DELAWARE MEDICARE CARRIER - 12102
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**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**447.54*425.16*488.93
#**G0186**384.53*365.30*420.10
**G0339**2954.78*2807.04*3228.10
**G0340**2222.06*2110.96*2427.60
**G0398**132.93*126.28*145.22
**G0398*TC*94.82*90.08*103.59
**G0398*26*38.11*36.20*41.63
**G0399**92.37*87.75*100.91
**G0399*TC*50.32*47.80*54.97
**G0399*26*42.38*40.26*46.30
**G0400**95.25*90.49*104.06
**G0400*TC*55.84*53.05*61.01
**G0400*26*39.41*37.44*43.06
**G0460**777.71*738.82*849.64
#**G0460**117.99*112.09*128.90
**G0465**777.71*738.82*849.64
#**G0465**117.99*112.09*128.90
**G0498**143.59*136.41*156.87
**G6017**76.35*72.53*83.41
**0042T**222.82*211.68*243.43
**0054T**225.29*214.03*246.13
**0055T**225.29*214.03*246.13
**0071T**562.16*534.05*614.16
**0072T**562.16*534.05*614.16
**0075T**945.55*898.27*1033.01
**0075T*TC*945.55*898.27*1033.01
**0075T*26*946.72*899.38*1034.29
**0076T**1064.27*1011.06*1162.72
**0076T*TC*851.43*808.86*930.19
**0076T*26*212.85*202.21*232.54
**0095T**613.45*582.78*670.20
**0098T**686.60*652.27*750.11
**0100T**1858.35*1765.43*2030.24
**0101T**307.16*291.80*335.57
#**0101T**221.08*210.03*241.53
**0102T**307.16*291.80*335.57
#**0102T**221.08*210.03*241.53
**0106T**32.81*31.17*35.85
**0107T**32.81*31.17*35.85
**0108T**32.81*31.17*35.85
**0109T**32.81*31.17*35.85
**0110T**32.81*31.17*35.85
**0164T**670.64*637.11*732.68
**0165T**687.09*652.74*750.65
**0174T**9.83*9.34*10.74
**0184T**807.66*767.28*882.37
**0198T**83.14*78.98*90.83
#**0198T**31.17*29.61*34.05
**0200T**1735.18*1648.42*1895.68
#**0200T**394.96*375.21*431.49
**0201T**2602.77*2472.63*2843.52
#**0201T**592.44*562.82*647.24
**0207T**121.70*115.62*132.96
**0208T**37.02*35.17*40.45
**0209T**44.81*42.57*48.96
**0210T**28.25*26.84*30.87
**0211T**43.84*41.65*47.90
**0212T**35.71*33.92*39.01
#**0212T**30.84*29.30*33.70
**0213T**188.83*179.39*206.30
#**0213T**102.75*97.61*112.25
**0214T**95.32*90.55*104.13
#**0214T**57.65*54.77*62.99
**0215T**95.65*90.87*104.50
#**0215T**58.62*55.69*64.04
**0216T**173.77*165.08*189.84
#**0216T**88.34*83.92*96.51
**0217T**89.09*84.64*97.34
#**0217T**49.46*46.99*54.04
**0218T**89.09*84.64*97.34
#**0218T**50.44*47.92*55.11
**0219T**1290.61*1226.08*1409.99
**0220T**1268.32*1204.90*1385.64
**0221T**1555.93*1478.13*1699.85
**0222T**380.69*361.66*415.91
**0232T**777.71*738.82*849.64
#**0232T**117.99*112.09*128.90
**0234T**8341.48*7924.41*9113.07
#**0234T**568.48*540.06*621.07
**0235T**8341.48*7924.41*9113.07
#**0235T**568.48*540.06*621.07
**0236T**8488.12*8063.71*9273.27
#**0236T**658.27*625.36*719.16
**0237T**8488.12*8063.71*9273.27
#**0237T**658.27*625.36*719.16
**0238T**8488.12*8063.71*9273.27
#**0238T**658.27*625.36*719.16
**0253T**920.34*874.32*1005.47
**0266T**875.67*831.89*956.67
**0267T**154.13*146.42*168.38
**0268T**326.06*309.76*356.22
**0269T**829.55*788.07*906.28
**0270T**154.13*146.42*168.38
**0271T**326.06*309.76*356.22
**0272T**54.78*52.04*59.85
**0273T**70.20*66.69*76.69
**0274T**1086.32*1032.00*1186.80
**0278T**14.09*13.39*15.40
**0308T**1363.97*1295.77*1490.14
**0329T**83.14*78.98*90.83
#**0329T**31.17*29.61*34.05
**0330T**38.21*36.30*41.75
**0331T**179.00*170.05*195.56
**0332T**305.64*290.36*333.91
**0347T**138.43*131.51*151.24
**0348T**32.24*30.63*35.22
**0349T**34.18*32.47*37.34
**0350T**34.83*33.09*38.05
**0351T**165.72*157.43*181.04
**0352T**41.98*39.88*45.86
**0353T**165.72*157.43*181.04
**0354T**41.98*39.88*45.86
**0358T**26.30*24.99*28.74
**0362T**89.26*84.80*97.52
#**0362T**64.25*61.04*70.20
**0378T**24.26*23.05*26.51
**0394T**244.07*231.87*266.65
**0395T**591.94*562.34*646.69
**0397T**45.91*43.61*50.15
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**497.38*472.51*543.39
**0409T**344.34*327.12*376.19
**0410T**358.00*340.10*391.12
**0411T**358.00*340.10*391.12
**0412T**225.51*214.23*246.36
**0413T**465.67*442.39*508.75
**0414T**358.99*341.04*392.20
**0415T**299.01*284.06*326.67
**0416T**331.79*315.20*362.48
**0417T**81.62*77.54*89.17
**0418T**54.78*52.04*59.85
**0419T**440.11*418.10*480.82
#**0419T**353.05*335.40*385.71
**0420T**625.40*594.13*683.25
#**0420T**517.89*492.00*565.80
**0421T**1570.63*1492.10*1715.92
#**0421T**677.70*643.82*740.39
**0437T**207.94*197.54*227.17
**0439T**70.25*66.74*76.75
**0440T**243.12*230.96*265.60
#**0440T**116.44*110.62*127.21
**0441T**243.12*230.96*265.60
#**0441T**116.44*110.62*127.21
**0442T**243.12*230.96*265.60
#**0442T**116.44*110.62*127.21
**0449T**744.22*707.01*813.06
**0464T**65.78*62.49*71.86
**0472T**65.61*62.33*71.68
**0473T**54.78*52.04*59.85
**0479T**61.64*58.56*67.34
**0480T**76.13*72.32*83.17
#**0480T**30.82*29.28*33.67
**0483T**1155.65*1097.87*1262.55
**0484T**1498.38*1423.46*1636.98
**0485T**23.04*21.89*25.17
**0485T*TC*8.59*8.16*9.38
**0485T*26*14.75*14.01*16.11
**0486T**46.07*43.77*50.34
**0486T*TC*16.88*16.04*18.45
**0486T*26*29.20*27.74*31.90
**0488T**61.52*58.44*67.21
#**0488T**48.86*46.42*53.38
**0505T**11166.40*10608.08*12199.29
#**0505T**570.71*542.17*623.50
**0507T**22.74*21.60*24.84
**0507T*TC*19.80*18.81*21.63
**0507T*26*2.94*2.79*3.21
**0510T**590.08*560.58*644.67
#**0510T**414.67*393.94*453.03
**0512T**307.16*291.80*335.57
#**0512T**221.08*210.03*241.53
**0513T**92.15*87.54*100.67
#**0513T**66.32*63.00*72.45
**0515T**497.38*472.51*543.39
**0516T**459.20*436.24*501.68
**0517T**326.06*309.76*356.22
**0518T**225.51*214.23*246.36
**0519T**327.02*310.67*357.27
**0520T**459.20*436.24*501.68
**0521T**54.78*52.04*59.85
**0521T*TC*35.07*33.32*38.32
**0521T*26*19.71*18.72*21.53
**0522T**65.61*62.33*71.68
**0522T*TC*35.72*33.93*39.02
**0522T*26*29.89*28.40*32.66
**0523T**148.55*141.12*162.29
**0524T**1601.33*1521.26*1749.45
#**0524T**171.79*163.20*187.68
**0525T**459.52*436.54*502.02
**0526T**358.00*340.10*391.12
**0527T**311.38*295.81*340.18
**0528T**65.61*62.33*71.68
**0528T*TC*35.72*33.93*39.02
**0528T*26*29.89*28.40*32.66
**0529T**54.78*52.04*59.85
**0529T*TC*35.07*33.32*38.32
**0529T*26*19.71*18.72*21.53
**0530T**612.02*581.42*668.63
**0531T**465.67*442.39*508.75
**0532T**327.02*310.67*357.27
**0540T**173.22*164.56*189.24
**0543T**1498.38*1423.46*1636.98
**0544T**1723.87*1637.68*1883.33
**0545T**1723.87*1637.68*1883.33
**0546T**70.23*66.72*76.73
**0552T**6.52*6.19*7.12
**0553T**2394.27*2274.56*2615.74
#**0553T**380.04*361.04*415.20
**0565T**600.63*570.60*656.19
#**0565T**503.51*478.33*550.08
**0566T**97.52*92.64*106.54
#**0566T**57.57*54.69*62.89
**0569T**1723.87*1637.68*1883.33
**0570T**404.00*383.80*441.37
**0571T**538.12*511.21*587.89
**0572T**437.99*416.09*478.50
**0573T**334.54*317.81*365.48
**0574T**387.71*368.32*423.57
**0575T**65.61*62.33*71.68
**0576T**54.78*52.04*59.85
**0577T**186.38*177.06*203.62
**0578T**28.54*27.11*31.18
**0579T**20.77*19.73*22.69
**0580T**207.62*197.24*226.83
**0581T**2209.83*2099.34*2414.24
#**0581T**204.38*194.16*223.28
**0582T**1616.32*1535.50*1765.83
#**0582T**375.17*356.41*409.87
**0583T**1496.16*1421.35*1634.55
#**0583T**130.14*123.63*142.17
**0587T**432.85*411.21*472.89
#**0587T**288.63*274.20*315.33
**0588T**356.68*338.85*389.68
#**0588T**225.12*213.86*245.94
**0589T**47.11*44.75*51.46
#**0589T**37.69*35.81*41.18
**0590T**55.55*52.77*60.69
#**0590T**38.99*37.04*42.60
**0596T**2235.23*2123.47*2441.99
#**0596T**128.14*121.73*139.99
**0597T**672.69*639.06*734.92
#**0597T**128.14*121.73*139.99
**0598T**147.59*140.21*161.24
**0599T**98.22*93.31*107.31
**0600T**3489.83*3315.34*3812.64
#**0600T**704.80*669.56*769.99
**0601T**1414.39*1343.67*1545.22
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**191.68*182.10*209.42
**0611T**39.60*37.62*43.26
**0614T**358.36*340.44*391.51
**0615T**46.13*43.82*50.39
**0616T**646.69*614.36*706.51
**0617T**722.78*686.64*789.64
**0618T**875.02*831.27*955.96
**0619T**638.60*606.67*697.67
#**0619T**465.45*442.18*508.51
**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**252.81*240.17*276.20
#**0627T**96.90*92.06*105.87
**0628T**75.84*72.05*82.86
#**0628T**29.07*27.62*31.76
**0629T**252.81*240.17*276.20
#**0629T**96.90*92.06*105.87
**0630T**75.84*72.05*82.86
#**0630T**29.07*27.62*31.76
**0631T**80.30*76.29*87.73
**0632T**554.63*526.90*605.94
**0633T**196.78*186.94*214.98
*C*0633T*TC*103.93*98.73*113.54
**0633T*26*57.46*54.59*62.78
**0634T**196.78*186.94*214.98
**0634T*TC*139.32*132.35*152.20
**0634T*26*57.46*54.59*62.78
**0635T**196.78*186.94*214.98
**0635T*TC*139.32*132.35*152.20
**0635T*26*57.46*54.59*62.78
**0636T**196.78*186.94*214.98
**0636T*TC*139.32*132.35*152.20
**0636T*26*57.46*54.59*62.78
**0637T**196.78*186.94*214.98
**0637T*TC*139.32*132.35*152.20
**0637T*26*57.46*54.59*62.78
**0638T**196.78*186.94*214.98
**0638T*TC*139.32*132.35*152.20
**0638T*26*57.46*54.59*62.78
**0639T**80.30*76.29*87.73
**0640T**22.74*21.60*24.84
**0640T*TC*19.80*18.81*21.63
**0640T*26*2.94*2.79*3.21
**0644T**1132.67*1076.04*1237.45
#**0644T**231.94*220.34*253.39
**0646T**1723.87*1637.68*1883.33
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**58.39*55.47*63.79
**0652T**281.12*267.06*307.12
#**0652T**118.71*112.77*129.69
**0653T**367.31*348.94*401.28
#**0653T**134.09*127.39*146.50
**0654T**137.67*130.79*150.41
**0655T**1570.63*1492.10*1715.92
#**0655T**677.70*643.82*740.39
**0658T**92.56*87.93*101.12
**0659T**2623.17*2492.01*2865.81
#**0659T**419.25*398.29*458.03
**0671T**1000.48*950.46*1093.03
**0673T**3345.14*3177.88*3654.56
#**0673T**353.84*336.15*386.57
**0699T**110.11*104.60*120.29
#**0699T**88.67*84.24*96.88
**0707T**363.27*345.11*396.88
#**0707T**273.29*259.63*298.57
**0714T**1372.19*1303.58*1499.12
#**0714T**350.30*332.79*382.71
**0730T**267.80*254.41*292.57
#**0730T**239.86*227.87*262.05
**0738T**69.15*65.69*75.54
**0739T**1570.63*1492.10*1715.92
#**0739T**677.70*643.82*740.39
**0740T**19.46*18.49*21.26
**0741T**46.11*43.80*50.37
**0742T**91.69*87.11*100.18
**0742T*TC*73.06*69.41*79.82
**0742T*26*18.63*17.70*20.36
**0743T**52.10*49.50*56.93
**0744T**858.74*815.80*938.17
**0745T**250.66*238.13*273.85
**0746T**219.77*208.78*240.10
**0747T**969.24*920.78*1058.90
**0748T**179.26*170.30*195.85
**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**424.69*403.46*463.98
**0756T**109.09*103.64*119.19
**0757T**79.36*75.39*86.70
**0758T**87.92*83.52*96.05
**0759T**131.48*124.91*143.65
**0760T**97.16*92.30*106.15
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**114.78*109.04*125.40
**0764T**4.21*4.00*4.60
**0765T**7.88*7.49*8.61
**0771T**25.70*24.42*28.08
**0772T**25.70*24.42*28.08
**0773T**22.82*21.68*24.93
**0774T**22.82*21.68*24.93
**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**426.41*405.09*465.85
**0779T*TC*401.14*381.08*438.24
**0779T*26*25.27*24.01*27.61
**0780T**22.82*21.68*24.93
**0783T**13.95*13.25*15.24
**0784T**2070.15*1966.64*2261.64
#**0784T**316.76*300.92*346.06
**0785T**237.22*225.36*259.16
#**0785T**141.40*134.33*154.48
**0786T**716.60*680.77*782.89
#**0786T**296.28*281.47*323.69
**0787T**237.22*225.36*259.16
#**0787T**141.40*134.33*154.48
**0788T**18.34*17.42*20.03
#**0788T**17.69*16.81*19.33
**0789T**25.49*24.22*27.85
#**0789T**22.12*21.01*24.16
**0790T**1876.71*1782.87*2050.30
**0791T**8.86*8.42*9.68
**0793T**554.63*526.90*605.94
**0794T**130.35*123.83*142.40
**0795T**688.80*654.36*752.51
**0796T**459.20*436.24*501.68
**0797T**459.20*436.24*501.68
**0798T**727.97*691.57*795.31
**0799T**485.32*461.05*530.21
**0800T**485.32*461.05*530.21
**0801T**944.52*897.29*1031.88
**0802T**472.26*448.65*515.95
**0803T**472.26*448.65*515.95
**0804T**76.72*72.88*83.81
**0804T*TC*41.24*39.18*45.06
**0804T*26*35.48*33.71*38.77
**0805T**2886.82*2742.48*3153.85
#**0805T**315.20*299.44*344.36
**0806T**3849.09*3656.64*4205.14
#**0806T**420.26*399.25*459.14
**0807T**41.69*39.61*45.55
**0807T*TC*27.27*25.91*29.80
**0807T*26*14.42*13.70*15.76
**0808T**41.69*39.61*45.55
**0808T*TC*27.27*25.91*29.80
**0808T*26*14.42*13.70*15.76
**0810T**1105.51*1050.23*1207.76
**0811T**19.46*18.49*21.26
**0813T**2534.37*2407.65*2768.80
#**0813T**175.51*166.73*191.74
**0814T**454.08*431.38*496.09
#**0814T**341.61*324.53*373.21
**0818T**356.68*338.85*389.68
#**0818T**225.12*213.86*245.94
**0820T**144.61*137.38*157.99
#**0820T**127.39*121.02*139.17
**0821T**144.61*137.38*157.99
#**0821T**127.39*121.02*139.17
**0822T**122.92*116.77*134.29
#**0822T**108.28*102.87*118.30
**0823T**688.80*654.36*752.51
**0824T**727.97*691.57*795.31
**0825T**944.52*897.29*1031.88
**0826T**65.61*62.33*71.68
**0826T*TC*35.72*33.93*39.02
**0826T*26*29.89*28.40*32.66
**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**22.74*21.60*24.84
**0859T*TC*19.80*18.81*21.63
**0859T*26*2.94*2.79*3.21
**0864T**307.16*291.80*335.57
#**0864T**221.08*210.03*241.53
**10011**416.40*395.58*454.92
#**10011**104.89*99.65*114.60
**10012**229.62*218.14*250.86
#**10012**69.81*66.32*76.27
**15847**344.34*327.12*376.19
**21088**1674.38*1590.66*1829.26
**21742**1126.75*1070.41*1230.97
**21743**1293.77*1229.08*1413.44
**32855**410.35*389.83*448.30
**32856**439.26*417.30*479.90
**33928**3216.58*3055.75*3514.11
**33929**1204.87*1144.63*1316.32
**33933**526.43*500.11*575.13
**33944**465.04*441.79*508.06
**34841**2116.67*2010.84*2312.47
**34842**2342.48*2225.36*2559.16
**34843**2568.26*2439.85*2805.83
**34844**2794.03*2654.33*3052.48
**34845**2116.67*2010.84*2312.47
**34846**2342.48*2225.36*2559.16
**34847**2568.26*2439.85*2805.83
**34848**2794.03*2654.33*3052.48
**43496**2101.82*1996.73*2296.24
**43647**718.53*682.60*784.99
**43648**537.55*510.67*587.27
#**43648**241.64*229.56*263.99
**43881**671.70*638.12*733.84
#**43881**612.29*581.68*668.93
**43882**716.80*680.96*783.10
#**43882**652.86*620.22*713.25
**44137**1609.46*1528.99*1758.34
**44715**410.33*389.81*448.28
**47143**424.30*403.09*463.55
**47144**503.86*478.67*550.47
**47145**477.34*453.47*521.49
**48551**410.33*389.81*448.28
**49906**2039.77*1937.78*2228.45
**50323**551.46*523.89*602.47
**50325**275.01*261.26*300.45
**53451**741.05*704.00*809.60
**53452**370.52*351.99*404.79
**53453**629.84*598.35*688.10
**53454**55.52*52.74*60.65
#**53454**34.41*32.69*37.59
**54440**734.64*697.91*802.60
**63043**562.41*534.29*614.43
**63044**505.54*480.26*552.30
**64596**2070.15*1966.64*2261.64
#**64596**316.76*300.92*346.06
**64597**621.05*590.00*678.50
#**64597**95.03*90.28*103.82
**64598**237.22*225.36*259.16
#**64598**141.40*134.33*154.48
**65757**116.92*111.07*127.73
**66983**646.69*614.36*706.51
**66987**747.94*710.54*817.12
**66988**621.59*590.51*679.09
*C*70170**245.69*233.41*268.42
*C*70170*TC*231.58*220.00*253.00
**70555**233.47*221.80*255.07
**70555*TC*118.54*112.61*129.50
*C*70557**668.93*635.48*730.80
*C*70557*TC*521.33*495.26*569.55
*C*70558**336.46*319.64*367.59
*C*70558*TC*173.77*165.08*189.84
*C*70559**326.55*310.22*356.75
*C*70559*TC*173.77*165.08*189.84
*C*74190**542.66*515.53*592.86
*C*74190*TC*521.33*495.26*569.55
**74235**143.22*136.06*156.47
**74235*TC*88.40*83.98*96.58
**74300**82.94*78.79*90.61
**74300*TC*70.15*66.64*76.64
**74301**25.54*24.26*27.90
**74301*TC*16.02*15.22*17.50
**74328**175.06*166.31*191.26
**74328*TC*152.74*145.10*166.87
**74329**139.09*132.14*151.96
**74329*TC*116.44*110.62*127.21
**74330**262.59*249.46*286.88
**74330*TC*236.33*224.51*258.19
**74340**86.58*82.25*94.59
**74340*TC*61.96*58.86*67.69
**74355**86.58*82.25*94.59
**74355*TC*51.46*48.89*56.22
**74360**86.58*82.25*94.59
**74360*TC*60.36*57.34*65.94
**74363**175.06*166.31*191.26
**74363*TC*135.01*128.26*147.50
*C*74445**155.83*148.04*170.25
*C*74445*TC*103.93*98.73*113.54
*C*74450**246.70*234.37*269.53
*C*74450*TC*231.58*220.00*253.00
*C*74470**545.30*518.04*595.75
*C*74470*TC*521.33*495.26*569.55
**74742**233.47*221.80*255.07
**74742*TC*205.24*194.98*224.23
*C*74775**260.15*247.14*284.21
*C*74775*TC*231.58*220.00*253.00
*C*75801**634.96*603.21*693.69
*C*75801*TC*593.76*564.07*648.68
*C*75803**1567.82*1489.43*1712.84
*C*75803*TC*1513.66*1437.98*1653.68
*C*75805**3050.14*2897.63*3332.27
*C*75805*TC*3012.71*2862.07*3291.38
*C*75807**3063.60*2910.42*3346.98
*C*75807*TC*3012.71*2862.07*3291.38
*C*75810**3059.33*2906.36*3342.31
*C*75810*TC*3012.71*2862.07*3291.38
**75894**885.18*840.92*967.06
**75894*TC*816.29*775.48*891.80
*C*75898**3100.50*2945.48*3387.30
*C*75898*TC*3012.71*2862.07*3291.38
**75970**432.17*410.56*472.14
**75970*TC*395.74*375.95*432.34
**76125**39.03*37.08*42.64
**76125*TC*26.24*24.93*28.67
**76390**201.82*191.73*220.49
**76390*TC*151.02*143.47*164.99
**76390*26*50.80*48.26*55.50
**76932**83.31*79.14*91.01
**76932*TC*48.63*46.20*53.13
**76940**155.08*147.33*169.43
**76940*TC*58.20*55.29*63.58
**76941**113.81*108.12*124.34
**76941*TC*51.71*49.12*56.49
**76945**82.35*78.23*89.96
**76945*TC*51.46*48.89*56.22
*C*76975**270.97*257.42*296.03
*C*76975*TC*231.58*220.00*253.00
**76998**175.06*166.31*191.26
**76998*TC*129.95*123.45*141.97
**77013**415.10*394.35*453.50
**77013*TC*238.80*226.86*260.89
**77022**464.56*441.33*507.53
**77022*TC*272.16*258.55*297.33
**77371**1308.16*1242.75*1429.16
**77520**932.62*885.99*1018.89
**77522**932.62*885.99*1018.89
**77523**1070.96*1017.41*1170.02
**77525**1209.27*1148.81*1321.13
*C*78282**404.59*384.36*442.01
*C*78282*TC*389.77*370.28*425.82
**78414**514.99*489.24*562.63
**78414*TC*494.61*469.88*540.36
*C*78429**1554.83*1477.09*1698.65
*C*78429*TC*1478.58*1404.65*1615.35
*C*78430**1551.22*1473.66*1694.71
*C*78430*TC*1478.58*1404.65*1615.35
*C*78431**2317.27*2201.41*2531.62
*C*78431*TC*2232.49*2120.87*2439.00
*C*78432**1926.26*1829.95*2104.44
*C*78432*TC*1835.56*1743.78*2005.35
*C*78433**2034.20*1932.49*2222.36
*C*78433*TC*1934.95*1838.20*2113.93
**78434**695.18*660.42*759.48
**78434*TC*667.25*633.89*728.97
*C*78459**1412.80*1342.16*1543.48
*C*78459*TC*1342.15*1275.04*1466.30
*C*78491**1547.91*1470.51*1691.09
*C*78491*TC*1478.58*1404.65*1615.35
*C*78492**1560.05*1482.05*1704.36
*C*78492*TC*1478.58*1404.65*1615.35
*C*78608**1545.27*1468.01*1688.21
*C*78608*TC*1478.58*1404.65*1615.35
*C*78811**1410.80*1340.26*1541.30
*C*78811*TC*1342.15*1275.04*1466.30
*C*78812**1565.28*1487.02*1710.07
*C*78812*TC*1478.58*1404.65*1615.35
*C*78813**1567.27*1488.91*1712.25
*C*78813*TC*1478.58*1404.65*1615.35
*C*78814**1576.78*1497.94*1722.63
*C*78814*TC*1478.58*1404.65*1615.35
*C*78815**1587.95*1508.55*1734.83
*C*78815*TC*1478.58*1404.65*1615.35
*C*78816**1588.97*1509.52*1735.95
*C*78816*TC*1478.58*1404.65*1615.35
**79300**237.04*225.19*258.97
**79300*TC*175.44*166.67*191.67
**79445**237.04*225.19*258.97
**79445*TC*131.63*125.05*143.81
**86485**5.29*5.03*5.78
**90867**292.71*278.07*319.78
#**90867**133.39*126.72*145.73
**90868**196.68*186.85*214.88
#**90868**103.03*97.88*112.56
**90869**271.16*257.60*296.24
#**90869**157.05*149.20*171.58
**90952**492.14*467.53*537.66
**90953**351.23*333.67*383.72
**92978**240.18*228.17*262.40
**92978*TC*150.01*142.51*163.89
**92979**145.96*138.66*159.46
**92979*TC*74.39*70.67*81.27
*C*93315**642.56*610.43*701.99
*C*93315*TC*521.33*495.26*569.55
**93317**209.66*199.18*229.06
**93317*TC*125.33*119.06*136.92
*C*93318**618.83*587.89*676.07
*C*93318*TC*521.33*495.26*569.55
**93571**239.21*227.25*261.34
**93571*TC*170.58*162.05*186.36
**93572**143.70*136.52*157.00
**93572*TC*93.71*89.02*102.37
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.40*3275.03*3766.28
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.32*3276.85*3768.38
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.32*3276.85*3768.38
**93609**2134.69*2027.96*2332.15
**93609*TC*1875.65*1781.87*2049.15
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.55*3234.32*3719.47
**93612**3557.81*3379.92*3886.91
**93612*TC*3406.78*3236.44*3721.91
**93619**7115.62*6759.84*7773.82
**93619*TC*6749.76*6412.27*7374.11
**93620**7115.62*6759.84*7773.82
**93620*TC*6528.64*6202.21*7132.54
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.56*6685.68*7688.53
**93622**7115.62*6759.84*7773.82
**93622*TC*6954.59*6606.86*7597.89
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.10*1966.60*2261.59
**93624**3557.81*3379.92*3886.91
**93624*TC*3330.12*3163.61*3638.15
**93631**7115.62*6759.84*7773.82
**93631*TC*6740.34*6403.32*7363.82
**93640**1133.95*1077.25*1238.84
**93640*TC*966.36*918.04*1055.75
**93641**1133.95*1077.25*1238.84
**93641*TC*840.98*798.93*918.77
**93662**419.18*398.22*457.95
**93662*TC*351.85*334.26*384.40
**93745**87.09*82.74*95.15
**93745*TC*65.32*62.05*71.36
**93745*26*21.76*20.67*23.77
**94642**29.57*28.09*32.30
**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**931.76*885.17*1017.95
**95965*TC*535.74*508.95*585.29
**95967**475.55*451.77*519.54
**96020**345.62*328.34*377.59
**96020*TC*193.84*184.15*211.77
**96547**727.94*691.54*795.27
#**96547**131.24*124.68*143.38
**96548**363.97*345.77*397.64
#**96548**65.62*62.34*71.69
**97039**13.00*12.35*14.20
**97139**17.59*16.71*19.22
**97151**48.80*46.36*53.31
#**97151**43.28*41.12*47.29
**97152**41.48*39.41*45.32
#**97152**36.79*34.95*40.19
**97153**33.04*31.39*36.10
#**97153**28.98*27.53*31.66
**97154**4.50*4.28*4.92
#**97154**4.09*3.89*4.47
**97155**33.04*31.39*36.10
#**97155**28.98*27.53*31.66
**97156**34.85*33.11*38.08
#**97156**30.63*29.10*33.47
**97157**10.18*9.67*11.12
#**97157**9.20*8.74*10.05
**97158**5.24*4.98*5.73
#**97158**4.76*4.52*5.20
**98978**46.11*43.80*50.37
# - 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.