MARYLAND MEDICARE CARRIER - 12302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**455.40*432.63*497.52
#**G0186**390.86*371.32*427.02
**G0339**2930.10*2783.60*3201.14
**G0340**2203.70*2093.52*2407.55
**G0398**135.55*128.77*148.09
**G0398*TC*97.11*92.25*106.09
**G0398*26*38.44*36.52*42.00
**G0399**93.96*89.26*102.65
**G0399*TC*51.54*48.96*56.30
**G0399*26*42.75*40.61*46.70
**G0400**96.96*92.11*105.93
**G0400*TC*57.19*54.33*62.48
**G0400*26*39.77*37.78*43.45
**G0460**794.96*755.21*868.49
#**G0460**119.28*113.32*130.32
**G0465**794.96*755.21*868.49
#**G0465**119.28*113.32*130.32
**G0498**146.92*139.57*160.51
**G6017**77.65*73.77*84.84
**0042T**226.87*215.53*247.86
**0054T**228.16*216.75*249.26
**0055T**228.16*216.75*249.26
**0071T**569.57*541.09*622.25
**0072T**569.57*541.09*622.25
**0075T**956.75*908.91*1045.25
**0075T*TC*956.75*908.91*1045.25
**0075T*26*957.33*909.46*1045.88
**0076T**1075.07*1021.32*1174.52
**0076T*TC*860.07*817.07*939.63
**0076T*26*215.00*204.25*234.89
**0095T**622.24*591.13*679.80
**0098T**696.34*661.52*760.75
**0100T**1884.16*1789.95*2058.44
**0101T**312.18*296.57*341.06
#**0101T**224.02*212.82*244.74
**0102T**312.18*296.57*341.06
#**0102T**224.02*212.82*244.74
**0106T**33.57*31.89*36.67
**0107T**33.57*31.89*36.67
**0108T**33.57*31.89*36.67
**0109T**33.57*31.89*36.67
**0110T**33.57*31.89*36.67
**0164T**680.32*646.30*743.25
**0165T**696.99*662.14*761.46
**0174T**9.91*9.41*10.82
**0184T**818.77*777.83*894.50
**0198T**84.73*80.49*92.56
#**0198T**31.50*29.93*34.42
**0200T**1772.05*1683.45*1935.97
#**0200T**399.41*379.44*436.36
**0201T**2658.08*2525.18*2903.96
#**0201T**599.12*569.16*654.53
**0207T**121.70*115.62*132.96
**0208T**37.91*36.01*41.41
**0209T**45.90*43.61*50.15
**0210T**28.93*27.48*31.60
**0211T**44.90*42.66*49.06
**0212T**36.16*34.35*39.50
#**0212T**31.17*29.61*34.05
**0213T**192.13*182.52*209.90
#**0213T**103.97*98.77*113.59
**0214T**96.82*91.98*105.78
#**0214T**58.23*55.32*63.62
**0215T**97.15*92.29*106.13
#**0215T**59.23*56.27*64.71
**0216T**176.91*168.06*193.27
#**0216T**89.41*84.94*97.68
**0217T**90.55*86.02*98.92
#**0217T**49.96*47.46*54.58
**0218T**90.55*86.02*98.92
#**0218T**50.96*48.41*55.67
**0219T**1309.85*1244.36*1431.01
**0220T**1287.08*1222.73*1406.14
**0221T**1577.31*1498.44*1723.21
**0222T**385.47*366.20*421.13
**0232T**794.96*755.21*868.49
#**0232T**119.28*113.32*130.32
**0234T**8535.14*8108.38*9324.64
#**0234T**574.08*545.38*627.19
**0235T**8535.14*8108.38*9324.64
#**0235T**574.08*545.38*627.19
**0236T**8683.89*8249.70*9487.16
#**0236T**664.62*631.39*726.10
**0237T**8683.89*8249.70*9487.16
#**0237T**664.62*631.39*726.10
**0238T**8683.89*8249.70*9487.16
#**0238T**664.62*631.39*726.10
**0253T**915.60*869.82*1000.29
**0266T**886.51*842.18*968.51
**0267T**155.74*147.95*170.14
**0268T**330.29*313.78*360.85
**0269T**840.09*798.09*917.80
**0270T**155.74*147.95*170.14
**0271T**330.29*313.78*360.85
**0272T**55.81*53.02*60.97
**0273T**71.37*67.80*77.97
**0274T**1102.32*1047.20*1204.28
**0278T**14.26*13.55*15.58
**0308T**1383.18*1314.02*1511.12
**0329T**84.73*80.49*92.56
#**0329T**31.50*29.93*34.42
**0330T**38.21*36.30*41.75
**0331T**182.77*173.63*199.67
**0332T**312.07*296.47*340.94
**0347T**140.04*133.04*153.00
**0348T**32.88*31.24*35.93
**0349T**34.88*33.14*38.11
**0350T**35.55*33.77*38.84
**0351T**169.17*160.71*184.82
**0352T**42.44*40.32*46.37
**0353T**169.17*160.71*184.82
**0354T**42.44*40.32*46.37
**0358T**26.93*25.58*29.42
**0362T**90.51*85.98*98.88
#**0362T**64.89*61.65*70.90
**0378T**24.51*23.28*26.77
**0394T**249.25*236.79*272.31
**0395T**603.60*573.42*659.43
**0397T**46.39*44.07*50.68
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**503.51*478.33*550.08
**0409T**348.82*331.38*381.09
**0410T**362.76*344.62*396.31
**0411T**362.76*344.62*396.31
**0412T**228.79*217.35*249.95
**0413T**471.63*448.05*515.26
**0414T**363.66*345.48*397.30
**0415T**302.83*287.69*330.84
**0416T**336.46*319.64*367.59
**0417T**83.00*78.85*90.68
**0418T**55.81*53.02*60.97
**0419T**447.41*425.04*488.80
#**0419T**358.25*340.34*391.39
**0420T**635.32*603.55*694.08
#**0420T**525.20*498.94*573.78
**0421T**1600.17*1520.16*1748.18
#**0421T**685.63*651.35*749.05
**0437T**210.44*199.92*229.91
**0439T**71.58*68.00*78.20
**0440T**247.63*235.25*270.54
#**0440T**117.88*111.99*128.79
**0441T**247.63*235.25*270.54
#**0441T**117.88*111.99*128.79
**0442T**247.63*235.25*270.54
#**0442T**117.88*111.99*128.79
**0449T**755.41*717.64*825.29
**0464T**67.13*63.77*73.34
**0472T**66.74*63.40*72.91
**0473T**55.81*53.02*60.97
**0479T**62.32*59.20*68.08
**0480T**77.57*73.69*84.74
#**0480T**31.16*29.60*34.04
**0483T**1168.04*1109.64*1276.09
**0484T**1514.28*1438.57*1654.36
**0485T**23.40*22.23*25.56
**0485T*TC*8.80*8.36*9.61
**0485T*26*14.92*14.17*16.30
**0486T**46.81*44.47*51.14
**0486T*TC*17.29*16.43*18.89
**0486T*26*29.52*28.04*32.25
**0488T**62.31*59.19*68.07
#**0488T**49.34*46.87*53.90
**0505T**11311.26*10745.70*12357.56
#**0505T**569.97*541.47*622.69
**0507T**23.25*22.09*25.40
**0507T*TC*20.28*19.27*22.16
**0507T*26*2.97*2.82*3.24
**0510T**600.21*570.20*655.73
#**0510T**420.56*399.53*459.46
**0512T**312.18*296.57*341.06
#**0512T**224.02*212.82*244.74
**0513T**93.65*88.97*102.32
#**0513T**67.21*63.85*73.43
**0515T**503.51*478.33*550.08
**0516T**464.90*441.66*507.91
**0517T**330.29*313.78*360.85
**0518T**228.79*217.35*249.95
**0519T**331.29*314.73*361.94
**0520T**464.90*441.66*507.91
**0521T**55.81*53.02*60.97
**0521T*TC*35.92*34.12*39.24
**0521T*26*19.89*18.90*21.74
**0522T**66.74*63.40*72.91
**0522T*TC*36.58*34.75*39.96
**0522T*26*30.16*28.65*32.95
**0523T**151.15*143.59*165.13
**0524T**1637.65*1555.77*1789.14
#**0524T**173.52*164.84*189.57
**0525T**465.23*441.97*508.27
**0526T**362.76*344.62*396.31
**0527T**315.44*299.67*344.62
**0528T**66.74*63.40*72.91
**0528T*TC*36.58*34.75*39.96
**0528T*26*30.16*28.65*32.95
**0529T**55.81*53.02*60.97
**0529T*TC*35.92*34.12*39.24
**0529T*26*19.89*18.90*21.74
**0530T**619.96*588.96*677.30
**0531T**471.63*448.05*515.26
**0532T**331.29*314.73*361.94
**0540T**175.31*166.54*191.52
**0543T**1514.28*1438.57*1654.36
**0544T**1743.22*1656.06*1904.47
**0545T**1743.22*1656.06*1904.47
**0546T**71.40*67.83*78.00
**0552T**6.63*6.30*7.25
**0553T**2446.71*2324.37*2673.03
#**0553T**383.76*364.57*419.26
**0565T**610.49*579.97*666.97
#**0565T**511.02*485.47*558.29
**0566T**99.12*94.16*108.28
#**0566T**58.20*55.29*63.58
**0569T**1743.22*1656.06*1904.47
**0570T**408.27*387.86*446.04
**0571T**544.83*517.59*595.23
**0572T**443.39*421.22*484.40
**0573T**338.87*321.93*370.22
**0574T**392.58*372.95*428.89
**0575T**66.74*63.40*72.91
**0576T**55.81*53.02*60.97
**0577T**188.76*179.32*206.22
**0578T**28.81*27.37*31.48
**0579T**21.28*20.22*23.25
**0580T**210.53*200.00*230.00
**0581T**2260.74*2147.70*2469.86
#**0581T**206.77*196.43*225.89
**0582T**1651.29*1568.73*1804.04
#**0582T**380.11*361.10*415.27
**0583T**1496.16*1421.35*1634.55
#**0583T**132.21*125.60*144.44
**0587T**439.77*417.78*480.45
#**0587T**292.06*277.46*319.08
**0588T**362.67*344.54*396.22
#**0588T**227.93*216.53*249.01
**0589T**47.71*45.32*52.12
#**0589T**38.06*36.16*41.58
**0590T**56.34*53.52*61.55
#**0590T**39.37*37.40*43.01
**0596T**2235.23*2123.47*2441.99
#**0596T**129.09*122.64*141.04
**0597T**672.69*639.06*734.92
#**0597T**129.09*122.64*141.04
**0598T**150.97*143.42*164.93
**0599T**100.42*95.40*109.71
**0600T**3563.82*3385.63*3893.47
#**0600T**711.41*675.84*777.22
**0601T**1431.59*1360.01*1564.01
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**195.28*185.52*213.35
**0611T**40.56*38.53*44.31
**0614T**363.00*344.85*396.58
**0615T**46.78*44.44*51.11
**0616T**655.62*622.84*716.27
**0617T**733.10*696.45*800.92
**0618T**887.63*843.25*969.74
**0619T**648.77*616.33*708.78
#**0619T**471.45*447.88*515.06
**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**257.67*244.79*281.51
#**0627T**97.98*93.08*107.04
**0628T**77.30*73.44*84.46
#**0628T**29.40*27.93*32.12
**0629T**257.67*244.79*281.51
#**0629T**97.98*93.08*107.04
**0630T**77.30*73.44*84.46
#**0630T**29.40*27.93*32.12
**0631T**82.07*77.97*89.67
**0632T**560.95*532.90*612.84
**0633T**200.66*190.63*219.22
*C*0633T*TC*106.44*101.12*116.29
**0633T*26*57.97*55.07*63.33
**0634T**200.66*190.63*219.22
**0634T*TC*142.69*135.56*155.89
**0634T*26*57.97*55.07*63.33
**0635T**200.66*190.63*219.22
**0635T*TC*142.69*135.56*155.89
**0635T*26*57.97*55.07*63.33
**0636T**200.66*190.63*219.22
**0636T*TC*142.69*135.56*155.89
**0636T*26*57.97*55.07*63.33
**0637T**200.66*190.63*219.22
**0637T*TC*142.69*135.56*155.89
**0637T*26*57.97*55.07*63.33
**0638T**200.66*190.63*219.22
**0638T*TC*142.69*135.56*155.89
**0638T*26*57.97*55.07*63.33
**0639T**82.07*77.97*89.67
**0640T**23.25*22.09*25.40
**0640T*TC*20.28*19.27*22.16
**0640T*26*2.97*2.82*3.24
**0644T**1156.66*1098.83*1263.65
#**0644T**234.14*222.43*255.79
**0646T**1743.22*1656.06*1904.47
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.44*56.47*64.94
**0652T**286.46*272.14*312.96
#**0652T**120.12*114.11*131.23
**0653T**374.53*355.80*409.17
#**0653T**135.66*128.88*148.21
**0654T**139.27*132.31*152.16
**0655T**1600.17*1520.16*1748.18
#**0655T**685.63*651.35*749.05
**0658T**94.80*90.06*103.57
**0659T**2680.57*2546.54*2928.52
#**0659T**423.33*402.16*462.48
**0671T**1015.46*964.69*1109.39
**0673T**3421.18*3250.12*3737.64
#**0673T**357.52*339.64*390.59
**0699T**111.77*106.18*122.11
#**0699T**89.81*85.32*98.12
**0707T**370.06*351.56*404.29
#**0707T**277.90*264.01*303.61
**0714T**1401.61*1331.53*1531.26
#**0714T**354.99*337.24*387.83
**0730T**271.85*258.26*297.00
#**0730T**243.50*231.33*266.03
**0738T**69.91*66.41*76.37
**0739T**1600.17*1520.16*1748.18
#**0739T**685.63*651.35*749.05
**0740T**19.93*18.93*21.77
**0741T**47.23*44.87*51.60
**0742T**93.62*88.94*102.28
**0742T*TC*74.83*71.09*81.75
**0742T*26*18.79*17.85*20.53
**0743T**53.15*50.49*58.06
**0744T**867.84*824.45*948.12
**0745T**256.73*243.89*280.47
**0746T**222.08*210.98*242.63
**0747T**992.70*943.07*1084.53
**0748T**181.59*172.51*198.39
**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**433.00*411.35*473.05
**0756T**111.35*105.78*121.65
**0757T**81.11*77.05*88.61
**0758T**89.74*85.25*98.04
**0759T**134.29*127.58*146.72
**0760T**99.02*94.07*108.18
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**116.96*111.11*127.78
**0764T**4.28*4.07*4.68
**0765T**7.95*7.55*8.68
**0771T**25.95*24.65*28.35
**0772T**25.95*24.65*28.35
**0773T**23.25*22.09*25.40
**0774T**23.25*22.09*25.40
**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**436.37*414.55*476.73
**0779T*TC*410.85*390.31*448.86
**0779T*26*25.52*24.24*27.88
**0780T**23.25*22.09*25.40
**0783T**14.29*13.58*15.62
**0784T**2116.22*2010.41*2311.97
#**0784T**320.41*304.39*350.05
**0785T**241.49*229.42*263.83
#**0785T**143.35*136.18*156.61
**0786T**730.14*693.63*797.67
#**0786T**299.65*284.67*327.37
**0787T**241.49*229.42*263.83
#**0787T**143.35*136.18*156.61
**0788T**18.54*17.61*20.25
#**0788T**17.88*16.99*19.54
**0789T**25.81*24.52*28.20
#**0789T**22.35*21.23*24.41
**0790T**1897.00*1802.15*2072.47
**0791T**8.98*8.53*9.81
**0793T**560.95*532.90*612.84
**0794T**130.35*123.83*142.40
**0795T**697.35*662.48*761.85
**0796T**464.90*441.66*507.91
**0797T**464.90*441.66*507.91
**0798T**736.65*699.82*804.79
**0799T**491.10*466.55*536.53
**0800T**491.10*466.55*536.53
**0801T**956.00*908.20*1044.43
**0802T**478.00*454.10*522.22
**0803T**478.00*454.10*522.22
**0804T**78.04*74.14*85.26
**0804T*TC*42.24*40.13*46.15
**0804T*26*35.80*34.01*39.11
**0805T**2952.00*2804.40*3225.06
#**0805T**318.17*302.26*347.60
**0806T**3936.00*3739.20*4300.08
#**0806T**424.22*403.01*463.46
**0807T**42.49*40.37*46.43
**0807T*TC*27.93*26.53*30.51
**0807T*26*14.56*13.83*15.90
**0808T**42.49*40.37*46.43
**0808T*TC*27.93*26.53*30.51
**0808T*26*14.56*13.83*15.90
**0810T**1120.85*1064.81*1224.53
**0811T**19.93*18.93*21.77
**0813T**2593.53*2463.85*2833.43
#**0813T**177.60*168.72*194.03
**0814T**462.57*439.44*505.36
#**0814T**347.38*330.01*379.51
**0818T**362.67*344.54*396.22
#**0818T**227.93*216.53*249.01
**0820T**145.81*138.52*159.30
#**0820T**128.18*121.77*140.04
**0821T**145.81*138.52*159.30
#**0821T**128.18*121.77*140.04
**0822T**123.94*117.74*135.40
#**0822T**108.95*103.50*119.03
**0823T**697.35*662.48*761.85
**0824T**736.65*699.82*804.79
**0825T**956.00*908.20*1044.43
**0826T**66.74*63.40*72.91
**0826T*TC*36.58*34.75*39.96
**0826T*26*30.16*28.65*32.95
**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**23.25*22.09*25.40
**0859T*TC*20.28*19.27*22.16
**0859T*26*2.97*2.82*3.24
**0864T**312.18*296.57*341.06
#**0864T**224.02*212.82*244.74
**10011**424.89*403.65*464.20
#**10011**105.85*100.56*115.64
**10012**234.03*222.33*255.68
#**10012**70.35*66.83*76.85
**15847**349.11*331.65*381.40
**21088**1657.76*1574.87*1811.10
**21742**1139.99*1082.99*1245.44
**21743**1309.09*1243.64*1430.19
**32855**406.28*385.97*443.87
**32856**444.03*421.83*485.10
**33928**3249.12*3086.66*3549.66
**33929**1217.04*1156.19*1329.62
**33933**551.14*523.58*602.12
**33944**460.40*437.38*502.99
**34841**2145.63*2038.35*2344.10
**34842**2371.43*2252.86*2590.79
**34843**2597.20*2467.34*2837.44
**34844**2822.98*2681.83*3084.10
**34845**2145.63*2038.35*2344.10
**34846**2371.43*2252.86*2590.79
**34847**2597.20*2467.34*2837.44
**34848**2822.98*2681.83*3084.10
**43496**2164.93*2056.68*2365.18
**43647**711.41*675.84*777.22
**43648**547.98*520.58*598.67
#**43648**246.17*233.86*268.94
**43881**700.73*665.69*765.54
#**43881**641.81*609.72*701.18
**43882**744.37*707.15*813.22
#**43882**680.99*646.94*743.98
**44137**1593.47*1513.80*1740.87
**44715**406.27*385.96*443.85
**47143**429.53*408.05*469.26
**47144**510.06*484.56*557.24
**47145**483.20*459.04*527.90
**48551**406.27*385.96*443.85
**49906**2090.05*1985.55*2283.38
**50323**545.98*518.68*596.48
**50325**272.28*258.67*297.47
**53451**749.91*712.41*819.27
**53452**374.96*356.21*409.64
**53453**637.40*605.53*696.36
**53454**56.38*53.56*61.59
#**53454**34.76*33.02*37.97
**54440**759.19*721.23*829.41
**63043**570.99*542.44*623.81
**63044**531.82*505.23*581.01
**64596**2116.22*2010.41*2311.97
#**64596**320.41*304.39*350.05
**64597**634.87*603.13*693.60
#**64597**96.12*91.31*105.01
**64598**241.49*229.42*263.83
#**64598**143.35*136.18*156.61
**65757**118.57*112.64*129.54
**66983**655.62*622.84*716.27
**66987**756.92*719.07*826.93
**66988**629.53*598.05*687.76
*C*70170**251.43*238.86*274.69
*C*70170*TC*237.19*225.33*259.13
**70555**233.47*221.80*255.07
**70555*TC*117.53*111.65*128.40
*C*70557**683.08*648.93*746.27
*C*70557*TC*533.94*507.24*583.33
*C*70558**342.36*325.24*374.03
*C*70558*TC*177.97*169.07*194.43
*C*70559**332.21*315.60*362.94
*C*70559*TC*177.97*169.07*194.43
*C*74190**555.46*527.69*606.84
*C*74190*TC*533.94*507.24*583.33
**74235**145.90*138.61*159.40
**74235*TC*90.58*86.05*98.96
**74300**84.74*80.50*92.58
**74300*TC*71.83*68.24*78.48
**74301**26.09*24.79*28.51
**74301*TC*16.48*15.66*18.01
**74328**175.06*166.31*191.26
**74328*TC*152.53*144.90*166.64
**74329**141.99*134.89*155.12
**74329*TC*119.12*113.16*130.13
**74330**262.59*249.46*286.88
**74330*TC*236.09*224.29*257.93
**74340**86.58*82.25*94.59
**74340*TC*61.74*58.65*67.45
**74355**86.58*82.25*94.59
**74355*TC*51.14*48.58*55.87
**74360**86.58*82.25*94.59
**74360*TC*60.11*57.10*65.67
**74363**175.06*166.31*191.26
**74363*TC*134.66*127.93*147.12
*C*74445**158.80*150.86*173.49
*C*74445*TC*106.44*101.12*116.29
*C*74450**252.43*239.81*275.78
*C*74450*TC*237.19*225.33*259.13
*C*74470**558.11*530.20*609.73
*C*74470*TC*533.94*507.24*583.33
**74742**233.47*221.80*255.07
**74742*TC*204.98*194.73*223.94
*C*74775**266.01*252.71*290.62
*C*74775*TC*237.19*225.33*259.13
*C*75801**649.76*617.27*709.86
*C*75801*TC*608.13*577.72*664.38
*C*75803**1604.93*1524.68*1753.38
*C*75803*TC*1550.28*1472.77*1693.69
*C*75805**3123.37*2967.20*3412.28
*C*75805*TC*3085.60*2931.32*3371.02
*C*75807**3136.90*2980.06*3427.07
*C*75807*TC*3085.60*2931.32*3371.02
*C*75810**3132.55*2975.92*3422.31
*C*75810*TC*3085.60*2931.32*3371.02
**75894**905.77*860.48*989.55
**75894*TC*836.13*794.32*913.47
*C*75898**3174.37*3015.65*3468.00
*C*75898*TC*3085.60*2931.32*3371.02
**75970**442.09*419.99*482.99
**75970*TC*405.36*385.09*442.85
**76125**39.79*37.80*43.47
**76125*TC*26.88*25.54*29.37
**76390**205.97*195.67*225.02
**76390*TC*154.67*146.94*168.98
**76390*26*51.30*48.74*56.05
**76932**84.89*80.65*92.75
**76932*TC*49.84*47.35*54.45
**76940**157.52*149.64*172.09
**76940*TC*59.69*56.71*65.22
**76941**115.68*109.90*126.39
**76941*TC*53.02*50.37*57.93
**76945**83.90*79.71*91.67
**76945*TC*52.73*50.09*57.60
*C*76975**276.96*263.11*302.58
*C*76975*TC*237.19*225.33*259.13
**76998**175.06*166.31*191.26
**76998*TC*129.49*123.02*141.47
**77013**424.14*402.93*463.37
**77013*TC*246.36*234.04*269.15
**77022**473.80*450.11*517.63
**77022*TC*279.71*265.72*305.58
**77371**1242.72*1180.58*1357.67
**77520**925.16*878.90*1010.74
**77522**925.16*878.90*1010.74
**77523**1062.32*1009.20*1160.58
**77525**1199.44*1139.47*1310.39
*C*78282**414.11*393.40*452.41
*C*78282*TC*399.20*379.24*436.13
**78414**514.99*489.24*562.63
**78414*TC*494.44*469.72*540.18
*C*78429**1591.22*1511.66*1738.41
*C*78429*TC*1514.35*1438.63*1654.42
*C*78430**1587.58*1508.20*1734.43
*C*78430*TC*1514.35*1438.63*1654.42
*C*78431**2372.00*2253.40*2591.41
*C*78431*TC*2286.50*2172.18*2498.01
*C*78432**1971.42*1872.85*2153.78
*C*78432*TC*1879.97*1785.97*2053.87
*C*78433**2081.83*1977.74*2274.40
*C*78433*TC*1981.77*1882.68*2165.08
**78434**711.60*676.02*777.42
**78434*TC*683.43*649.26*746.65
*C*78459**1445.86*1373.57*1579.61
*C*78459*TC*1374.62*1305.89*1501.77
*C*78491**1584.27*1505.06*1730.82
*C*78491*TC*1514.35*1438.63*1654.42
*C*78492**1596.53*1516.70*1744.21
*C*78492*TC*1514.35*1438.63*1654.42
*C*78608**1581.60*1502.52*1727.90
*C*78608*TC*1514.35*1438.63*1654.42
*C*78811**1443.85*1371.66*1577.41
*C*78811*TC*1374.62*1305.89*1501.77
*C*78812**1601.80*1521.71*1749.97
*C*78812*TC*1514.35*1438.63*1654.42
*C*78813**1603.79*1523.60*1752.14
*C*78813*TC*1514.35*1438.63*1654.42
*C*78814**1613.39*1532.72*1762.63
*C*78814*TC*1514.35*1438.63*1654.42
*C*78815**1624.66*1543.43*1774.94
*C*78815*TC*1514.35*1438.63*1654.42
*C*78816**1625.66*1544.38*1776.04
*C*78816*TC*1514.35*1438.63*1654.42
**79300**237.04*225.19*258.97
**79300*TC*175.07*166.32*191.27
**79445**237.04*225.19*258.97
**79445*TC*130.76*124.22*142.85
**86485**5.22*4.96*5.70
**90867**298.33*283.41*325.92
#**90867**135.15*128.39*147.65
**90868**199.96*189.96*218.45
#**90868**104.05*98.85*113.68
**90869**275.51*261.73*300.99
#**90869**159.38*151.41*174.12
**90952**496.00*471.20*541.88
**90953**353.95*336.25*386.69
**92978**253.91*241.21*277.39
**92978*TC*162.80*154.66*177.86
**92979**148.54*141.11*162.28
**92979*TC*76.24*72.43*83.29
*C*93315**656.22*623.41*716.92
*C*93315*TC*533.94*507.24*583.33
**93317**213.52*202.84*233.27
**93317*TC*128.43*122.01*140.31
*C*93318**632.29*600.68*690.78
*C*93318*TC*533.94*507.24*583.33
**93571**243.80*231.61*266.35
**93571*TC*174.47*165.75*190.61
**93572**146.22*138.91*159.75
**93572*TC*95.72*90.93*104.57
**93600**3557.81*3379.92*3886.91
**93600*TC*3446.20*3273.89*3764.97
**93602**3557.81*3379.92*3886.91
**93602*TC*3448.17*3275.76*3767.12
**93603**3557.81*3379.92*3886.91
**93603*TC*3448.17*3275.76*3767.12
**93609**2134.69*2027.96*2332.15
**93609*TC*1872.85*1779.21*2046.09
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.94*3232.79*3717.71
**93612**3557.81*3379.92*3886.91
**93612*TC*3405.22*3234.96*3720.20
**93619**7115.62*6759.84*7773.82
**93619*TC*6745.81*6408.52*7369.80
**93620**7115.62*6759.84*7773.82
**93620*TC*6522.30*6196.19*7125.62
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.71*6684.87*7687.60
**93622**7115.62*6759.84*7773.82
**93622*TC*6952.84*6605.20*7595.98
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.22*1965.76*2260.62
**93624**3557.81*3379.92*3886.91
**93624*TC*3327.77*3161.38*3635.59
**93631**7115.62*6759.84*7773.82
**93631*TC*6736.53*6399.70*7359.66
**93640**1133.95*1077.25*1238.84
**93640*TC*964.57*916.34*1053.79
**93641**1133.95*1077.25*1238.84
**93641*TC*837.83*795.94*915.33
**93662**427.23*405.87*466.75
**93662*TC*359.28*341.32*392.52
**93745**86.23*81.92*94.21
**93745*TC*64.70*61.47*70.69
**93745*26*21.56*20.48*23.55
**94642**29.27*27.81*31.98
**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**935.22*888.46*1021.73
**95965*TC*535.21*508.45*584.72
**95967**475.55*451.77*519.54
**96020**344.97*327.72*376.88
**96020*TC*191.92*182.32*209.67
**96547**744.07*706.87*812.90
#**96547**132.93*126.28*145.22
**96548**372.03*353.43*406.44
#**96548**66.47*63.15*72.62
**97039**12.88*12.24*14.08
**97139**17.41*16.54*19.02
**97151**49.21*46.75*53.76
#**97151**43.55*41.37*47.58
**97152**41.83*39.74*45.70
#**97152**37.02*35.17*40.45
**97153**33.31*31.64*36.39
#**97153**29.15*27.69*31.84
**97154**4.55*4.32*4.97
#**97154**4.12*3.91*4.50
**97155**33.31*31.64*36.39
#**97155**29.15*27.69*31.84
**97156**35.13*33.37*38.38
#**97156**30.81*29.27*33.66
**97157**10.27*9.76*11.22
#**97157**9.27*8.81*10.13
**97158**5.29*5.03*5.78
#**97158**4.80*4.56*5.24
**98978**47.23*44.87*51.60
# - 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.