DELAWARE MEDICARE CARRIER - 12102
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**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**454.97*432.22*497.05
#**G0186**390.91*371.36*427.06
**G0339**2954.78*2807.04*3228.10
**G0340**2222.06*2110.96*2427.60
**G0398**135.14*128.38*147.64
**G0398*TC*96.39*91.57*105.31
**G0398*26*38.74*36.80*42.32
**G0399**93.90*89.21*102.59
**G0399*TC*51.15*48.59*55.88
**G0399*26*43.08*40.93*47.07
**G0400**96.83*91.99*105.79
**G0400*TC*56.77*53.93*62.02
**G0400*26*40.06*38.06*43.77
**G0460**790.61*751.08*863.74
#**G0460**119.95*113.95*131.04
**G0465**790.61*751.08*863.74
#**G0465**119.95*113.95*131.04
**G0498**145.97*138.67*159.47
**G6017**77.62*73.74*84.80
**0042T**226.52*215.19*247.47
**0054T**229.03*217.58*250.22
**0055T**229.03*217.58*250.22
**0071T**571.49*542.92*624.36
**0072T**571.49*542.92*624.36
**0075T**961.24*913.18*1050.16
**0075T*TC*961.24*913.18*1050.16
**0075T*26*962.42*914.30*1051.45
**0095T**623.63*592.45*681.32
**0098T**697.99*663.09*762.55
**0100T**1889.18*1794.72*2063.93
**0101T**312.25*296.64*341.14
#**0101T**224.75*213.51*245.54
**0102T**312.25*296.64*341.14
#**0102T**224.75*213.51*245.54
**0106T**33.35*31.68*36.43
**0107T**33.35*31.68*36.43
**0108T**33.35*31.68*36.43
**0109T**33.35*31.68*36.43
**0110T**33.35*31.68*36.43
**0164T**681.77*647.68*744.83
**0165T**698.49*663.57*763.11
**0184T**821.06*780.01*897.01
**0198T**84.52*80.29*92.33
#**0198T**31.69*30.11*34.63
**0200T**1763.97*1675.77*1927.14
#**0200T**401.51*381.43*438.64
**0201T**2645.95*2513.65*2890.70
#**0201T**602.27*572.16*657.98
**0207T**121.71*115.62*132.96
**0208T**37.63*35.75*41.11
**0209T**45.55*43.27*49.76
**0210T**28.71*27.27*31.36
**0211T**44.56*42.33*48.68
**0212T**36.30*34.49*39.66
#**0212T**31.35*29.78*34.25
**0213T**191.97*182.37*209.73
#**0213T**104.46*99.24*114.13
**0214T**96.91*92.06*105.87
#**0214T**58.60*55.67*64.02
**0215T**97.24*92.38*106.24
#**0215T**59.59*56.61*65.10
**0216T**176.65*167.82*192.99
#**0216T**89.80*85.31*98.11
**0217T**90.57*86.04*98.95
#**0217T**50.28*47.77*54.94
**0218T**90.57*86.04*98.95
#**0218T**51.28*48.72*56.03
**0219T**1312.03*1246.43*1433.39
**0220T**1289.36*1224.89*1408.62
**0221T**1581.75*1502.66*1728.06
**0222T**387.01*367.66*422.81
**0232T**790.61*751.08*863.74
#**0232T**119.95*113.95*131.04
**0234T**8479.56*8055.58*9263.92
#**0234T**577.91*549.01*631.36
**0235T**8479.56*8055.58*9263.92
#**0235T**577.91*549.01*631.36
**0236T**8628.62*8197.19*9426.77
#**0236T**669.19*635.73*731.09
**0237T**8628.62*8197.19*9426.77
#**0237T**669.19*635.73*731.09
**0238T**8628.62*8197.19*9426.77
#**0238T**669.19*635.73*731.09
**0266T**890.20*845.69*972.54
**0267T**156.68*148.85*171.18
**0268T**331.47*314.90*362.14
**0269T**843.31*801.14*921.31
**0270T**156.68*148.85*171.18
**0271T**331.47*314.90*362.14
**0272T**55.69*52.91*60.85
**0273T**71.36*67.79*77.96
**0274T**1104.35*1049.13*1206.50
**0278T**14.33*13.61*15.65
**0308T**1386.60*1317.27*1514.86
**0329T**84.52*80.29*92.33
#**0329T**31.69*30.11*34.63
**0330T**38.21*36.30*41.75
**0331T**181.97*172.87*198.80
**0332T**310.71*295.17*339.45
**0347T**140.72*133.68*153.73
**0348T**32.78*31.14*35.81
**0349T**34.75*33.01*37.96
**0350T**35.41*33.64*38.69
**0351T**168.47*160.05*184.06
**0352T**42.68*40.55*46.63
**0353T**168.47*160.05*184.06
**0354T**42.68*40.55*46.63
**0358T**26.73*25.39*29.20
**0362T**90.74*86.20*99.13
#**0362T**65.31*62.04*71.35
**0378T**24.66*23.43*26.94
**0394T**248.12*235.71*271.07
**0395T**601.76*571.67*657.42
**0397T**46.67*44.34*50.99
**0398T*26*1746.88*1659.54*1908.47
**0408T**505.63*480.35*552.40
**0409T**350.06*332.56*382.44
**0410T**363.94*345.74*397.60
**0411T**363.94*345.74*397.60
**0412T**229.25*217.79*250.46
**0413T**473.40*449.73*517.19
**0414T**364.95*346.70*398.71
**0415T**303.97*288.77*332.09
**0416T**337.30*320.44*368.51
**0417T**82.98*78.83*90.65
**0418T**55.69*52.91*60.85
**0419T**447.41*425.04*488.80
#**0419T**358.91*340.96*392.10
**0420T**635.78*603.99*694.59
#**0420T**526.48*500.16*575.18
**0421T**1596.69*1516.86*1744.39
#**0421T**688.94*654.49*752.66
**0437T**211.39*200.82*230.94
**0439T**71.41*67.84*78.02
**0440T**247.16*234.80*270.02
#**0440T**118.38*112.46*129.33
**0441T**247.16*234.80*270.02
#**0441T**118.38*112.46*129.33
**0442T**247.16*234.80*270.02
#**0442T**118.38*112.46*129.33
**0449T**756.57*718.74*826.55
**0464T**66.87*63.53*73.06
**0472T**66.70*63.37*72.88
**0473T**55.69*52.91*60.85
**0479T**62.66*59.53*68.46
**0480T**154.79*147.05*169.11
#**0480T**31.33*29.76*34.22
**0483T**1174.83*1116.09*1283.50
**0484T**1523.24*1447.08*1664.14
**0485T**23.42*22.25*25.59
**0485T*TC*8.74*8.30*9.55
**0485T*26*15.00*14.25*16.39
**0486T**46.84*44.50*51.18
**0486T*TC*17.16*16.30*18.75
**0486T*26*29.68*28.20*32.43
**0488T**62.55*59.42*68.33
#**0488T**49.67*47.19*54.27
**0505T**11166.40*10608.08*12199.29
#**0505T**570.71*542.17*623.50
**0507T**23.11*21.95*25.24
**0507T*TC*20.13*19.12*21.99
**0507T*26*2.99*2.84*3.27
**0510T**599.87*569.88*655.36
#**0510T**421.55*400.47*460.54
**0512T**312.25*296.64*341.14
#**0512T**224.75*213.51*245.54
**0513T**93.68*89.00*102.35
#**0513T**67.42*64.05*73.66
**0515T**505.63*480.35*552.40
**0516T**466.82*443.48*510.00
**0517T**331.47*314.90*362.14
**0518T**229.25*217.79*250.46
**0519T**332.44*315.82*363.19
**0520T**466.82*443.48*510.00
**0521T**55.69*52.91*60.85
**0521T*TC*35.65*33.87*38.95
**0521T*26*20.04*19.04*21.90
**0522T**66.70*63.37*72.88
**0522T*TC*36.31*34.49*39.66
**0522T*26*30.39*28.87*33.20
**0523T**151.02*143.47*164.99
**0524T**1627.90*1546.51*1778.49
#**0524T**174.64*165.91*190.80
**0525T**467.15*443.79*510.36
**0526T**363.94*345.74*397.60
**0527T**316.54*300.71*345.82
**0528T**66.70*63.37*72.88
**0528T*TC*36.31*34.49*39.66
**0528T*26*30.39*28.87*33.20
**0529T**55.69*52.91*60.85
**0529T*TC*35.65*33.87*38.95
**0529T*26*20.04*19.04*21.90
**0530T**622.18*591.07*679.73
**0531T**473.40*449.73*517.19
**0532T**332.44*315.82*363.19
**0540T**176.09*167.29*192.38
**0543T**1523.24*1447.08*1664.14
**0544T**1752.47*1664.85*1914.58
**0545T**1752.47*1664.85*1914.58
**0546T**71.39*67.82*77.99
**0552T**6.62*6.29*7.23
**0553T**2433.99*2312.29*2659.13
#**0553T**386.35*367.03*422.08
**0565T**610.60*580.07*667.08
#**0565T**511.87*486.28*559.22
**0566T**99.14*94.18*108.31
#**0566T**58.53*55.60*63.94
**0569T**1752.47*1664.85*1914.58
**0570T**410.70*390.17*448.70
**0571T**547.05*519.70*597.66
**0572T**445.26*423.00*486.45
**0573T**340.09*323.09*371.55
**0574T**394.14*374.43*430.59
**0575T**66.70*63.37*72.88
**0576T**55.69*52.91*60.85
**0577T**189.47*180.00*207.00
**0578T**29.01*27.56*31.69
**0579T**21.12*20.06*23.07
**0580T**211.06*200.51*230.59
**0581T**2246.50*2134.18*2454.31
#**0581T**207.77*197.38*226.99
**0582T**1643.13*1560.97*1795.12
#**0582T**381.39*362.32*416.67
**0583T**1522.66*1446.53*1663.51
#**0583T**132.30*125.69*144.54
**0587T**440.03*418.03*480.73
#**0587T**293.42*278.75*320.56
**0588T**362.60*344.47*396.14
#**0588T**228.86*217.42*250.03
**0589T**47.89*45.50*52.33
#**0589T**38.32*36.40*41.86
**0590T**56.47*53.65*61.70
#**0590T**39.63*37.65*43.30
**0596T**672.69*639.06*734.92
#**0596T**130.27*123.76*142.32
**0597T**672.69*639.06*734.92
#**0597T**130.27*123.76*142.32
**0598T**150.03*142.53*163.91
**0599T**99.85*94.86*109.09
**0600T**3547.73*3370.34*3875.89
#**0600T**716.50*680.68*782.78
**0601T**1437.86*1365.97*1570.87
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**194.86*185.12*212.89
**0611T**40.26*38.25*43.99
**0614T**364.30*346.09*398.00
**0615T**46.90*44.56*51.24
**0616T**657.42*624.55*718.23
**0617T**734.77*698.03*802.73
**0618T**889.54*845.06*971.82
**0619T**649.20*616.74*709.25
#**0619T**473.17*449.51*516.94
**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**257.01*244.16*280.78
#**0627T**98.50*93.58*107.62
**0628T**77.10*73.25*84.24
#**0628T**29.55*28.07*32.28
**0629T**257.01*244.16*280.78
#**0629T**98.50*93.58*107.62
**0630T**77.10*73.25*84.24
#**0630T**29.55*28.07*32.28
**0631T**81.63*77.55*89.18
**0632T**563.83*535.64*615.99
**0633T**200.04*190.04*218.55
*C*0633T*TC*105.65*100.37*115.43
**0633T*26*58.41*55.49*63.81
**0634T**200.04*190.04*218.55
**0634T*TC*141.63*134.55*154.73
**0634T*26*58.41*55.49*63.81
**0635T**200.04*190.04*218.55
**0635T*TC*141.63*134.55*154.73
**0635T*26*58.41*55.49*63.81
**0636T**200.04*190.04*218.55
**0636T*TC*141.63*134.55*154.73
**0636T*26*58.41*55.49*63.81
**0637T**200.04*190.04*218.55
**0637T*TC*141.63*134.55*154.73
**0637T*26*58.41*55.49*63.81
**0638T**200.04*190.04*218.55
**0638T*TC*141.63*134.55*154.73
**0638T*26*58.41*55.49*63.81
**0639T**81.63*77.55*89.18
**0640T**23.11*21.95*25.24
**0640T*TC*20.25*19.24*22.13
**0640T*26*2.99*2.84*3.27
**0644T**1151.47*1093.90*1257.99
#**0644T**235.79*224.00*257.60
**0646T**1752.47*1664.85*1914.58
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.36*56.39*64.85
**0652T**285.78*271.49*312.21
#**0652T**120.68*114.65*131.85
**0653T**373.40*354.73*407.94
#**0653T**136.31*129.49*148.91
**0654T**139.96*132.96*152.90
**0655T**1596.69*1516.86*1744.39
#**0655T**688.94*654.49*752.66
**0658T**94.10*89.40*102.81
**0659T**2666.70*2533.37*2913.38
#**0659T**425.88*404.59*465.28
**0671T**1017.08*966.23*1111.16
**0673T**3400.64*3230.61*3715.20
#**0673T**359.72*341.73*392.99
**0699T**111.94*106.34*122.29
#**0699T**90.14*85.63*98.47
**0707T**369.30*350.84*403.47
#**0707T**277.83*263.94*303.53
**0714T**1394.96*1325.21*1523.99
#**0714T**356.11*338.30*389.05
**0730T**267.80*254.41*292.57
#**0730T**239.86*227.87*262.05
**0738T**70.30*66.79*76.81
**0739T**1596.69*1516.86*1744.39
#**0739T**688.94*654.49*752.66
**0740T**19.78*18.79*21.61
**0741T**46.88*44.54*51.22
**0742T**93.21*88.55*101.83
**0742T*TC*74.28*70.57*81.16
**0742T*26*18.94*17.99*20.69
**0743T**52.96*50.31*57.86
**0744T**872.99*829.34*953.74
**0745T**254.82*242.08*278.39
**0746T**223.41*212.24*244.08
**0747T**985.32*936.05*1076.46
**0748T**182.23*173.12*199.09
**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**4.28*4.07*4.68
**0765T**8.01*7.61*8.75
**0771T**26.13*24.82*28.54
**0772T**26.13*24.82*28.54
**0773T**23.20*22.04*25.35
**0774T**23.20*22.04*25.35
**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**433.49*411.82*473.59
**0779T*TC*407.80*387.41*445.52
**0779T*26*25.69*24.41*28.07
**0780T**23.20*22.04*25.35
**0783T**14.18*13.47*15.49
**0784T**2104.50*1999.28*2299.17
#**0784T**322.02*305.92*351.81
**0785T**241.16*229.10*263.47
#**0785T**143.75*136.56*157.04
**0786T**728.49*692.07*795.88
#**0786T**301.19*286.13*329.05
**0787T**241.16*229.10*263.47
#**0787T**143.75*136.56*157.04
**0788T**18.65*17.72*20.38
#**0788T**17.99*17.09*19.65
**0789T**25.91*24.61*28.30
#**0789T**22.48*21.36*24.56
**0790T**1907.85*1812.46*2084.33
**0791T**9.01*8.56*9.84
**0793T**563.83*535.64*615.99
**0794T**130.35*123.83*142.40
**0795T**700.23*665.22*765.00
**0796T**466.82*443.48*510.00
**0797T**466.82*443.48*510.00
**0798T**740.05*703.05*808.51
**0799T**493.37*468.70*539.01
**0800T**493.37*468.70*539.01
**0801T**960.19*912.18*1049.01
**0802T**480.09*456.09*524.50
**0803T**480.09*456.09*524.50
**0804T**77.99*74.09*85.20
**0804T*TC*41.92*39.82*45.79
**0804T*26*36.07*34.27*39.41
**0805T**2934.72*2787.98*3206.18
#**0805T**320.43*304.41*350.07
**0806T**3912.95*3717.30*4274.90
#**0806T**427.24*405.88*466.76
**0807T**42.38*40.26*46.30
**0807T*TC*27.72*26.33*30.28
**0807T*26*14.66*13.93*16.02
**0808T**42.38*40.26*46.30
**0808T*TC*27.72*26.33*30.28
**0808T*26*14.66*13.93*16.02
**0810T**1123.86*1067.67*1227.82
**0811T**19.78*18.79*21.61
**0813T**2576.43*2447.61*2814.75
#**0813T**178.43*169.51*194.94
**0814T**461.62*438.54*504.32
#**0814T**347.28*329.92*379.41
**0818T**362.60*344.47*396.14
#**0818T**228.86*217.42*250.03
**0820T**147.01*139.66*160.61
#**0820T**129.51*123.03*141.48
**0821T**147.01*139.66*160.61
#**0821T**129.51*123.03*141.48
**0822T**124.96*118.71*136.52
#**0822T**110.08*104.58*120.27
**0823T**700.23*665.22*765.00
**0824T**740.05*703.05*808.51
**0825T**960.19*912.18*1049.01
**0826T**66.70*63.37*72.88
**0826T*TC*36.31*34.49*39.66
**0826T*26*30.39*28.87*33.20
**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**23.11*21.95*25.24
**0859T*TC*20.13*19.12*21.99
**0859T*26*2.99*2.84*3.27
**0864T**312.25*296.64*341.14
#**0864T**224.75*213.51*245.54
**10011**423.31*402.14*462.46
#**10011**106.63*101.30*116.50
**10012**233.43*221.76*255.02
#**10012**70.97*67.42*77.53
**15847**350.06*332.56*382.44
**21088**1674.38*1590.66*1829.26
**21742**1145.45*1088.18*1251.41
**21743**1315.23*1249.47*1436.89
**32855**410.35*389.83*448.30
**32856**446.54*424.21*487.84
**33928**3269.95*3106.45*3572.42
**33929**1224.86*1163.62*1338.16
**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
**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
**50323**551.46*523.89*602.47
**50325**275.01*261.26*300.45
**53451**753.34*715.67*823.02
**53452**376.67*357.84*411.52
**53453**640.29*608.28*699.52
**53454**56.45*53.63*61.67
#**53454**34.98*33.23*38.21
**63043**571.75*543.16*624.63
**63044**505.54*480.26*552.30
**64596**2104.50*1999.28*2299.17
#**64596**322.02*305.92*351.81
**64597**631.35*599.78*689.75
#**64597**96.61*91.78*105.55
**64598**241.16*229.10*263.47
#**64598**143.75*136.56*157.04
**65757**118.86*112.92*129.86
**66983**657.42*624.55*718.23
**66987**760.35*722.33*830.68
**66988**631.91*600.31*690.36
*C*70170**249.77*237.28*272.87
*C*70170*TC*235.43*223.66*257.21
**70555**233.47*221.80*255.07
**70555*TC*116.63*110.80*127.42
*C*70557**680.03*646.03*742.93
*C*70557*TC*529.98*503.48*579.00
*C*70558**342.04*324.94*373.68
*C*70558*TC*176.65*167.82*192.99
*C*70559**331.97*315.37*362.68
*C*70559*TC*176.65*167.82*192.99
*C*74190**551.67*524.09*602.70
*C*74190*TC*529.98*503.48*579.00
**74235**143.22*136.06*156.47
**74235*TC*87.49*83.12*95.59
**74300**82.94*78.79*90.61
**74300*TC*69.94*66.44*76.41
**74301**25.54*24.26*27.90
**74301*TC*15.86*15.07*17.33
**74328**175.06*166.31*191.26
**74328*TC*152.37*144.75*166.46
**74329**139.09*132.14*151.96
**74329*TC*116.07*110.27*126.81
**74330**262.59*249.46*286.88
**74330*TC*235.90*224.11*257.73
**74340**86.58*82.25*94.59
**74340*TC*61.55*58.47*67.24
**74355**86.58*82.25*94.59
**74355*TC*50.87*48.33*55.58
**74360**86.58*82.25*94.59
**74360*TC*59.93*56.93*65.47
**74363**175.06*166.31*191.26
**74363*TC*134.35*127.63*146.77
*C*74445**158.41*150.49*173.06
*C*74445*TC*105.65*100.37*115.43
*C*74450**250.79*238.25*273.99
*C*74450*TC*235.43*223.66*257.21
*C*74470**554.34*526.62*605.61
*C*74470*TC*529.98*503.48*579.00
**74742**233.47*221.80*255.07
**74742*TC*204.77*194.53*223.71
*C*74775**264.46*251.24*288.93
*C*74775*TC*235.43*223.66*257.21
*C*75801**645.49*613.22*705.20
*C*75801*TC*603.61*573.43*659.44
*C*75803**1593.83*1514.14*1741.26
*C*75803*TC*1538.77*1461.83*1681.10
*C*75805**3100.75*2945.71*3387.57
*C*75805*TC*3062.70*2909.57*3346.01
*C*75807**3114.43*2958.71*3402.52
*C*75807*TC*3062.70*2909.57*3346.01
*C*75810**3110.09*2954.59*3397.78
*C*75810*TC*3062.70*2909.57*3346.01
**75894**885.18*840.92*967.06
**75894*TC*815.15*774.39*890.55
*C*75898**3151.95*2994.35*3443.50
*C*75898*TC*3062.70*2909.57*3346.01
**75970**432.17*410.56*472.14
**75970*TC*395.13*375.37*431.68
**76125**39.03*37.08*42.64
**76125*TC*26.03*24.73*28.44
**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*48.06*45.66*52.51
**76940**155.08*147.33*169.43
**76940*TC*56.59*53.76*61.82
**76941**113.81*108.12*124.34
**76941*TC*50.68*48.15*55.37
**76945**82.35*78.23*89.96
**76945*TC*50.95*48.40*55.66
*C*76975**275.47*261.70*300.96
*C*76975*TC*235.43*223.66*257.21
**76998**175.06*166.31*191.26
**76998*TC*129.20*122.74*141.15
**77013**415.10*394.35*453.50
**77013*TC*369.24*350.78*403.40
**77022**464.56*441.33*507.53
**77022*TC*268.97*255.52*293.85
**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**411.30*390.74*449.35
*C*78282*TC*396.24*376.43*432.89
**78414**514.99*489.24*562.63
**78414*TC*494.28*469.57*540.01
*C*78429**1580.63*1501.60*1726.84
*C*78429*TC*1503.11*1427.95*1642.14
*C*78430**1576.96*1498.11*1722.83
*C*78430*TC*1503.11*1427.95*1642.14
*C*78431**2355.72*2237.93*2573.62
*C*78431*TC*2269.53*2156.05*2479.46
*C*78432**1958.22*1860.31*2139.36
*C*78432*TC*1866.01*1772.71*2038.62
*C*78433**2067.95*1964.55*2259.23
*C*78433*TC*1967.06*1868.71*2149.02
**78434**695.18*660.42*759.48
**78434*TC*666.78*633.44*728.46
*C*78459**1436.24*1364.43*1569.09
*C*78459*TC*1364.42*1296.20*1490.63
*C*78491**1573.60*1494.92*1719.16
*C*78491*TC*1503.11*1427.95*1642.14
*C*78492**1585.94*1506.64*1732.64
*C*78492*TC*1503.11*1427.95*1642.14
*C*78608**1570.91*1492.36*1716.21
*C*78608*TC*1503.11*1427.95*1642.14
*C*78811**1434.21*1362.50*1566.88
*C*78811*TC*1364.42*1296.20*1490.63
*C*78812**1591.25*1511.69*1738.44
*C*78812*TC*1503.11*1427.95*1642.14
*C*78813**1593.27*1513.61*1740.65
*C*78813*TC*1503.11*1427.95*1642.14
*C*78814**1602.95*1522.80*1751.22
*C*78814*TC*1503.11*1427.95*1642.14
*C*78815**1614.29*1533.58*1763.62
*C*78815*TC*1503.11*1427.95*1642.14
*C*78816**1615.33*1534.56*1764.74
*C*78816*TC*1503.11*1427.95*1642.14
**79300**237.04*225.19*258.97
**79300*TC*174.77*166.03*190.93
**79445**237.04*225.19*258.97
**79445*TC*130.24*123.73*142.29
**86485**5.29*5.03*5.78
**90867**297.57*282.69*325.09
#**90867**135.60*128.82*148.14
**90868**199.94*189.94*218.43
#**90868**104.74*99.50*114.43
**90869**275.66*261.88*301.16
#**90869**159.65*151.67*174.42
**92978**240.18*228.17*262.40
**92978*TC*148.51*141.08*162.24
**92979**145.96*138.66*159.46
**92979*TC*73.20*69.54*79.97
*C*93315**653.22*620.56*713.64
*C*93315*TC*529.98*503.48*579.00
**93317**209.66*199.18*229.06
**93317*TC*123.93*117.73*135.39
*C*93318**629.09*597.64*687.29
*C*93318*TC*529.98*503.48*579.00
**93571**239.21*227.25*261.34
**93571*TC*169.44*160.97*185.12
**93572**143.70*136.52*157.00
**93572*TC*92.88*88.24*101.48
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.57*3273.29*3764.28
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.52*3275.14*3766.41
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.52*3275.14*3766.41
**93609**2134.69*2027.96*2332.15
**93609*TC*1871.35*1777.78*2044.45
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.00*3231.90*3716.69
**93612**3557.81*3379.92*3886.91
**93612*TC*3404.27*3234.06*3719.17
**93619**7115.62*6759.84*7773.82
**93619*TC*6743.69*6406.51*7367.49
**93620**7115.62*6759.84*7773.82
**93620*TC*6518.90*6192.96*7121.90
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.27*6684.46*7687.13
**93622**7115.62*6759.84*7773.82
**93622*TC*6951.92*6604.32*7594.97
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.03*1965.58*2260.42
**93624**3557.81*3379.92*3886.91
**93624*TC*3326.34*3160.02*3634.02
**93631**7115.62*6759.84*7773.82
**93631*TC*6734.12*6397.41*7357.02
**93640**1133.95*1077.25*1238.84
**93640*TC*963.58*915.40*1052.71
**93641**1133.95*1077.25*1238.84
**93641*TC*836.12*794.31*913.46
**93662**419.18*398.22*457.95
**93662*TC*350.73*333.19*383.17
**94642**29.57*28.09*32.30
**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
**96547**740.01*703.01*808.46
#**96547**133.41*126.74*145.75
**96548**370.01*351.51*404.24
#**96548**66.71*63.37*72.88
**97151**49.61*47.13*54.20
#**97151**44.00*41.80*48.07
**97152**42.17*40.06*46.07
#**97152**37.40*35.53*40.86
**97153**33.59*31.91*36.70
#**97153**29.46*27.99*32.19
**97154**4.58*4.35*5.00
#**97154**4.16*3.95*4.54
**97155**33.59*31.91*36.70
#**97155**29.46*27.99*32.19
**97156**35.43*33.66*38.71
#**97156**31.14*29.58*34.02
**97157**10.35*9.83*11.30
#**97157**9.36*8.89*10.22
**97158**5.33*5.06*5.82
#**97158**4.84*4.60*5.29
**98978**46.88*44.54*51.22
# - 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.