86
**95709**861.30*818.24*940.98
**95710**1076.88*1023.04*1176.50
**95711**129.56*123.08*141.54
**95712**518.23*492.32*566.17
**95713**647.79*615.40*707.71
**95714**207.29*196.93*226.47
**95715**1036.46*984.64*1132.34
**95716**1295.58*1230.80*1415.42
**95965**957.21*909.35*1045.75
**95965*TC*543.69*516.51*593.99
**95967**475.55*451.77*519.54
**96020**370.01*351.51*404.24
**96020*TC*212.39*201.77*232.04
**96547**787.01*747.66*859.81
#**96547**138.58*131.65*151.40
**96548**393.50*373.83*429.90
#**96548**69.29*65.83*75.70
**97039**14.27*13.56*15.59
**97139**19.29*18.33*21.08
**97151**50.59*48.06*55.27
#**97151**44.59*42.36*48.71
**97152**43.00*40.85*46.98
#**97152**37.90*36.01*41.41
**97153**34.18*32.47*37.34
#**97153**29.77*28.28*32.52
**97154**4.75*4.51*5.19
#**97154**4.30*4.09*4.70
**97155**34.18*32.47*37.34
#**97155**29.77*28.28*32.52
**97156**36.03*34.23*39.36
#**97156**31.44*29.87*34.35
**97157**10.60*10.07*11.58
#**97157**9.54*9.06*10.42
**97158**5.51*5.23*6.01
#**97158**4.98*4.73*5.44
**98978**50.20*47.69*54.84
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LC (LIMITING CHARGE) APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
SOME CODES ARE CARRIER PRICED & SUBJECT TO CHANGE. OUR FEE LOOKUP TOOL HAS CURRENT PRICING.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE
COPYRIGHTED 2023 BY THE AMERICAN MEDICAL ASSOCIATION.