WASHINGTON DC MEDICARE CARRIER - 12202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
DC + MD/VA SUBURBS
******
**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**516.45*490.63*564.22
#**G0186**440.73*418.69*481.49
**G0339**3391.55*3221.97*3705.27
**G0340**2550.73*2423.19*2786.67
**G0398**155.45*147.68*169.83
**G0398*TC*113.96*108.26*124.50
**G0398*26*41.50*39.43*45.34
**G0399**106.31*100.99*116.14
**G0399*TC*60.48*57.46*66.08
**G0399*26*46.22*43.91*50.50
**G0400**110.17*104.66*120.36
**G0400*TC*67.12*63.76*73.32
**G0400*26*43.06*40.91*47.05
**G0460**923.39*877.22*1008.80
#**G0460**130.67*124.14*142.76
**G0465**923.39*877.22*1008.80
#**G0465**130.67*124.14*142.76
**G0498**171.53*162.95*187.39
**G6017**87.79*83.40*95.91
**0042T**258.04*245.14*281.91
**0054T**252.85*240.21*276.24
**0055T**252.85*240.21*276.24
**0071T**631.53*599.95*689.94
**0072T**631.53*599.95*689.94
**0075T**1050.82*998.28*1148.02
**0075T*TC*1050.82*998.28*1148.02
**0075T*26*1051.40*998.83*1148.65
**0076T**1160.95*1102.90*1268.34
**0076T*TC*928.75*882.31*1014.66
**0076T*26*232.20*220.59*253.68
**0095T**695.58*660.80*759.92
**0098T**777.87*738.98*849.83
**0100T**2095.43*1990.66*2289.26
**0101T**351.80*334.21*384.34
#**0101T**248.36*235.94*271.33
**0102T**351.80*334.21*384.34
#**0102T**248.36*235.94*271.33
**0106T**39.18*37.22*42.80
**0107T**39.18*37.22*42.80
**0108T**39.18*37.22*42.80
**0109T**39.18*37.22*42.80
**0110T**39.18*37.22*42.80
**0164T**760.97*722.92*831.36
**0165T**779.50*740.53*851.61
**0174T**10.74*10.20*11.73
**0184T**910.71*865.17*994.95
**0198T**96.82*91.98*105.78
#**0198T**34.37*32.65*37.55
**0200T**2048.68*1946.25*2238.19
#**0200T**438.25*416.34*478.79
**0201T**3073.01*2919.36*3357.26
#**0201T**657.38*624.51*718.19
**0207T**121.70*115.62*132.96
**0208T**44.49*42.27*48.61
**0209T**53.86*51.17*58.85
**0210T**33.95*32.25*37.09
**0211T**52.68*50.05*57.56
**0212T**39.88*37.89*43.57
#**0212T**34.02*32.32*37.17
**0213T**217.80*206.91*237.95
#**0213T**114.37*108.65*124.95
**0214T**108.75*103.31*118.81
#**0214T**63.47*60.30*69.35
**0215T**109.14*103.68*119.23
#**0215T**64.64*61.41*70.62
**0216T**201.20*191.14*219.81
#**0216T**98.55*93.62*107.66
**0217T**102.06*96.96*111.50
#**0217T**54.44*51.72*59.48
**0218T**102.06*96.96*111.50
#**0218T**55.61*52.83*60.75
**0219T**1467.81*1394.42*1603.58
**0220T**1441.30*1369.24*1574.63
**0221T**1755.99*1668.19*1918.42
**0222T**426.61*405.28*466.07
**0232T**923.39*877.22*1008.80
#**0232T**130.67*124.14*142.76
**0234T**9965.73*9467.44*10887.56
#**0234T**625.59*594.31*683.46
**0235T**9965.73*9467.44*10887.56
#**0235T**625.59*594.31*683.46
**0236T**10131.72*9625.13*11068.90
#**0236T**723.28*687.12*790.19
**0237T**10131.72*9625.13*11068.90
#**0237T**723.28*687.12*790.19
**0238T**10131.72*9625.13*11068.90
#**0238T**723.28*687.12*790.19
**0253T**1049.82*997.33*1146.93
**0266T**979.36*930.39*1069.95
**0267T**170.25*161.74*186.00
**0268T**366.02*347.72*399.88
**0269T**929.73*883.24*1015.73
**0270T**170.25*161.74*186.00
**0271T**366.02*347.72*399.88
**0272T**63.66*60.48*69.55
**0273T**80.57*76.54*88.02
**0274T**1233.89*1172.20*1348.03
**0278T**15.67*14.89*17.12
**0308T**1539.90*1462.91*1682.35
**0329T**96.82*91.98*105.78
#**0329T**34.37*32.65*37.55
**0330T**38.21*36.30*41.75
**0331T**211.08*200.53*230.61
**0332T**360.32*342.30*393.65
**0347T**154.06*146.36*168.31
**0348T**37.74*35.85*41.23
**0349T**40.17*38.16*43.88
**0350T**40.95*38.90*44.74
**0351T**195.10*185.35*213.15
**0352T**46.40*44.08*50.69
**0353T**195.10*185.35*213.15
**0354T**46.40*44.08*50.69
**0358T**31.61*30.03*34.53
**0362T**100.73*95.69*110.04
#**0362T**70.68*67.15*77.22
**0378T**26.74*25.40*29.21
**0394T**288.02*273.62*314.66
**0395T**692.18*657.57*756.21
**0397T**50.58*48.05*55.26
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**556.04*528.24*607.48
**0409T**386.65*367.32*422.42
**0410T**402.72*382.58*439.97
**0411T**402.72*382.58*439.97
**0412T**255.65*242.87*279.30
**0413T**522.14*496.03*570.43
**0414T**403.10*382.95*440.39
**0415T**335.28*318.52*366.30
**0416T**375.02*356.27*409.71
**0417T**93.79*89.10*102.47
**0418T**63.66*60.48*69.55
**0419T**504.94*479.69*551.64
#**0419T**400.34*380.32*437.37
**0420T**714.31*678.59*780.38
#**0420T**585.11*555.85*639.23
**0421T**1826.81*1735.47*1995.79
#**0421T**753.84*716.15*823.57
**0437T**231.94*220.34*253.39
**0439T**81.83*77.74*89.40
**0440T**282.25*268.14*308.36
#**0440T**130.03*123.53*142.06
**0441T**282.25*268.14*308.36
#**0441T**130.03*123.53*142.06
**0442T**282.25*268.14*308.36
#**0442T**130.03*123.53*142.06
**0449T**845.30*803.04*923.50
**0464T**77.28*73.42*84.43
**0472T**75.56*71.78*82.55
**0473T**63.66*60.48*69.55
**0479T**68.26*64.85*74.58
**0480T**88.58*84.15*96.77
#**0480T**34.13*32.42*37.28
**0483T**1279.04*1215.09*1397.35
**0484T**1657.24*1574.38*1810.54
**0485T**26.32*25.00*28.75
**0485T*TC*10.34*9.82*11.29
**0485T*26*16.36*15.54*17.87
**0486T**52.63*50.00*57.50
**0486T*TC*20.29*19.28*22.17
**0486T*26*32.34*30.72*35.33
**0488T**68.90*65.46*75.28
#**0488T**53.68*51.00*58.65
**0505T**13145.29*12488.03*14361.23
#**0505T**615.53*584.75*672.46
**0507T**27.09*25.74*29.60
**0507T*TC*23.80*22.61*26.00
**0507T*26*3.28*3.12*3.59
**0510T**679.67*645.69*742.54
#**0510T**468.91*445.46*512.28
**0512T**351.80*334.21*384.34
#**0512T**248.36*235.94*271.33
**0513T**105.54*100.26*115.30
#**0513T**74.51*70.78*81.40
**0515T**556.04*528.24*607.48
**0516T**513.69*488.01*561.21
**0517T**366.02*347.72*399.88
**0518T**255.65*242.87*279.30
**0519T**367.32*348.95*401.29
**0520T**513.69*488.01*561.21
**0521T**63.66*60.48*69.55
**0521T*TC*42.15*40.04*46.05
**0521T*26*21.51*20.43*23.49
**0522T**75.56*71.78*82.55
**0522T*TC*42.93*40.78*46.90
**0522T*26*32.63*31.00*35.65
**0523T**171.41*162.84*187.27
**0524T**1907.02*1811.67*2083.42
#**0524T**189.27*179.81*206.78
**0525T**514.08*488.38*561.64
**0526T**402.72*382.58*439.97
**0527T**349.70*332.22*382.05
**0528T**75.56*71.78*82.55
**0528T*TC*42.93*40.78*46.90
**0528T*26*32.63*31.00*35.65
**0529T**63.66*60.48*69.55
**0529T*TC*42.15*40.04*46.05
**0529T*26*21.51*20.43*23.49
**0530T**687.07*652.72*750.63
**0531T**522.14*496.03*570.43
**0532T**367.32*348.95*401.29
**0540T**193.06*183.41*210.92
**0543T**1657.24*1574.38*1810.54
**0544T**1914.01*1818.31*2091.06
**0545T**1914.01*1818.31*2091.06
**0546T**80.59*76.56*88.04
**0552T**7.53*7.15*8.22
**0553T**2838.35*2696.43*3100.89
#**0553T**418.03*397.13*456.70
**0565T**688.61*654.18*752.31
#**0565T**571.91*543.31*624.81
**0566T**111.72*106.13*122.05
#**0566T**63.71*60.52*69.60
**0569T**1914.01*1818.31*2091.06
**0570T**446.73*424.39*488.05
**0571T**602.17*572.06*657.87
**0572T**489.68*465.20*534.98
**0573T**375.53*356.75*410.26
**0574T**434.16*412.45*474.32
**0575T**75.56*71.78*82.55
**0576T**63.66*60.48*69.55
**0577T**208.57*198.14*227.86
**0578T**31.27*29.71*34.17
**0579T**24.97*23.72*27.28
**0580T**234.64*222.91*256.35
**0581T**2637.45*2505.58*2881.42
#**0581T**227.67*216.29*248.73
**0582T**1912.67*1817.04*2089.60
#**0582T**421.29*400.23*460.26
**0583T**1496.16*1421.35*1634.55
#**0583T**148.75*141.31*162.51
**0587T**494.82*470.08*540.59
#**0587T**321.53*305.45*351.27
**0588T**409.81*389.32*447.72
#**0588T**251.73*239.14*275.01
**0589T**52.70*50.07*57.58
#**0589T**41.38*39.31*45.21
**0590T**62.75*59.61*68.55
#**0590T**42.85*40.71*46.82
**0596T**2235.23*2123.47*2441.99
#**0596T**138.46*131.54*151.27
**0597T**672.69*639.06*734.92
#**0597T**138.46*131.54*151.27
**0598T**176.04*167.24*192.33
**0599T**116.76*110.92*127.56
**0600T**4118.67*3912.74*4499.65
#**0600T**772.14*733.53*843.56
**0601T**1579.93*1500.93*1726.07
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**222.88*211.74*243.50
**0611T**47.60*45.22*52.00
**0614T**402.23*382.12*439.44
**0615T**52.05*49.45*56.87
**0616T**728.74*692.30*796.15
**0617T**817.05*776.20*892.63
**0618T**989.91*940.41*1081.47
**0619T**729.61*693.13*797.10
#**0619T**521.75*495.66*570.01
**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**294.78*280.04*322.05
#**0627T**107.43*102.06*117.37
**0628T**88.43*84.01*96.61
#**0628T**32.23*30.62*35.21
**0629T**294.78*280.04*322.05
#**0629T**107.43*102.06*117.37
**0630T**88.43*84.01*96.61
#**0630T**32.23*30.62*35.21
**0631T**95.26*90.50*104.08
**0632T**616.44*585.62*673.46
**0633T**230.16*218.65*251.45
*C*0633T*TC*124.89*118.65*136.45
**0633T*26*62.73*59.59*68.53
**0634T**230.16*218.65*251.45
**0634T*TC*167.43*159.06*182.92
**0634T*26*62.73*59.59*68.53
**0635T**230.16*218.65*251.45
**0635T*TC*167.43*159.06*182.92
**0635T*26*62.73*59.59*68.53
**0636T**230.16*218.65*251.45
**0636T*TC*167.43*159.06*182.92
**0636T*26*62.73*59.59*68.53
**0637T**230.16*218.65*251.45
**0637T*TC*167.43*159.06*182.92
**0637T*26*62.73*59.59*68.53
**0638T**230.16*218.65*251.45
**0638T*TC*167.43*159.06*182.92
**0638T*26*62.73*59.59*68.53
**0639T**95.26*90.50*104.08
**0640T**27.09*25.74*29.60
**0640T*TC*23.80*22.61*26.00
**0640T*26*3.28*3.12*3.59
**0644T**1336.91*1270.06*1460.57
#**0644T**254.58*241.85*278.13
**0646T**1914.01*1818.31*2091.06
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**67.54*64.16*73.78
**0652T**327.40*311.03*357.68
#**0652T**132.24*125.63*144.47
**0653T**429.47*408.00*469.20
#**0653T**149.23*141.77*163.04
**0654T**153.05*145.40*167.21
**0655T**1826.81*1735.47*1995.79
#**0655T**753.84*716.15*823.57
**0658T**111.23*105.67*121.52
**0659T**3109.24*2953.78*3396.85
#**0659T**460.98*437.93*503.62
**0671T**1135.96*1079.16*1241.03
**0673T**3984.81*3785.57*4353.41
#**0673T**390.44*370.92*426.56
**0699T**125.08*118.83*136.65
#**0699T**99.32*94.35*108.50
**0707T**422.23*401.12*461.29
#**0707T**314.11*298.40*343.16
**0714T**1621.85*1540.76*1771.87
#**0714T**393.94*374.24*430.38
**0730T**306.93*291.58*335.32
#**0730T**273.14*259.48*298.40
**0738T**76.55*72.72*83.63
**0739T**1826.81*1735.47*1995.79
#**0739T**753.84*716.15*823.57
**0740T**23.40*22.23*25.56
**0741T**55.42*52.65*60.55
**0742T**108.10*102.70*118.11
**0742T*TC*87.81*83.42*95.93
**0742T*26*20.29*19.28*22.17
**0743T**61.10*58.05*66.76
**0744T**949.91*902.41*1037.77
**0745T**301.26*286.20*329.13
**0746T**242.40*230.28*264.82
**0747T**1164.88*1106.64*1272.64
**0748T**201.13*191.07*219.73
**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**496.13*471.32*542.02
**0756T**128.35*121.93*140.22
**0757T**94.16*89.45*102.87
**0758T**103.38*98.21*112.94
**0759T**155.32*147.55*169.68
**0760T**113.20*107.54*123.67
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**133.62*126.94*145.98
**0764T**4.80*4.56*5.24
**0765T**8.61*8.18*9.41
**0771T**28.26*26.85*30.88
**0772T**28.26*26.85*30.88
**0773T**26.52*25.19*28.97
**0774T**26.52*25.19*28.97
**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**509.77*484.28*556.92
**0779T*TC*482.03*457.93*526.62
**0779T*26*27.74*26.35*30.30
**0780T**26.52*25.19*28.97
**0783T**16.78*15.94*18.33
**0784T**2458.77*2335.83*2686.20
#**0784T**351.87*334.28*384.42
**0785T**274.58*260.85*299.98
#**0785T**159.44*151.47*174.19
**0786T**834.06*792.36*911.21
#**0786T**328.99*312.54*359.42
**0787T**274.58*260.85*299.98
#**0787T**159.44*151.47*174.19
**0788T**20.29*19.28*22.17
#**0788T**19.51*18.53*21.31
**0789T**28.51*27.08*31.14
#**0789T**24.38*23.16*26.63
**0790T**2075.22*1971.46*2267.18
**0791T**9.97*9.47*10.89
**0793T**616.44*585.62*673.46
**0794T**130.35*123.83*142.40
**0795T**770.53*732.00*841.80
**0796T**513.69*488.01*561.21
**0797T**513.69*488.01*561.21
**0798T**811.87*771.28*886.97
**0799T**541.25*514.19*591.32
**0800T**541.25*514.19*591.32
**0801T**1054.93*1002.18*1152.51
**0802T**527.47*501.10*576.27
**0803T**527.47*501.10*576.27
**0804T**88.30*83.89*96.47
**0804T*TC*49.56*47.08*54.14
**0804T*26*38.73*36.79*42.31
**0805T**3435.64*3263.86*3753.44
#**0805T**345.55*328.27*377.51
**0806T**4580.86*4351.82*5004.59
#**0806T**460.74*437.70*503.36
**0807T**48.60*46.17*53.10
**0807T*TC*32.78*31.14*35.81
**0807T*26*15.82*15.03*17.28
**0808T**48.60*46.17*53.10
**0808T*TC*32.78*31.14*35.81
**0808T*26*15.82*15.03*17.28
**0810T**1246.45*1184.13*1361.75
**0811T**23.40*22.23*25.56
**0813T**3030.13*2878.62*3310.41
#**0813T**195.70*185.92*213.81
**0814T**527.78*501.39*576.60
#**0814T**392.64*373.01*428.96
**0818T**409.81*389.32*447.72
#**0818T**251.73*239.14*275.01
**0820T**157.16*149.30*171.70
#**0820T**136.47*129.65*149.10
**0821T**157.16*149.30*171.70
#**0821T**136.47*129.65*149.10
**0822T**133.59*126.91*145.95
#**0822T**116.00*110.20*126.73
**0823T**770.53*732.00*841.80
**0824T**811.87*771.28*886.97
**0825T**1054.93*1002.18*1152.51
**0826T**75.56*71.78*82.55
**0826T*TC*42.93*40.78*46.90
**0826T*26*32.63*31.00*35.65
**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**27.09*25.74*29.60
**0859T*TC*23.80*22.61*26.00
**0859T*26*3.28*3.12*3.59
**0864T**351.80*334.21*384.34
#**0864T**248.36*235.94*271.33
**10011**489.04*464.59*534.28
#**10011**114.74*109.00*125.35
**10012**267.71*254.32*292.47
#**10012**75.68*71.90*82.69
**15847**388.56*369.13*424.50
**21088**1931.39*1834.82*2110.04
**21742**1255.00*1192.25*1371.09
**21743**1442.33*1370.21*1575.74
**32855**473.30*449.64*517.09
**32856**486.69*462.36*531.71
**33928**3546.47*3369.15*3874.52
**33929**1328.25*1261.84*1451.12
**33933**596.57*566.74*651.75
**33944**536.42*509.60*586.04
**34841**2340.22*2223.21*2556.69
**34842**2565.99*2437.69*2803.34
**34843**2791.78*2652.19*3050.02
**34844**3017.56*2866.68*3296.68
**34845**2340.22*2223.21*2556.69
**34846**2565.99*2437.69*2803.34
**34847**2791.78*2652.19*3050.02
**34848**3017.56*2866.68*3296.68
**43496**2388.71*2269.27*2609.66
**43647**828.82*787.38*905.49
**43648**605.47*575.20*661.48
#**43648**268.52*255.09*293.35
**43881**784.52*745.29*857.08
#**43881**716.34*680.52*782.60
**43882**838.03*796.13*915.55
#**43882**764.65*726.42*835.38
**44137**1856.50*1763.68*2028.23
**44715**473.29*449.63*517.07
**47143**470.07*446.57*513.56
**47144**558.20*530.29*609.83
**47145**528.81*502.37*577.73
**48551**473.29*449.63*517.07
**49906**2324.39*2208.17*2539.40
**50323**636.13*604.32*694.97
**50325**317.22*301.36*346.56
**53451**825.73*784.44*902.11
**53452**412.86*392.22*451.05
**53453**701.96*666.86*766.89
**53454**63.21*60.05*69.06
#**53454**37.84*35.95*41.34
**54440**820.13*779.12*895.99
**63043**641.61*609.53*700.96
**63044**586.38*557.06*640.62
**64596**2458.77*2335.83*2686.20
#**64596**351.87*334.28*384.42
**64597**737.63*700.75*805.86
#**64597**105.56*100.28*115.32
**64598**274.58*260.85*299.98
#**64598**159.44*151.47*174.19
**65757**132.09*125.49*144.31
**66983**728.74*692.30*796.15
**66987**833.26*791.60*910.34
**66988**695.79*661.00*760.15
*C*70170**293.73*279.04*320.90
*C*70170*TC*278.28*264.37*304.03
**70555**233.47*221.80*255.07
**70555*TC*108.18*102.77*118.19
*C*70557**789.16*749.70*862.16
*C*70557*TC*626.44*595.12*684.39
*C*70558**388.15*368.74*424.05
*C*70558*TC*208.81*198.37*228.13
*C*70559**376.34*357.52*411.15
*C*70559*TC*208.81*198.37*228.13
*C*74190**649.67*617.19*709.77
*C*74190*TC*626.44*595.12*684.39
**74235**166.28*157.97*181.67
**74235*TC*106.41*101.09*116.25
**74300**98.08*93.18*107.16
**74300*TC*84.07*79.87*91.85
**74301**30.23*28.72*33.03
**74301*TC*19.85*18.86*21.69
**74328**175.06*166.31*191.26
**74328*TC*150.61*143.08*164.54
**74329**163.78*155.59*178.93
**74329*TC*138.94*131.99*151.79
**74330**262.59*249.46*286.88
**74330*TC*233.86*222.17*255.50
**74340**86.58*82.25*94.59
**74340*TC*59.72*56.73*65.24
**74355**86.58*82.25*94.59
**74355*TC*48.21*45.80*52.67
**74360**86.58*82.25*94.59
**74360*TC*57.78*54.89*63.12
**74363**175.06*166.31*191.26
**74363*TC*131.37*124.80*143.52
*C*74445**181.49*172.42*198.28
*C*74445*TC*124.89*118.65*136.45
*C*74450**294.77*280.03*322.03
*C*74450*TC*278.28*264.37*304.03
*C*74470**652.52*619.89*712.87
*C*74470*TC*626.44*595.12*684.39
**74742**233.47*221.80*255.07
**74742*TC*202.62*192.49*221.36
*C*74775**309.48*294.01*338.11
*C*74775*TC*278.28*264.37*304.03
*C*75801**758.98*721.03*829.18
*C*75801*TC*713.48*677.81*779.48
*C*75803**1878.02*1784.12*2051.74
*C*75803*TC*1818.84*1727.90*1987.09
*C*75805**3661.01*3477.96*3999.65
*C*75805*TC*3620.13*3439.12*3954.99
*C*75807**3675.39*3491.62*4015.36
*C*75807*TC*3620.13*3439.12*3954.99
*C*75810**3670.43*3486.91*4009.95
*C*75810*TC*3620.13*3439.12*3954.99
**75894**1058.26*1005.35*1156.15
**75894*TC*981.91*932.81*1072.73
*C*75898**3717.54*3531.66*4061.41
*C*75898*TC*3620.13*3439.12*3954.99
**75970**515.69*489.91*563.40
**75970*TC*476.08*452.28*520.12
**76125**45.59*43.31*49.81
**76125*TC*31.58*30.00*34.50
**76390**237.03*225.18*258.96
**76390*TC*181.48*172.41*198.27
**76390*26*55.55*52.77*60.69
**76932**96.84*92.00*105.80
**76932*TC*58.50*55.58*63.92
**76940**176.80*167.96*193.15
**76940*TC*70.32*66.80*76.82
**76941**130.13*123.62*142.16
**76941*TC*62.31*59.19*68.07
**76945**95.68*90.90*104.54
**76945*TC*61.96*58.86*67.69
*C*76975**321.52*305.44*351.26
*C*76975*TC*278.28*264.37*304.03
**76998**175.06*166.31*191.26
**76998*TC*125.35*119.08*136.94
**77013**491.29*466.73*536.74
**77013*TC*299.53*284.55*327.23
**77022**543.16*516.00*593.40
**77022*TC*333.35*316.68*364.18
**77371**1564.21*1486.00*1708.90
**77520**1070.85*1017.31*1169.91
**77522**1070.85*1017.31*1169.91
**77523**1229.58*1168.10*1343.32
**77525**1388.31*1318.89*1516.72
*C*78282**484.24*460.03*529.03
*C*78282*TC*468.37*444.95*511.69
**78414**514.99*489.24*562.63
**78414*TC*492.79*468.15*538.37
*C*78429**1859.41*1766.44*2031.41
*C*78429*TC*1776.69*1687.86*1941.04
*C*78430**1855.52*1762.74*2027.15
*C*78430*TC*1776.69*1687.86*1941.04
*C*78431**2774.85*2636.11*3031.53
*C*78431*TC*2682.60*2548.47*2930.74
*C*78432**2304.16*2188.95*2517.29
*C*78432*TC*2205.64*2095.36*2409.66
*C*78433**2432.89*2311.25*2657.94
*C*78433*TC*2325.07*2208.82*2540.14
**78434**832.45*790.83*909.45
**78434*TC*802.07*761.97*876.27
*C*78459**1689.51*1605.03*1845.78
*C*78459*TC*1612.76*1532.12*1761.94
*C*78491**1852.11*1759.50*2023.43
*C*78491*TC*1776.69*1687.86*1941.04
*C*78492**1865.48*1772.21*2038.04
*C*78492*TC*1776.69*1687.86*1941.04
*C*78608**1849.24*1756.78*2020.30
*C*78608*TC*613.86*583.17*670.65
*C*78811**1687.47*1603.10*1843.57
*C*78811*TC*1612.76*1532.12*1761.94
*C*78812**1871.13*1777.57*2044.21
*C*78812*TC*1776.69*1687.86*1941.04
*C*78813**1873.16*1779.50*2046.43
*C*78813*TC*1776.69*1687.86*1941.04
*C*78814**1883.59*1789.41*2057.82
*C*78814*TC*1776.69*1687.86*1941.04
*C*78815**1895.79*1801.00*2071.15
*C*78815*TC*1776.69*1687.86*1941.04
*C*78816**1896.70*1801.87*2072.15
*C*78816*TC*1776.69*1687.86*1941.04
**79300**237.04*225.19*258.97
**79300*TC*171.14*162.58*186.97
**79445**237.04*225.19*258.97
**79445*TC*122.47*116.35*133.80
**86485**6.10*5.80*6.67
**90867**341.30*324.24*372.88
#**90867**149.85*142.36*163.71
**90868**225.83*214.54*246.72
#**90868**113.11*107.45*123.57
**90869**309.96*294.46*338.63
#**90869**178.21*169.30*194.70
**90952**531.95*505.35*581.15
**90953**381.30*362.24*416.58
**92978**279.80*265.81*305.68
**92978*TC*180.30*171.29*196.98
**92979**168.30*159.89*183.87
**92979*TC*89.39*84.92*97.66
*C*93315**758.50*720.58*828.67
*C*93315*TC*626.44*595.12*684.39
**93317**242.98*230.83*265.45
**93317*TC*150.90*143.36*164.86
*C*93318**732.77*696.13*800.55
*C*93318*TC*626.44*595.12*684.39
**93571**278.63*264.70*304.41
**93571*TC*202.96*192.81*221.73
**93572**165.57*157.29*180.88
**93572*TC*110.42*104.90*120.64
**93600**3557.81*3379.92*3886.91
**93600*TC*3435.57*3263.79*3753.36
**93602**3557.81*3379.92*3886.91
**93602*TC*3437.90*3266.01*3755.91
**93603**3557.81*3379.92*3886.91
**93603*TC*3437.90*3266.01*3755.91
**93609**2134.69*2027.96*2332.15
**93609*TC*1847.97*1755.57*2018.91
**93610**3557.81*3379.92*3886.91
**93610*TC*3388.53*3219.10*3701.97
**93612**3557.81*3379.92*3886.91
**93612*TC*3391.24*3221.68*3704.93
**93619**7115.62*6759.84*7773.82
**93619*TC*6710.73*6375.19*7331.47
**93620**7115.62*6759.84*7773.82
**93620*TC*6465.96*6142.66*7064.06
**93621**7115.62*6759.84*7773.82
**93621*TC*7029.19*6677.73*7679.39
**93622**7115.62*6759.84*7773.82
**93622*TC*6937.36*6590.49*7579.06
**93623**2134.69*2027.96*2332.15
**93623*TC*2061.89*1958.80*2252.62
**93624**3557.81*3379.92*3886.91
**93624*TC*3306.57*3141.24*3612.43
**93631**7115.62*6759.84*7773.82
**93631*TC*6701.91*6366.81*7321.83
**93640**1133.95*1077.25*1238.84
**93640*TC*948.61*901.18*1036.36
**93641**1133.95*1077.25*1238.84
**93641*TC*809.77*769.28*884.67
**93662**494.28*469.57*540.01
**93662*TC*420.66*399.63*459.57
**93745**100.46*95.44*109.76
**93745*TC*75.35*71.58*82.32
**93745*26*25.12*23.86*27.44
**94642**34.09*32.39*37.25
**94772**324.24*308.03*354.23
**94772*TC*201.05*191.00*219.65
**94772*26*123.19*117.03*134.58
**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**990.85*941.31*1082.51
**95965*TC*555.34*527.57*606.71
**95967**475.55*451.77*519.54
**96020**388.65*369.22*424.60
**96020*TC*223.60*212.42*244.28
**96547**864.03*820.83*943.95
#**96547**147.03*139.68*160.63
**96548**432.02*410.42*471.98
#**96548**73.52*69.84*80.32
**97039**14.99*14.24*16.38
**97139**20.33*19.31*22.21
**97151**53.07*50.42*57.98
#**97151**46.44*44.12*50.74
**97152**45.11*42.85*49.28
#**97152**39.47*37.50*43.13
**97153**35.85*34.06*39.17
#**97153**30.97*29.42*33.83
**97154**4.95*4.70*5.41
#**97154**4.45*4.23*4.86
**97155**35.85*34.06*39.17
#**97155**30.97*29.42*33.83
**97156**37.78*35.89*41.27
#**97156**32.70*31.07*35.73
**97157**11.12*10.56*12.14
#**97157**9.95*9.45*10.87
**97158**5.75*5.46*6.28
#**97158**5.17*4.91*5.65
**98978**55.42*52.65*60.55
# - 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.