WASHINGTON DC MEDICARE CARRIER - 12202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
DC + MD/VA SUBURBS
******
**A2001**1174.20*1115.49*1282.81
**A2002**344.73*327.49*376.61
**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**525.02*498.77*573.59
#**G0186**448.04*425.64*489.49
**G0339**3391.55*3221.97*3705.27
**G0340**2550.73*2423.19*2786.67
**G0398**158.03*150.13*172.65
**G0398*TC*115.85*110.06*126.57
**G0398*26*42.18*40.07*46.08
**G0399**108.07*102.67*118.07
**G0399*TC*61.49*58.42*67.18
**G0399*26*46.98*44.63*51.32
**G0400**112.00*106.40*122.36
**G0400*TC*68.23*64.82*74.54
**G0400*26*43.77*41.58*47.82
**G0460**938.71*891.77*1025.54
#**G0460**132.83*126.19*145.12
**G0465**938.71*891.77*1025.54
#**G0465**132.83*126.19*145.12
**G0498**174.38*165.66*190.51
**G6017**89.24*84.78*97.50
**0042T**262.32*249.20*286.58
**0054T**257.04*244.19*280.82
**0055T**257.04*244.19*280.82
**0071T**642.01*609.91*701.40
**0072T**642.01*609.91*701.40
**0075T**1068.25*1014.84*1167.07
**0075T*TC*1068.25*1014.84*1167.07
**0075T*26*1068.85*1015.41*1167.72
**0095T**707.12*671.76*772.52
**0098T**790.78*751.24*863.93
**0100T**2130.19*2023.68*2327.23
**0101T**357.63*339.75*390.71
#**0101T**252.48*239.86*275.84
**0102T**357.63*339.75*390.71
#**0102T**252.48*239.86*275.84
**0106T**39.83*37.84*43.52
**0107T**39.83*37.84*43.52
**0108T**39.83*37.84*43.52
**0109T**39.83*37.84*43.52
**0110T**39.83*37.84*43.52
**0164T**773.59*734.91*845.15
**0165T**792.43*752.81*865.73
**0184T**925.82*879.53*1011.46
**0198T**98.42*93.50*107.53
#**0198T**34.94*33.19*38.17
**0200T**2082.67*1978.54*2275.32
#**0200T**445.52*423.24*486.73
**0201T**3124.00*2967.80*3412.97
#**0201T**668.29*634.88*730.11
**0207T**121.71*115.62*132.96
**0208T**45.23*42.97*49.42
**0209T**54.75*52.01*59.81
**0210T**34.51*32.78*37.70
**0211T**53.56*50.88*58.51
**0212T**40.54*38.51*44.29
#**0212T**34.59*32.86*37.79
**0213T**221.42*210.35*241.90
#**0213T**116.27*110.46*127.03
**0214T**110.55*105.02*120.77
#**0214T**64.53*61.30*70.50
**0215T**110.95*105.40*121.21
#**0215T**65.72*62.43*71.79
**0216T**204.54*194.31*223.46
#**0216T**100.18*95.17*109.45
**0217T**103.75*98.56*113.34
#**0217T**55.34*52.57*60.46
**0218T**103.75*98.56*113.34
#**0218T**56.53*53.70*61.76
**0219T**1492.16*1417.55*1630.18
**0220T**1465.21*1391.95*1600.74
**0221T**1785.12*1695.86*1950.24
**0222T**433.68*412.00*473.80
**0232T**938.71*891.77*1025.54
#**0232T**132.83*126.19*145.12
**0234T**10130.69*9624.16*11067.78
#**0234T**635.97*604.17*694.80
**0235T**10130.69*9624.16*11067.78
#**0235T**635.97*604.17*694.80
**0236T**10299.44*9784.47*11252.14
#**0236T**735.28*698.52*803.30
**0237T**10299.44*9784.47*11252.14
#**0237T**735.28*698.52*803.30
**0238T**10299.44*9784.47*11252.14
#**0238T**735.28*698.52*803.30
**0266T**995.61*945.83*1087.70
**0267T**173.07*164.42*189.08
**0268T**372.09*353.49*406.51
**0269T**945.16*897.90*1032.59
**0270T**173.07*164.42*189.08
**0271T**372.09*353.49*406.51
**0272T**64.71*61.47*70.69
**0273T**81.91*77.81*89.48
**0274T**1254.36*1191.64*1370.39
**0278T**15.93*15.13*17.40
**0308T**1565.45*1487.18*1710.26
**0329T**98.42*93.50*107.53
#**0329T**34.94*33.19*38.17
**0330T**38.21*36.30*41.75
**0331T**214.58*203.85*234.43
**0332T**366.30*347.99*400.19
**0347T**156.61*148.78*171.10
**0348T**38.37*36.45*41.92
**0349T**40.84*38.80*44.62
**0350T**41.63*39.55*45.48
**0351T**198.34*188.42*216.68
**0352T**47.17*44.81*51.53
**0353T**198.34*188.42*216.68
**0354T**47.17*44.81*51.53
**0358T**32.13*30.52*35.10
**0362T**102.40*97.28*111.87
#**0362T**71.85*68.26*78.50
**0378T**27.18*25.82*29.69
**0394T**292.80*278.16*319.88
**0395T**703.67*668.49*768.76
**0397T**51.42*48.85*56.18
**0398T*26*1746.88*1659.54*1908.47
**0408T**565.27*537.01*617.56
**0409T**393.07*373.42*429.43
**0410T**409.40*388.93*447.27
**0411T**409.40*388.93*447.27
**0412T**259.89*246.90*283.94
**0413T**530.81*504.27*579.91
**0414T**409.79*389.30*447.70
**0415T**340.84*323.80*372.37
**0416T**381.24*362.18*416.51
**0417T**95.35*90.58*104.17
**0418T**64.71*61.47*70.69
**0419T**513.32*487.65*560.80
#**0419T**406.98*386.63*444.62
**0420T**726.16*689.85*793.33
#**0420T**594.82*565.08*649.84
**0421T**1857.12*1764.26*2028.90
#**0421T**766.35*728.03*837.23
**0437T**235.78*223.99*257.59
**0439T**83.19*79.03*90.88
**0440T**286.94*272.59*313.48
#**0440T**132.19*125.58*144.42
**0441T**286.94*272.59*313.48
#**0441T**132.19*125.58*144.42
**0442T**286.94*272.59*313.48
#**0442T**132.19*125.58*144.42
**0449T**859.33*816.36*938.81
**0464T**78.56*74.63*85.82
**0472T**76.81*72.97*83.92
**0473T**64.71*61.47*70.69
**0479T**69.39*65.92*75.81
**0480T**180.09*171.09*196.75
#**0480T**34.69*32.96*37.90
**0483T**1300.26*1235.25*1420.54
**0484T**1684.74*1600.50*1840.58
**0485T**26.75*25.41*29.22
**0485T*TC*10.51*9.98*11.48
**0485T*26*16.63*15.80*18.17
**0486T**53.50*50.83*58.45
**0486T*TC*20.62*19.59*22.53
**0486T*26*32.88*31.24*35.93
**0488T**70.05*66.55*76.53
#**0488T**54.57*51.84*59.62
**0505T**13145.29*12488.03*14361.23
#**0505T**615.53*584.75*672.46
**0507T**27.53*26.15*30.07
**0507T*TC*24.20*22.99*26.44
**0507T*26*3.34*3.17*3.65
**0510T**690.95*656.40*754.86
#**0510T**476.69*452.86*520.79
**0512T**357.63*339.75*390.71
#**0512T**252.48*239.86*275.84
**0513T**107.29*101.93*117.22
#**0513T**75.75*71.96*82.75
**0515T**565.27*537.01*617.56
**0516T**522.21*496.10*570.52
**0517T**372.09*353.49*406.51
**0518T**259.89*246.90*283.94
**0519T**373.42*354.75*407.96
**0520T**522.21*496.10*570.52
**0521T**64.71*61.47*70.69
**0521T*TC*42.85*40.71*46.82
**0521T*26*21.87*20.78*23.90
**0522T**76.81*72.97*83.92
**0522T*TC*43.64*41.46*47.68
**0522T*26*33.17*31.51*36.24
**0523T**174.26*165.55*190.38
**0524T**1938.67*1841.74*2118.00
#**0524T**192.41*182.79*210.21
**0525T**522.61*496.48*570.95
**0526T**409.40*388.93*447.27
**0527T**355.50*337.73*388.39
**0528T**76.81*72.97*83.92
**0528T*TC*43.64*41.46*47.68
**0528T*26*33.17*31.51*36.24
**0529T**64.71*61.47*70.69
**0529T*TC*42.85*40.71*46.82
**0529T*26*21.87*20.78*23.90
**0530T**698.47*663.55*763.08
**0531T**530.81*504.27*579.91
**0532T**373.42*354.75*407.96
**0540T**196.26*186.45*214.42
**0543T**1684.74*1600.50*1840.58
**0544T**1945.77*1848.48*2125.75
**0545T**1945.77*1848.48*2125.75
**0546T**81.92*77.82*89.49
**0552T**7.66*7.28*8.37
**0553T**2885.45*2741.18*3152.36
#**0553T**424.97*403.72*464.28
**0565T**700.04*665.04*764.80
#**0565T**581.40*552.33*635.18
**0566T**113.58*107.90*124.09
#**0566T**64.77*61.53*70.76
**0569T**1945.77*1848.48*2125.75
**0570T**454.14*431.43*496.14
**0571T**612.16*581.55*668.78
**0572T**497.81*472.92*543.86
**0573T**381.76*362.67*417.07
**0574T**441.36*419.29*482.18
**0575T**76.81*72.97*83.92
**0576T**64.71*61.47*70.69
**0577T**212.03*201.43*231.64
**0578T**31.79*30.20*34.73
**0579T**25.39*24.12*27.74
**0580T**238.53*226.60*260.59
**0581T**2681.21*2547.15*2929.22
#**0581T**231.44*219.87*252.85
**0582T**1944.40*1847.18*2124.26
#**0582T**428.28*406.87*467.90
**0583T**1522.66*1446.53*1663.51
#**0583T**151.21*143.65*165.20
**0587T**503.03*477.88*549.56
#**0587T**326.86*310.52*357.10
**0588T**416.61*395.78*455.15
#**0588T**255.91*243.11*279.58
**0589T**53.58*50.90*58.54
#**0589T**42.07*39.97*45.97
**0590T**63.79*60.60*69.69
#**0590T**43.56*41.38*47.59
**0596T**672.69*639.06*734.92
#**0596T**140.76*133.72*153.78
**0597T**672.69*639.06*734.92
#**0597T**140.76*133.72*153.78
**0598T**178.96*170.01*195.51
**0599T**118.70*112.77*129.69
**0600T**4187.01*3977.66*4574.31
#**0600T**784.95*745.70*857.56
**0601T**1606.15*1525.84*1754.72
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**226.58*215.25*247.54
**0611T**48.39*45.97*52.87
**0614T**408.91*388.46*446.73
**0615T**52.91*50.26*57.80
**0616T**740.84*703.80*809.37
**0617T**830.60*789.07*907.43
**0618T**1006.34*956.02*1099.42
**0619T**741.71*704.62*810.31
#**0619T**530.41*503.89*579.47
**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**299.67*284.69*327.39
#**0627T**109.22*103.76*119.32
**0628T**89.90*85.41*98.22
#**0628T**32.76*31.12*35.79
**0629T**299.67*284.69*327.39
#**0629T**109.22*103.76*119.32
**0630T**89.90*85.41*98.22
#**0630T**32.76*31.12*35.79
**0631T**96.84*92.00*105.80
**0632T**626.67*595.34*684.64
**0633T**233.98*222.28*255.62
*C*0633T*TC*126.96*120.61*138.70
**0633T*26*63.77*60.58*69.67
**0634T**233.98*222.28*255.62
**0634T*TC*170.21*161.70*185.96
**0634T*26*63.77*60.58*69.67
**0635T**233.98*222.28*255.62
**0635T*TC*170.21*161.70*185.96
**0635T*26*63.77*60.58*69.67
**0636T**233.98*222.28*255.62
**0636T*TC*170.21*161.70*185.96
**0636T*26*63.77*60.58*69.67
**0637T**233.98*222.28*255.62
**0637T*TC*170.21*161.70*185.96
**0637T*26*63.77*60.58*69.67
**0638T**233.98*222.28*255.62
**0638T*TC*170.21*161.70*185.96
**0638T*26*63.77*60.58*69.67
**0639T**96.84*92.00*105.80
**0640T**27.53*26.15*30.07
**0640T*TC*24.35*23.13*26.60
**0640T*26*3.34*3.17*3.65
**0644T**1359.09*1291.14*1484.81
#**0644T**258.80*245.86*282.74
**0646T**1945.77*1848.48*2125.75
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**68.66*65.23*75.01
**0652T**332.83*316.19*363.62
#**0652T**134.43*127.71*146.87
**0653T**436.60*414.77*476.99
#**0653T**151.70*144.12*165.74
**0654T**155.59*147.81*169.98
**0655T**1857.12*1764.26*2028.90
#**0655T**766.35*728.03*837.23
**0658T**113.08*107.43*123.54
**0659T**3160.83*3002.79*3453.21
#**0659T**468.23*444.82*511.54
**0671T**1154.80*1097.06*1261.62
**0673T**4050.93*3848.38*4425.64
#**0673T**396.91*377.06*433.62
**0699T**127.16*120.80*138.92
#**0699T**100.97*95.92*110.31
**0707T**429.23*407.77*468.94
#**0707T**319.32*303.35*348.85
**0714T**1648.76*1566.32*1801.27
#**0714T**400.47*380.45*437.52
**0730T**306.93*291.58*335.32
#**0730T**273.14*259.48*298.40
**0738T**77.82*73.93*85.02
**0739T**1857.12*1764.26*2028.90
#**0739T**766.35*728.03*837.23
**0740T**23.79*22.60*25.99
**0741T**56.34*53.52*61.55
**0742T**109.89*104.40*120.06
**0742T*TC*89.27*84.81*97.53
**0742T*26*20.63*19.60*22.54
**0743T**62.11*59.00*67.85
**0744T**965.67*917.39*1055.00
**0745T**306.26*290.95*334.59
**0746T**246.43*234.11*269.23
**0747T**1184.21*1125.00*1293.75
**0748T**204.47*194.25*223.39
**0751T**0.01*0.01*0.01
**0752T**0.01*0.01*0.01
**0753T**0.01*0.01*0.01
**0754T**0.01*0.01*0.01
**0755T**0.01*0.01*0.01
**0756T**0.01*0.01*0.01
**0757T**0.01*0.01*0.01
**0758T**0.01*0.01*0.01
**0759T**0.01*0.01*0.01
**0760T**0.01*0.01*0.01
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**0.01*0.01*0.01
**0764T**4.88*4.64*5.34
**0765T**8.75*8.31*9.56
**0771T**28.73*27.29*31.38
**0772T**28.73*27.29*31.38
**0773T**26.96*25.61*29.45
**0774T**26.96*25.61*29.45
**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*48.75*46.31*53.26
#**0777T*26*3.75*3.56*4.09
**0779T**518.22*492.31*566.16
**0779T*TC*490.02*465.52*535.35
**0779T*26*28.20*26.79*30.81
**0780T**26.96*25.61*29.45
**0783T**17.05*16.20*18.63
**0784T**2499.57*2374.59*2730.78
#**0784T**357.71*339.82*390.79
**0785T**279.14*265.18*304.96
#**0785T**162.09*153.99*177.09
**0786T**847.89*805.50*926.33
#**0786T**334.45*317.73*365.39
**0787T**279.14*265.18*304.96
#**0787T**162.09*153.99*177.09
**0788T**20.62*19.59*22.53
#**0788T**19.83*18.84*21.67
**0789T**28.99*27.54*31.67
#**0789T**24.79*23.55*27.08
**0790T**2109.65*2004.17*2304.80
**0791T**10.14*9.63*11.07
**0793T**626.67*595.34*684.64
**0794T**130.35*123.83*142.40
**0795T**783.32*744.15*855.77
**0796T**522.21*496.10*570.52
**0797T**522.21*496.10*570.52
**0798T**825.34*784.07*901.68
**0799T**550.23*522.72*601.13
**0800T**550.23*522.72*601.13
**0801T**1072.44*1018.82*1171.64
**0802T**536.22*509.41*585.82
**0803T**536.22*509.41*585.82
**0804T**89.76*85.27*98.06
**0804T*TC*50.38*47.86*55.04
**0804T*26*39.38*37.41*43.02
**0805T**3492.65*3318.02*3815.72
#**0805T**351.29*333.73*383.79
**0806T**4656.87*4424.03*5087.63
#**0806T**468.38*444.96*511.70
**0807T**49.41*46.94*53.98
**0807T*TC*33.32*31.65*36.40
**0807T*26*16.09*15.29*17.58
**0808T**49.41*46.94*53.98
**0808T*TC*33.32*31.65*36.40
**0808T*26*16.09*15.29*17.58
**0810T**1267.13*1203.77*1384.34
**0811T**23.79*22.60*25.99
**0813T**3080.41*2926.39*3365.35
#**0813T**198.94*188.99*217.34
**0814T**536.54*509.71*586.17
#**0814T**399.15*379.19*436.07
**0818T**416.61*395.78*455.15
#**0818T**255.91*243.11*279.58
**0820T**159.77*151.78*174.55
#**0820T**138.74*131.80*151.57
**0821T**159.77*151.78*174.55
#**0821T**138.74*131.80*151.57
**0822T**135.80*129.01*148.36
#**0822T**117.93*112.03*128.83
**0823T**783.32*744.15*855.77
**0824T**825.34*784.07*901.68
**0825T**1072.44*1018.82*1171.64
**0826T**76.81*72.97*83.92
**0826T*TC*43.64*41.46*47.68
**0826T*26*33.17*31.51*36.24
**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**27.53*26.15*30.07
**0859T*TC*24.20*22.99*26.44
**0859T*26*3.34*3.17*3.65
**0864T**357.63*339.75*390.71
#**0864T**252.48*239.86*275.84
**10011**497.16*472.30*543.15
#**10011**116.64*110.81*127.43
**10012**272.15*258.54*297.32
#**10012**76.93*73.08*84.04
**15847**395.01*375.26*431.55
**21088**1931.39*1834.82*2110.04
**21742**1275.82*1212.03*1393.83
**21743**1466.26*1392.95*1601.89
**32855**473.30*449.64*517.09
**32856**494.76*470.02*540.52
**33928**3605.32*3425.05*3938.81
**33929**1350.29*1282.78*1475.20
**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
**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
**50323**636.13*604.32*694.97
**50325**317.22*301.36*346.56
**53451**839.43*797.46*917.08
**53452**419.71*398.72*458.53
**53453**713.61*677.93*779.62
**53454**64.26*61.05*70.21
#**53454**38.47*36.55*42.03
**63043**652.26*619.65*712.60
**63044**586.38*557.06*640.62
**64596**2499.57*2374.59*2730.78
#**64596**357.71*339.82*390.79
**64597**749.87*712.38*819.24
#**64597**107.31*101.94*117.23
**64598**279.14*265.18*304.96
#**64598**162.09*153.99*177.09
**65757**134.28*127.57*146.71
**66983**740.84*703.80*809.37
**66987**847.09*804.74*925.45
**66988**707.33*671.96*772.75
*C*70170**298.60*283.67*326.22
*C*70170*TC*282.90*268.76*309.07
**70555**233.47*221.80*255.07
**70555*TC*106.10*100.80*115.92
*C*70557**802.25*762.14*876.46
*C*70557*TC*636.84*605.00*695.75
*C*70558**394.59*374.86*431.09
*C*70558*TC*212.27*201.66*231.91
*C*70559**382.59*363.46*417.98
*C*70559*TC*212.27*201.66*231.91
*C*74190**660.45*627.43*721.54
*C*74190*TC*636.84*605.00*695.75
**74235**166.28*157.97*181.67
**74235*TC*105.41*100.14*115.16
**74300**98.08*93.18*107.16
**74300*TC*83.83*79.64*91.59
**74301**30.23*28.72*33.03
**74301*TC*19.67*18.69*21.49
**74328**175.06*166.31*191.26
**74328*TC*150.21*142.70*164.11
**74329**163.78*155.59*178.93
**74329*TC*138.53*131.60*151.34
**74330**262.59*249.46*286.88
**74330*TC*233.39*221.72*254.98
**74340**86.58*82.25*94.59
**74340*TC*59.27*56.31*64.76
**74355**86.58*82.25*94.59
**74355*TC*47.57*45.19*51.97
**74360**86.58*82.25*94.59
**74360*TC*57.30*54.44*62.61
**74363**175.06*166.31*191.26
**74363*TC*130.65*124.12*142.74
*C*74445**184.50*175.28*201.57
*C*74445*TC*126.96*120.61*138.70
*C*74450**299.66*284.68*327.38
*C*74450*TC*282.90*268.76*309.07
*C*74470**663.35*630.18*724.71
*C*74470*TC*636.84*605.00*695.75
**74742**233.47*221.80*255.07
**74742*TC*202.11*192.00*220.80
*C*74775**314.61*298.88*343.71
*C*74775*TC*282.90*268.76*309.07
*C*75801**771.57*732.99*842.94
*C*75801*TC*725.32*689.05*792.41
*C*75803**1909.18*1813.72*2085.78
*C*75803*TC*1849.02*1756.57*2020.06
*C*75805**3721.75*3535.66*4066.01
*C*75805*TC*3680.19*3496.18*4020.61
*C*75807**3736.37*3549.55*4081.98
*C*75807*TC*3680.19*3496.18*4020.61
*C*75810**3731.33*3544.76*4076.47
*C*75810*TC*3680.19*3496.18*4020.61
**75894**1058.26*1005.35*1156.15
**75894*TC*980.64*931.61*1071.35
*C*75898**3779.22*3590.26*4128.80
*C*75898*TC*3680.19*3496.18*4020.61
**75970**515.69*489.91*563.40
**75970*TC*475.42*451.65*519.40
**76125**45.59*43.31*49.81
**76125*TC*31.34*29.77*34.24
**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*57.86*54.97*63.22
**76940**176.80*167.96*193.15
**76940*TC*68.55*65.12*74.89
**76941**130.13*123.62*142.16
**76941*TC*61.18*58.12*66.84
**76945**95.68*90.90*104.54
**76945*TC*61.40*58.33*67.08
*C*76975**326.85*310.51*357.09
*C*76975*TC*282.90*268.76*309.07
**76998**175.06*166.31*191.26
**76998*TC*124.52*118.29*136.03
**77013**491.29*466.73*536.74
**77013*TC*296.35*281.53*323.76
**77022**543.16*516.00*593.40
**77022*TC*329.87*313.38*360.39
**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**492.28*467.67*537.82
*C*78282*TC*476.14*452.33*520.18
**78414**514.99*489.24*562.63
**78414*TC*492.42*467.80*537.97
*C*78429**1890.26*1795.75*2065.11
*C*78429*TC*1806.17*1715.86*1973.24
*C*78430**1886.31*1791.99*2060.79
*C*78430*TC*1806.17*1715.86*1973.24
*C*78431**2820.89*2679.85*3081.83
*C*78431*TC*2727.11*2590.75*2979.36
*C*78432**2342.39*2225.27*2559.06
*C*78432*TC*2242.24*2130.13*2449.65
*C*78433**2473.26*2349.60*2702.04
*C*78433*TC*2363.65*2245.47*2582.29
**78434**832.45*790.83*909.45
**78434*TC*801.57*761.49*875.71
*C*78459**1717.54*1631.66*1876.41
*C*78459*TC*1639.52*1557.54*1791.17
*C*78491**1882.84*1788.70*2057.01
*C*78491*TC*1806.17*1715.86*1973.24
*C*78492**1896.43*1801.61*2071.85
*C*78492*TC*1806.17*1715.86*1973.24
*C*78608**1879.93*1785.93*2053.82
*C*78608*TC*624.05*592.85*681.78
*C*78811**1715.47*1629.70*1874.16
*C*78811*TC*1639.52*1557.54*1791.17
*C*78812**1902.17*1807.06*2078.12
*C*78812*TC*1806.17*1715.86*1973.24
*C*78813**1904.24*1809.03*2080.38
*C*78813*TC*1806.17*1715.86*1973.24
*C*78814**1914.84*1819.10*2091.97
*C*78814*TC*1806.17*1715.86*1973.24
*C*78815**1927.24*1830.88*2105.51
*C*78815*TC*1806.17*1715.86*1973.24
*C*78816**1928.17*1831.76*2106.52
*C*78816*TC*1806.17*1715.86*1973.24
**79300**237.04*225.19*258.97
**79300*TC*170.05*161.55*185.78
**79445**237.04*225.19*258.97
**79445*TC*120.57*114.54*131.72
**86485**6.10*5.80*6.67
**90867**346.96*329.61*379.05
#**90867**152.33*144.71*166.42
**90868**229.57*218.09*250.80
#**90868**114.99*109.24*125.63
**90869**315.10*299.35*344.25
#**90869**181.16*172.10*197.92
**92978**279.80*265.81*305.68
**92978*TC*178.65*169.72*195.18
**92979**168.30*159.89*183.87
**92979*TC*88.08*83.68*96.23
*C*93315**771.09*732.54*842.42
*C*93315*TC*636.84*605.00*695.75
**93317**242.98*230.83*265.45
**93317*TC*149.37*141.90*163.19
*C*93318**744.92*707.67*813.82
*C*93318*TC*636.84*605.00*695.75
**93571**278.63*264.70*304.41
**93571*TC*201.71*191.62*220.36
**93572**165.57*157.29*180.88
**93572*TC*109.61*104.13*119.75
**93600**3557.81*3379.92*3886.91
**93600*TC*3433.54*3261.86*3751.14
**93602**3557.81*3379.92*3886.91
**93602*TC*3435.91*3264.11*3753.73
**93603**3557.81*3379.92*3886.91
**93603*TC*3435.91*3264.11*3753.73
**93609**2134.69*2027.96*2332.15
**93609*TC*1843.21*1751.05*2013.71
**93610**3557.81*3379.92*3886.91
**93610*TC*3385.72*3216.43*3698.89
**93612**3557.81*3379.92*3886.91
**93612*TC*3388.47*3219.05*3701.91
**93619**7115.62*6759.84*7773.82
**93619*TC*6704.01*6368.81*7324.13
**93620**7115.62*6759.84*7773.82
**93620*TC*6455.18*6132.42*7052.28
**93621**7115.62*6759.84*7773.82
**93621*TC*7027.76*6676.37*7677.83
**93622**7115.62*6759.84*7773.82
**93622*TC*6934.41*6587.69*7575.84
**93623**2134.69*2027.96*2332.15
**93623*TC*2060.68*1957.65*2251.30
**93624**3557.81*3379.92*3886.91
**93624*TC*3302.40*3137.28*3607.87
**93631**7115.62*6759.84*7773.82
**93631*TC*6695.05*6360.30*7314.35
**93640**1133.95*1077.25*1238.84
**93640*TC*945.54*898.26*1033.00
**93641**1133.95*1077.25*1238.84
**93641*TC*804.39*764.17*878.80
**93662**494.28*469.57*540.01
**93662*TC*419.44*398.47*458.24
**94642**34.09*32.39*37.25
**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
**96547**878.37*834.45*959.62
#**96547**149.47*142.00*163.30
**96548**439.19*417.23*479.81
#**96548**74.74*71.00*81.65
**97151**53.95*51.25*58.94
#**97151**47.21*44.85*51.58
**97152**45.86*43.57*50.11
#**97152**40.13*38.12*43.84
**97153**36.45*34.63*39.82
#**97153**31.49*29.92*34.41
**97154**5.03*4.78*5.50
#**97154**4.52*4.29*4.93
**97155**36.45*34.63*39.82
#**97155**31.49*29.92*34.41
**97156**38.40*36.48*41.95
#**97156**33.25*31.59*36.33
**97157**11.30*10.74*12.35
#**97157**10.11*9.60*11.04
**97158**5.85*5.56*6.39
#**97158**5.25*4.99*5.74
**98978**56.34*53.52*61.55
# - 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.