MARYLAND MEDICARE CARRIER - 12302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BALTIMORE/SURR. CNTYS
******
**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**486.74*462.40*531.76
#**G0186**417.12*396.26*455.70
**G0339**3106.03*2950.73*3393.34
**G0340**2336.11*2219.30*2552.20
**G0398**145.15*137.89*158.57
**G0398*TC*104.93*99.68*114.63
**G0398*26*40.21*38.20*43.93
**G0399**100.14*95.13*109.40
**G0399*TC*55.77*52.98*60.93
**G0399*26*44.73*42.49*48.86
**G0400**103.52*98.34*113.09
**G0400*TC*61.87*58.78*67.60
**G0400*26*41.65*39.57*45.51
**G0460**856.84*814.00*936.10
#**G0460**128.04*121.64*139.89
**G0465**856.84*814.00*936.10
#**G0465**128.04*121.64*139.89
**G0498**158.74*150.80*173.42
**G6017**82.98*78.83*90.65
**0042T**241.92*229.82*264.29
**0054T**251.82*239.23*275.11
**0055T**251.82*239.23*275.11
**0071T**612.41*581.79*669.06
**0072T**612.41*581.79*669.06
**0075T**1045.38*993.11*1142.08
**0075T*TC*1045.38*993.11*1142.08
**0075T*26*1043.02*990.87*1139.50
**0095T**689.22*654.76*752.97
**0098T**771.58*733.00*842.95
**0100T**2003.13*1902.97*2188.42
**0101T**333.31*316.64*364.14
#**0101T**238.22*226.31*260.26
**0102T**333.31*316.64*364.14
#**0102T**238.22*226.31*260.26
**0106T**36.30*34.49*39.66
**0107T**36.30*34.49*39.66
**0108T**36.30*34.49*39.66
**0109T**36.30*34.49*39.66
**0110T**36.30*34.49*39.66
**0164T**753.29*715.63*822.97
**0165T**771.85*733.26*843.25
**0184T**881.24*837.18*962.76
**0198T**90.48*85.96*98.85
#**0198T**33.07*31.42*36.13
**0200T**1908.12*1812.71*2084.62
#**0200T**427.55*406.17*467.10
**0201T**2862.19*2719.08*3126.94
#**0201T**641.33*609.26*700.65
**0207T**121.71*115.62*132.96
**0208T**40.98*38.93*44.77
**0209T**49.60*47.12*54.19
**0210T**31.30*29.74*34.20
**0211T**48.52*46.09*53.00
**0212T**38.11*36.20*41.63
#**0212T**32.73*31.09*35.75
**0213T**205.64*195.36*224.66
#**0213T**110.55*105.02*120.77
**0214T**103.46*98.29*113.03
#**0214T**61.84*58.75*67.56
**0215T**103.82*98.63*113.42
#**0215T**62.92*59.77*68.74
**0216T**189.48*180.01*207.01
#**0216T**95.11*90.35*103.90
**0217T**96.80*91.96*105.75
#**0217T**53.02*50.37*57.93
**0218T**96.80*91.96*105.75
#**0218T**54.10*51.40*59.11
**0219T**1438.06*1366.16*1571.08
**0220T**1410.40*1339.88*1540.86
**0221T**1721.29*1635.23*1880.51
**0222T**423.42*402.25*462.59
**0232T**856.84*814.00*936.10
#**0232T**128.04*121.64*139.89
**0234T**9208.25*8747.84*10060.02
#**0234T**621.58*590.50*679.08
**0235T**9208.25*8747.84*10060.02
#**0235T**621.58*590.50*679.08
**0236T**9367.33*8898.96*10233.80
#**0236T**717.87*681.98*784.28
**0237T**9367.33*8898.96*10233.80
#**0237T**717.87*681.98*784.28
**0238T**9367.33*8898.96*10233.80
#**0238T**717.87*681.98*784.28
**0266T**960.82*912.78*1049.70
**0267T**168.33*159.91*183.90
**0268T**357.95*340.05*391.06
**0269T**910.66*865.13*994.90
**0270T**168.33*159.91*183.90
**0271T**357.95*340.05*391.06
**0272T**59.61*56.63*65.12
**0273T**76.01*72.21*83.04
**0274T**1207.34*1146.97*1319.02
**0278T**15.02*14.27*16.41
**0308T**1470.88*1397.34*1606.94
**0329T**90.48*85.96*98.85
#**0329T**33.07*31.42*36.13
**0330T**38.21*36.30*41.75
**0331T**196.36*186.54*214.52
**0332T**335.05*318.30*366.05
**0347T**151.09*143.54*165.07
**0348T**35.29*33.53*38.56
**0349T**37.48*35.61*40.95
**0350T**38.20*36.29*41.73
**0351T**181.41*172.34*198.19
**0352T**44.62*42.39*48.75
**0353T**181.41*172.34*198.19
**0354T**44.62*42.39*48.75
**0358T**29.14*27.68*31.83
**0362T**96.22*91.41*105.12
#**0362T**68.59*65.16*74.93
**0378T**25.86*24.57*28.26
**0394T**267.79*254.40*292.56
**0395T**646.75*614.41*706.57
**0397T**48.87*46.43*53.39
**0398T*26*1746.88*1659.54*1908.47
**0408T**545.62*518.34*596.09
**0409T**377.83*358.94*412.78
**0410T**392.92*373.27*429.26
**0411T**392.92*373.27*429.26
**0412T**247.79*235.40*270.71
**0413T**510.94*485.39*558.20
**0414T**394.05*374.35*430.50
**0415T**328.25*311.84*358.62
**0416T**364.55*346.32*398.27
**0417T**88.38*83.96*96.55
**0418T**59.61*56.63*65.12
**0419T**478.90*454.96*523.20
#**0419T**382.73*363.59*418.13
**0420T**681.35*647.28*744.37
#**0420T**562.58*534.45*614.62
**0421T**1717.96*1632.06*1876.87
#**0421T**731.51*694.93*799.17
**0437T**226.99*215.64*247.99
**0439T**77.19*73.33*84.33
**0440T**265.49*252.22*290.05
#**0440T**125.54*119.26*137.15
**0441T**265.49*252.22*290.05
#**0441T**125.54*119.26*137.15
**0442T**265.49*252.22*290.05
#**0442T**125.54*119.26*137.15
**0449T**804.50*764.28*878.92
**0464T**71.96*68.36*78.61
**0472T**71.10*67.55*77.68
**0473T**59.61*56.63*65.12
**0479T**65.63*62.35*71.70
**0480T**165.74*157.45*181.07
#**0480T**32.81*31.17*35.85
**0483T**1267.92*1204.52*1385.20
**0484T**1643.26*1561.10*1795.27
**0485T**24.85*23.61*27.15
**0485T*TC*9.59*9.11*10.48
**0485T*26*15.70*14.92*17.16
**0486T**49.71*47.22*54.30
**0486T*TC*18.74*17.80*20.47
**0486T*26*30.97*29.42*33.83
**0488T**66.07*62.77*72.19
#**0488T**52.07*49.47*56.89
**0505T**11984.52*11385.29*13093.08
#**0505T**598.56*568.63*653.92
**0507T**25.18*23.92*27.51
**0507T*TC*21.97*20.87*24.00
**0507T*26*3.21*3.05*3.51
**0510T**646.50*614.18*706.31
#**0510T**452.73*430.09*494.60
**0512T**333.31*316.64*364.14
#**0512T**238.22*226.31*260.26
**0513T**99.99*94.99*109.24
#**0513T**71.47*67.90*78.09
**0515T**545.62*518.34*596.09
**0516T**503.80*478.61*550.40
**0517T**357.95*340.05*391.06
**0518T**247.79*235.40*270.71
**0519T**359.08*341.13*392.30
**0520T**503.80*478.61*550.40
**0521T**59.61*56.63*65.12
**0521T*TC*38.83*36.89*42.42
**0521T*26*20.78*19.74*22.70
**0522T**71.10*67.55*77.68
**0522T*TC*39.55*37.57*43.21
**0522T*26*31.55*29.97*34.47
**0523T**162.85*154.71*177.92
**0524T**1766.78*1678.44*1930.21
#**0524T**187.53*178.15*204.87
**0525T**504.16*478.95*550.79
**0526T**392.92*373.27*429.26
**0527T**341.86*324.77*373.49
**0528T**71.10*67.55*77.68
**0528T*TC*39.55*37.57*43.21
**0528T*26*31.55*29.97*34.47
**0529T**59.61*56.63*65.12
**0529T*TC*38.83*36.89*42.42
**0529T*26*20.78*19.74*22.70
**0530T**671.81*638.22*733.95
**0531T**510.94*485.39*558.20
**0532T**359.08*341.13*392.30
**0540T**185.57*176.29*202.73
**0543T**1643.26*1561.10*1795.27
**0544T**1890.90*1796.36*2065.81
**0545T**1890.90*1796.36*2065.81
**0546T**75.86*72.07*82.88
**0552T**7.14*6.78*7.80
**0553T**2640.98*2508.93*2885.27
#**0553T**415.82*395.03*454.28
**0565T**657.96*625.06*718.82
#**0565T**550.67*523.14*601.61
**0566T**106.32*101.00*116.15
#**0566T**62.19*59.08*67.94
**0569T**1890.90*1796.36*2065.81
**0570T**442.85*420.71*483.82
**0571T**590.36*560.84*644.97
**0572T**480.67*456.64*525.14
**0573T**367.24*348.88*401.21
**0574T**425.72*404.43*465.09
**0575T**71.10*67.55*77.68
**0576T**59.61*56.63*65.12
**0577T**199.08*189.13*217.50
**0578T**30.37*28.85*33.18
**0579T**23.04*21.89*25.17
**0580T**228.09*216.69*249.19
**0581T**2440.65*2318.62*2666.41
#**0581T**225.17*213.91*246.00
**0582T**1777.24*1688.38*1941.64
#**0582T**406.11*385.80*443.67
**0583T**1522.66*1446.53*1663.51
#**0583T**141.97*134.87*155.10
**0587T**471.95*448.35*515.60
#**0587T**312.62*296.99*341.54
**0588T**389.56*370.08*425.59
#**0588T**244.23*232.02*266.82
**0589T**50.71*48.17*55.40
#**0589T**40.30*38.29*44.03
**0590T**60.07*57.07*65.63
#**0590T**41.77*39.68*45.63
**0596T**672.69*639.06*734.92
#**0596T**135.38*128.61*147.90
**0597T**672.69*639.06*734.92
#**0597T**135.38*128.61*147.90
**0598T**162.56*154.43*177.59
**0599T**107.96*102.56*117.94
**0600T**3831.80*3640.21*4186.24
#**0600T**755.11*717.35*824.95
**0601T**1554.90*1477.16*1698.73
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**208.91*198.46*228.23
**0611T**43.93*41.73*47.99
**0614T**393.30*373.64*429.69
**0615T**49.53*47.05*54.11
**0616T**695.43*660.66*759.76
**0617T**779.68*740.70*851.81
**0618T**944.32*897.10*1031.67
**0619T**694.69*659.96*758.95
#**0619T**503.50*478.33*550.08
**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**276.37*262.55*301.93
#**0627T**104.13*98.92*113.76
**0628T**82.91*78.76*90.57
#**0628T**31.24*29.68*34.13
**0629T**276.37*262.55*301.93
#**0629T**104.13*98.92*113.76
**0630T**82.91*78.76*90.57
#**0630T**31.24*29.68*34.13
**0631T**88.54*84.11*96.73
**0632T**608.10*577.70*664.36
**0633T**214.94*204.19*234.82
*C*0633T*TC*114.91*109.16*125.53
**0633T*26*60.84*57.80*66.47
**0634T**214.94*204.19*234.82
**0634T*TC*154.10*146.40*168.36
**0634T*26*60.84*57.80*66.47
**0635T**214.94*204.19*234.82
**0635T*TC*154.10*146.40*168.36
**0635T*26*60.84*57.80*66.47
**0636T**214.94*204.19*234.82
**0636T*TC*154.10*146.40*168.36
**0636T*26*60.84*57.80*66.47
**0637T**214.94*204.19*234.82
**0637T*TC*154.10*146.40*168.36
**0637T*26*60.84*57.80*66.47
**0638T**214.94*204.19*234.82
**0638T*TC*154.10*146.40*168.36
**0638T*26*60.84*57.80*66.47
**0639T**88.54*84.11*96.73
**0640T**25.18*23.92*27.51
**0640T*TC*22.14*21.03*24.18
**0640T*26*3.21*3.05*3.51
**0644T**1248.10*1185.70*1363.56
#**0644T**253.04*240.39*276.45
**0646T**1890.90*1796.36*2065.81
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**63.46*60.29*69.33
**0652T**307.64*292.26*336.10
#**0652T**128.22*121.81*140.08
**0653T**402.46*382.34*439.69
#**0653T**144.82*137.58*158.22
**0654T**148.80*141.36*162.56
**0655T**1717.96*1632.06*1876.87
#**0655T**731.51*694.93*799.17
**0658T**102.35*97.23*111.81
**0659T**2893.27*2748.61*3160.90
#**0659T**458.18*435.27*500.56
**0671T**1081.35*1027.28*1181.37
**0673T**3687.57*3503.19*4028.67
#**0673T**383.02*363.87*418.45
**0699T**118.99*113.04*130.00
#**0699T**95.31*90.54*104.12
**0707T**397.33*377.46*434.08
#**0707T**297.93*283.03*325.48
**0714T**1508.19*1432.78*1647.70
#**0714T**379.29*360.33*414.38
**0730T**284.26*270.05*310.56
#**0730T**254.30*241.59*277.83
**0738T**73.82*70.13*80.65
**0739T**1717.96*1632.06*1876.87
#**0739T**731.51*694.93*799.17
**0740T**21.68*20.60*23.69
**0741T**51.03*48.48*55.75
**0742T**100.52*95.49*109.81
**0742T*TC*80.85*76.81*88.33
**0742T*26*19.66*18.68*21.48
**0743T**57.07*54.22*62.35
**0744T**944.51*897.28*1031.87
**0745T**277.56*263.68*303.23
**0746T**233.52*221.84*255.12
**0747T**1073.06*1019.41*1172.32
**0748T**195.11*185.35*213.15
**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**4.58*4.35*5.00
**0765T**8.36*7.94*9.13
**0771T**27.65*26.27*30.21
**0772T**27.65*26.27*30.21
**0773T**24.85*23.61*27.15
**0774T**24.85*23.61*27.15
**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**470.02*446.52*513.50
**0779T*TC*443.24*421.08*484.24
**0779T*26*26.78*25.44*29.26
**0780T**24.85*23.61*27.15
**0783T**15.51*14.73*16.94
**0784T**2278.02*2164.12*2488.74
#**0784T**341.00*323.95*372.54
**0785T**259.47*246.50*283.48
#**0785T**153.61*145.93*167.82
**0786T**784.63*745.40*857.21
#**0786T**320.30*304.29*349.93
**0787T**259.47*246.50*283.48
#**0787T**153.61*145.93*167.82
**0788T**19.65*18.67*21.47
#**0788T**18.93*17.98*20.68
**0789T**28.16*26.75*30.76
#**0789T**23.67*22.49*25.86
**0790T**2015.81*1915.02*2202.27
**0791T**9.54*9.06*10.42
**0793T**608.10*577.70*664.36
**0794T**130.35*123.83*142.40
**0795T**755.69*717.91*825.60
**0796T**503.80*478.61*550.40
**0797T**503.80*478.61*550.40
**0798T**799.01*759.06*872.92
**0799T**532.67*506.04*581.95
**0800T**532.67*506.04*581.95
**0801T**1036.47*984.65*1132.35
**0802T**518.23*492.32*566.17
**0803T**518.23*492.32*566.17
**0804T**83.07*78.92*90.76
**0804T*TC*45.65*43.37*49.88
**0804T*26*37.42*35.55*40.88
**0805T**3180.84*3021.80*3475.07
#**0805T**339.91*322.91*371.35
**0806T**4241.12*4029.06*4633.42
#**0806T**453.22*430.56*495.14
**0807T**45.66*43.38*49.89
**0807T*TC*30.22*28.71*33.02
**0807T*26*15.44*14.67*16.87
**0808T**45.66*43.38*49.89
**0808T*TC*30.22*28.71*33.02
**0808T*26*15.44*14.67*16.87
**0810T**1191.55*1131.97*1301.77
**0811T**21.68*20.60*23.69
**0813T**2798.25*2658.34*3057.09
#**0813T**192.36*182.74*210.15
**0814T**496.67*471.84*542.62
#**0814T**372.42*353.80*406.87
**0818T**389.56*370.08*425.59
#**0818T**244.23*232.02*266.82
**0820T**152.33*144.71*166.42
#**0820T**133.31*126.64*145.64
**0821T**152.33*144.71*166.42
#**0821T**133.31*126.64*145.64
**0822T**129.48*123.01*141.46
#**0822T**113.31*107.64*123.79
**0823T**755.69*717.91*825.60
**0824T**799.01*759.06*872.92
**0825T**1036.47*984.65*1132.35
**0826T**71.10*67.55*77.68
**0826T*TC*39.55*37.57*43.21
**0826T*26*31.55*29.97*34.47
**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**25.18*23.92*27.51
**0859T*TC*21.97*20.87*24.00
**0859T*26*3.21*3.05*3.51
**0864T**333.31*316.64*364.14
#**0864T**238.22*226.31*260.26
**10011**456.28*433.47*498.49
#**10011**112.16*106.55*122.53
**10012**251.41*238.84*274.67
#**10012**74.86*71.12*81.79
**15847**376.71*357.87*411.55
**21088**1834.61*1742.88*2004.31
**21742**1233.43*1171.76*1347.52
**21743**1422.86*1351.72*1554.48
**32855**449.60*427.12*491.19
**32856**482.91*458.76*527.57
**33928**3528.67*3352.24*3855.08
**33929**1321.29*1255.23*1443.51
**33933**582.62*553.49*636.51
**33944**509.55*484.07*556.68
**34841**2252.32*2139.70*2460.66
**34842**2478.11*2354.20*2707.33
**34843**2703.88*2568.69*2953.99
**34844**2929.67*2783.19*3200.67
**34845**2252.32*2139.70*2460.66
**34846**2478.11*2354.20*2707.33
**34847**2703.88*2568.69*2953.99
**34848**2929.67*2783.19*3200.67
**43496**2289.45*2174.98*2501.23
**43647**787.28*747.92*860.11
**43648**577.02*548.17*630.40
#**43648**257.74*244.85*281.58
**43881**749.94*712.44*819.31
#**43881**687.51*653.13*751.10
**43882**796.88*757.04*870.60
#**43882**729.68*693.20*797.18
**47143**450.81*428.27*492.51
**47144**535.33*508.56*584.84
**47145**507.15*481.79*554.06
**48551**449.58*427.10*491.17
**50323**604.25*574.04*660.15
**50325**301.33*286.26*329.20
**53451**800.26*760.25*874.29
**53452**400.13*380.12*437.14
**53453**680.23*646.22*743.15
**53454**60.11*57.10*65.67
#**53454**36.79*34.95*40.19
**63043**634.89*603.15*693.62
**63044**567.72*539.33*620.23
**64596**2278.02*2164.12*2488.74
#**64596**341.00*323.95*372.54
**64597**683.41*649.24*746.63
#**64597**102.30*97.19*111.77
**64598**259.47*246.50*283.48
#**64598**153.61*145.93*167.82
**65757**126.89*120.55*138.63
**66983**695.43*660.66*759.76
**66987**803.19*763.03*877.48
**66988**666.74*633.40*728.41
*C*70170**270.93*257.38*295.99
*C*70170*TC*255.93*243.13*279.60
**70555**233.47*221.80*255.07
**70555*TC*111.86*106.27*122.21
*C*70557**732.89*696.25*800.69
*C*70557*TC*576.01*547.21*629.29
*C*70558**364.94*346.69*398.69
*C*70558*TC*192.06*182.46*209.83
*C*70559**355.10*337.35*387.95
*C*70559*TC*192.06*182.46*209.83
*C*74190**598.64*568.71*654.02
*C*74190*TC*576.01*547.21*629.29
**74235**154.72*146.98*169.03
**74235*TC*96.63*91.80*105.57
**74300**89.67*85.19*97.97
**74300*TC*76.04*72.24*83.08
**74301**27.80*26.41*30.37
**74301*TC*17.72*16.83*19.35
**74328**175.06*166.31*191.26
**74328*TC*151.41*143.84*165.42
**74329**151.35*143.78*165.35
**74329*TC*127.34*120.97*139.12
**74330**262.59*249.46*286.88
**74330*TC*234.73*222.99*256.44
**74340**86.58*82.25*94.59
**74340*TC*60.48*57.46*66.08
**74355**86.58*82.25*94.59
**74355*TC*49.34*46.87*53.90
**74360**86.58*82.25*94.59
**74360*TC*58.53*55.60*63.94
**74363**175.06*166.31*191.26
**74363*TC*132.60*125.97*144.87
*C*74445**169.71*161.22*185.40
*C*74445*TC*114.91*109.16*125.53
*C*74450**271.88*258.29*297.03
*C*74450*TC*255.93*243.13*279.60
*C*74470**601.40*571.33*657.03
*C*74470*TC*576.01*547.21*629.29
**74742**233.47*221.80*255.07
**74742*TC*203.56*193.38*222.39
*C*74775**286.18*271.87*312.65
*C*74775*TC*255.93*243.13*279.60
*C*75801**700.68*665.65*765.50
*C*75801*TC*656.04*623.24*716.73
*C*75803**1729.68*1643.20*1889.68
*C*75803*TC*1672.27*1588.66*1826.96
*C*75805**3367.96*3199.56*3679.49
*C*75805*TC*3328.31*3161.89*3636.17
*C*75807**3382.29*3213.18*3695.16
*C*75807*TC*3328.31*3161.89*3636.17
*C*75810**3377.83*3208.94*3690.28
*C*75810*TC*3328.31*3161.89*3636.17
**75894**971.18*922.62*1061.01
**75894*TC*895.92*851.12*978.79
*C*75898**3424.42*3253.20*3741.18
*C*75898*TC*3328.31*3161.89*3636.17
**75970**473.55*449.87*517.35
**75970*TC*434.86*413.12*475.09
**76125**42.33*40.21*46.24
**76125*TC*28.70*27.27*31.36
**76390**217.51*206.63*237.62
**76390*TC*164.29*156.08*179.49
**76390*26*53.22*50.56*58.14
**76932**90.09*85.59*98.43
**76932*TC*52.65*50.02*57.52
**76940**169.37*160.90*185.04
**76940*TC*64.94*61.69*70.94
**76941**121.96*115.86*133.24
**76941*TC*56.50*53.68*61.73
**76945**88.95*84.50*97.18
**76945*TC*56.44*53.62*61.66
*C*76975**297.66*282.78*325.20
*C*76975*TC*255.93*243.13*279.60
**76998**175.06*166.31*191.26
**76998*TC*126.07*119.77*137.74
**77013**448.36*425.94*489.83
**77013*TC*261.44*248.37*285.63
**77022**498.65*473.72*544.78
**77022*TC*294.86*280.12*322.14
**77371**1354.89*1287.15*1480.22
**77520**980.87*931.83*1071.60
**77522**980.87*931.83*1071.60
**77523**1126.23*1069.92*1230.41
**77525**1271.59*1208.01*1389.21
*C*78282**446.17*423.86*487.44
*C*78282*TC*430.68*409.15*470.52
**78414**514.99*489.24*562.63
**78414*TC*493.53*468.85*539.18
*C*78429**1713.83*1628.14*1872.36
*C*78429*TC*1633.51*1551.83*1784.60
*C*78430**1709.98*1624.48*1868.15
*C*78430*TC*1633.51*1551.83*1784.60
*C*78431**2555.75*2427.96*2792.15
*C*78431*TC*2466.38*2343.06*2694.52
*C*78432**2123.46*2017.29*2319.88
*C*78432*TC*2027.88*1926.49*2215.46
*C*78433**2242.30*2130.19*2449.72
*C*78433*TC*2137.68*2030.80*2335.42
**78434**754.21*716.50*823.98
**78434*TC*724.77*688.53*791.81
*C*78459**1557.30*1479.44*1701.36
*C*78459*TC*1482.80*1408.66*1619.96
*C*78491**1706.60*1621.27*1864.46
*C*78491*TC*1633.51*1551.83*1784.60
*C*78492**1719.49*1633.52*1878.55
*C*78492*TC*1633.51*1551.83*1784.60
*C*78608**1703.92*1618.72*1861.53
*C*78608*TC*1633.51*1551.83*1784.60
*C*78811**1555.36*1477.59*1699.23
*C*78811*TC*1482.80*1408.66*1619.96
*C*78812**1725.21*1638.95*1884.79
*C*78812*TC*1633.51*1551.83*1784.60
*C*78813**1727.23*1640.87*1887.00
*C*78813*TC*1633.51*1551.83*1784.60
*C*78814**1737.33*1650.46*1898.03
*C*78814*TC*1633.51*1551.83*1784.60
*C*78815**1749.14*1661.68*1910.93
*C*78815*TC*1633.51*1551.83*1784.60
*C*78816**1750.03*1662.53*1911.91
*C*78816*TC*1633.51*1551.83*1784.60
**79300**237.04*225.19*258.97
**79300*TC*172.87*164.23*188.86
**79445**237.04*225.19*258.97
**79445*TC*125.41*119.14*137.01
**86485**5.81*5.52*6.35
**90867**321.14*305.08*350.84
#**90867**145.13*137.87*158.55
**90868**214.31*203.59*234.13
#**90868**108.93*103.48*119.00
**90869**293.90*279.21*321.09
#**90869**170.53*162.00*186.30
**92978**259.59*246.61*283.60
**92978*TC*161.41*153.34*176.34
**92979**157.03*149.18*171.56
**92979*TC*79.23*75.27*86.56
*C*93315**703.92*668.72*769.03
*C*93315*TC*576.01*547.21*629.29
**93317**226.35*215.03*247.28
**93317*TC*136.76*129.92*149.41
*C*93318**679.36*645.39*742.20
*C*93318*TC*576.01*547.21*629.29
**93571**258.53*245.60*282.44
**93571*TC*183.92*174.72*200.93
**93572**154.48*146.76*168.77
**93572*TC*100.05*95.05*109.31
**93600**3557.81*3379.92*3886.91
**93600*TC*3437.54*3265.66*3755.51
**93602**3557.81*3379.92*3886.91
**93602*TC*3439.85*3267.86*3758.04
**93603**3557.81*3379.92*3886.91
**93603*TC*3439.85*3267.86*3758.04
**93609**2134.69*2027.96*2332.15
**93609*TC*1852.54*1759.91*2023.90
**93610**3557.81*3379.92*3886.91
**93610*TC*3391.19*3221.63*3704.87
**93612**3557.81*3379.92*3886.91
**93612*TC*3393.94*3224.24*3707.88
**93619**7115.62*6759.84*7773.82
**93619*TC*6717.12*6381.26*7338.45
**93620**7115.62*6759.84*7773.82
**93620*TC*6476.11*6152.30*7075.15
**93621**7115.62*6759.84*7773.82
**93621*TC*7030.52*6678.99*7680.84
**93622**7115.62*6759.84*7773.82
**93622*TC*6940.16*6593.15*7582.12
**93623**2134.69*2027.96*2332.15
**93623*TC*2064.07*1960.87*2255.00
**93624**3557.81*3379.92*3886.91
**93624*TC*3309.72*3144.23*3615.86
**93631**7115.62*6759.84*7773.82
**93631*TC*6706.13*6370.82*7326.44
**93640**1133.95*1077.25*1238.84
**93640*TC*951.47*903.90*1039.49
**93641**1133.95*1077.25*1238.84
**93641*TC*814.56*773.83*889.90
**93662**452.04*429.44*493.86
**93662*TC*380.95*361.90*416.19
**94642**32.38*30.76*35.37
**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**957.21*909.35*1045.75
**95965*TC*543.69*516.51*593.99
**95967**475.55*451.77*519.54
**96020**370.01*351.51*404.24
**96547**800.07*760.07*874.08
#**96547**140.88*133.84*153.92
**96548**400.03*380.03*437.03
#**96548**70.44*66.92*76.96
**97151**51.43*48.86*56.19
#**97151**45.33*43.06*49.52
**97152**43.72*41.53*47.76
#**97152**38.53*36.60*42.09
**97153**34.75*33.01*37.96
#**97153**30.26*28.75*33.06
**97154**4.83*4.59*5.28
#**97154**4.37*4.15*4.77
**97155**34.75*33.01*37.96
#**97155**30.26*28.75*33.06
**97156**36.63*34.80*40.02
#**97156**31.96*30.36*34.91
**97157**10.78*10.24*11.78
#**97157**9.70*9.22*10.60
**97158**5.61*5.33*6.13
#**97158**5.07*4.82*5.54
**98978**51.03*48.48*55.75
# - 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.