MARYLAND MEDICARE CARRIER - 12302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**462.96*439.81*505.78
#**G0186**397.35*377.48*434.10
**G0339**2930.10*2783.60*3201.14
**G0340**2203.70*2093.52*2407.55
**G0398**137.80*130.91*150.55
**G0398*TC*98.73*93.79*107.86
**G0398*26*39.08*37.13*42.70
**G0399**95.52*90.74*104.35
**G0399*TC*52.39*49.77*57.24
**G0399*26*43.46*41.29*47.48
**G0400**98.57*93.64*107.69
**G0400*TC*58.14*55.23*63.51
**G0400*26*40.43*38.41*44.17
**G0460**808.15*767.74*882.90
#**G0460**121.26*115.20*132.48
**G0465**808.15*767.74*882.90
#**G0465**121.26*115.20*132.48
**G0498**149.36*141.89*163.17
**G6017**78.93*74.98*86.23
**0042T**230.64*219.11*251.98
**0054T**231.94*220.34*253.39
**0055T**231.94*220.34*253.39
**0071T**579.02*550.07*632.58
**0072T**579.02*550.07*632.58
**0075T**972.63*924.00*1062.60
**0075T*TC*972.63*924.00*1062.60
**0075T*26*973.22*924.56*1063.24
**0095T**632.56*600.93*691.07
**0098T**707.89*672.50*773.38
**0100T**1915.42*1819.65*2092.60
**0101T**317.36*301.49*346.71
#**0101T**227.74*216.35*248.80
**0102T**317.36*301.49*346.71
#**0102T**227.74*216.35*248.80
**0106T**34.12*32.41*37.27
**0107T**34.12*32.41*37.27
**0108T**34.12*32.41*37.27
**0109T**34.12*32.41*37.27
**0110T**34.12*32.41*37.27
**0164T**691.61*657.03*755.58
**0165T**708.56*673.13*774.10
**0184T**832.35*790.73*909.34
**0198T**86.13*81.82*94.09
#**0198T**32.02*30.42*34.98
**0200T**1801.46*1711.39*1968.10
#**0200T**406.04*385.74*443.60
**0201T**2702.18*2567.07*2952.13
#**0201T**609.06*578.61*665.40
**0207T**121.71*115.62*132.96
**0208T**38.54*36.61*42.10
**0209T**46.66*44.33*50.98
**0210T**29.41*27.94*32.13
**0211T**45.64*43.36*49.86
**0212T**36.76*34.92*40.16
#**0212T**31.68*30.10*34.62
**0213T**195.32*185.55*213.38
#**0213T**105.70*100.42*115.48
**0214T**98.43*93.51*107.54
#**0214T**59.20*56.24*64.68
**0215T**98.77*93.83*107.90
#**0215T**60.21*57.20*65.78
**0216T**179.84*170.85*196.48
#**0216T**90.90*86.36*99.31
**0217T**92.05*87.45*100.57
#**0217T**50.79*48.25*55.49
**0218T**92.05*87.45*100.57
#**0218T**51.81*49.22*56.60
**0219T**1331.58*1265.00*1454.75
**0220T**1308.44*1243.02*1429.47
**0221T**1603.48*1523.31*1751.81
**0222T**391.86*372.27*428.11
**0232T**808.15*767.74*882.90
#**0232T**121.26*115.20*132.48
**0234T**8676.42*8242.60*9478.99
#**0234T**583.61*554.43*637.59
**0235T**8676.42*8242.60*9478.99
#**0235T**583.61*554.43*637.59
**0236T**8827.64*8386.26*9644.20
#**0236T**675.64*641.86*738.14
**0237T**8827.64*8386.26*9644.20
#**0237T**675.64*641.86*738.14
**0238T**8827.64*8386.26*9644.20
#**0238T**675.64*641.86*738.14
**0266T**901.22*856.16*984.58
**0267T**158.32*150.40*172.96
**0268T**335.77*318.98*366.83
**0269T**854.03*811.33*933.03
**0270T**158.32*150.40*172.96
**0271T**335.77*318.98*366.83
**0272T**56.73*53.89*61.97
**0273T**72.56*68.93*79.27
**0274T**1120.61*1064.58*1224.27
**0278T**14.50*13.78*15.85
**0308T**1406.13*1335.82*1536.19
**0329T**86.13*81.82*94.09
#**0329T**32.02*30.42*34.98
**0330T**38.21*36.30*41.75
**0331T**185.80*176.51*202.99
**0332T**317.24*301.38*346.59
**0347T**142.36*135.24*155.53
**0348T**33.43*31.76*36.52
**0349T**35.46*33.69*38.74
**0350T**36.13*34.32*39.47
**0351T**171.98*163.38*187.89
**0352T**43.14*40.98*47.13
**0353T**171.98*163.38*187.89
**0354T**43.14*40.98*47.13
**0358T**27.38*26.01*29.91
**0362T**92.01*87.41*100.52
#**0362T**65.97*62.67*72.07
**0378T**24.92*23.67*27.22
**0394T**253.38*240.71*276.82
**0395T**613.62*582.94*670.38
**0397T**47.16*44.80*51.52
**0398T*26*1746.88*1659.54*1908.47
**0408T**511.86*486.27*559.21
**0409T**354.61*336.88*387.41
**0410T**368.78*350.34*402.89
**0411T**368.78*350.34*402.89
**0412T**232.59*220.96*254.10
**0413T**479.45*455.48*523.80
**0414T**369.70*351.22*403.90
**0415T**307.86*292.47*336.34
**0416T**342.04*324.94*373.68
**0417T**84.38*80.16*92.18
**0418T**56.73*53.89*61.97
**0419T**454.84*432.10*496.92
#**0419T**364.20*345.99*397.89
**0420T**645.86*613.57*705.61
#**0420T**533.92*507.22*583.30
**0421T**1626.72*1545.38*1777.19
#**0421T**697.00*662.15*761.47
**0437T**213.93*203.23*233.71
**0439T**72.77*69.13*79.50
**0440T**251.73*239.14*275.01
#**0440T**119.84*113.85*130.93
**0441T**251.73*239.14*275.01
#**0441T**119.84*113.85*130.93
**0442T**251.73*239.14*275.01
#**0442T**119.84*113.85*130.93
**0449T**767.94*729.54*838.97
**0464T**68.24*64.83*74.55
**0472T**67.85*64.46*74.13
**0473T**56.73*53.89*61.97
**0479T**63.36*60.19*69.22
**0480T**157.72*149.83*172.30
#**0480T**31.68*30.10*34.62
**0483T**1187.42*1128.05*1297.26
**0484T**1539.41*1462.44*1681.81
**0485T**23.79*22.60*25.99
**0485T*TC*8.95*8.50*9.78
**0485T*26*15.17*14.41*16.57
**0486T**47.59*45.21*51.99
**0486T*TC*17.57*16.69*19.19
**0486T*26*30.01*28.51*32.79
**0488T**63.35*60.18*69.21
#**0488T**50.16*47.65*54.80
**0505T**11311.26*10745.70*12357.56
#**0505T**569.97*541.47*622.69
**0507T**23.64*22.46*25.83
**0507T*TC*20.62*19.59*22.53
**0507T*26*3.02*2.87*3.30
**0510T**610.17*579.66*666.61
#**0510T**427.54*406.16*467.08
**0512T**317.36*301.49*346.71
#**0512T**227.74*216.35*248.80
**0513T**95.21*90.45*104.02
#**0513T**68.32*64.90*74.64
**0515T**511.86*486.27*559.21
**0516T**472.61*448.98*516.33
**0517T**335.77*318.98*366.83
**0518T**232.59*220.96*254.10
**0519T**336.78*319.94*367.93
**0520T**472.61*448.98*516.33
**0521T**56.73*53.89*61.97
**0521T*TC*36.51*34.68*39.88
**0521T*26*20.22*19.21*22.09
**0522T**67.85*64.46*74.13
**0522T*TC*37.19*35.33*40.63
**0522T*26*30.66*29.13*33.50
**0523T**153.66*145.98*167.88
**0524T**1664.82*1581.58*1818.82
#**0524T**176.40*167.58*192.72
**0525T**472.95*449.30*516.70
**0526T**368.78*350.34*402.89
**0527T**320.67*304.64*350.34
**0528T**67.85*64.46*74.13
**0528T*TC*37.19*35.33*40.63
**0528T*26*30.66*29.13*33.50
**0529T**56.73*53.89*61.97
**0529T*TC*36.51*34.68*39.88
**0529T*26*20.22*19.21*22.09
**0530T**630.25*598.74*688.55
**0531T**479.45*455.48*523.80
**0532T**336.78*319.94*367.93
**0540T**178.22*169.31*194.71
**0543T**1539.41*1462.44*1681.81
**0544T**1772.14*1683.53*1936.06
**0545T**1772.14*1683.53*1936.06
**0546T**72.58*68.95*79.29
**0552T**6.74*6.40*7.36
**0553T**2487.31*2362.94*2717.38
#**0553T**390.12*370.61*426.20
**0565T**620.62*589.59*678.03
#**0565T**519.50*493.53*567.56
**0566T**100.76*95.72*110.08
#**0566T**59.16*56.20*64.63
**0569T**1772.14*1683.53*1936.06
**0570T**415.05*394.30*453.45
**0571T**553.87*526.18*605.11
**0572T**450.74*428.20*492.43
**0573T**344.50*327.28*376.37
**0574T**399.09*379.14*436.01
**0575T**67.85*64.46*74.13
**0576T**56.73*53.89*61.97
**0577T**191.89*182.30*209.65
**0578T**29.29*27.83*32.00
**0579T**21.63*20.55*23.63
**0580T**214.03*203.33*233.83
**0581T**2298.25*2183.34*2510.84
#**0581T**210.20*199.69*229.64
**0582T**1678.69*1594.76*1833.97
#**0582T**386.42*367.10*422.17
**0583T**1522.66*1446.53*1663.51
#**0583T**134.41*127.69*146.84
**0587T**447.07*424.72*488.43
#**0587T**296.91*282.06*324.37
**0588T**368.69*350.26*402.80
#**0588T**231.71*220.12*253.14
**0589T**48.50*46.08*52.99
#**0589T**38.69*36.76*42.27
**0590T**57.27*54.41*62.57
#**0590T**40.02*38.02*43.72
**0596T**672.69*639.06*734.92
#**0596T**131.23*124.67*143.37
**0597T**672.69*639.06*734.92
#**0597T**131.23*124.67*143.37
**0598T**153.48*145.81*167.68
**0599T**102.09*96.99*111.54
**0600T**3622.95*3441.80*3958.07
#**0600T**723.22*687.06*790.12
**0601T**1455.34*1382.57*1589.96
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**198.52*188.59*216.88
**0611T**41.23*39.17*45.05
**0614T**369.02*350.57*403.16
**0615T**47.55*45.17*51.95
**0616T**666.50*633.18*728.16
**0617T**745.27*708.01*814.21
**0618T**902.36*857.24*985.83
**0619T**659.53*626.55*720.53
#**0619T**479.28*455.32*523.62
**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**261.95*248.85*286.18
#**0627T**99.61*94.63*108.82
**0628T**78.58*74.65*85.85
#**0628T**29.88*28.39*32.65
**0629T**261.95*248.85*286.18
#**0629T**99.61*94.63*108.82
**0630T**78.58*74.65*85.85
#**0630T**29.88*28.39*32.65
**0631T**83.43*79.26*91.15
**0632T**570.26*541.75*623.01
**0633T**203.99*193.79*222.86
*C*0633T*TC*108.21*102.80*118.22
**0633T*26*58.93*55.98*64.38
**0634T**203.99*193.79*222.86
**0634T*TC*145.06*137.81*158.48
**0634T*26*58.93*55.98*64.38
**0635T**203.99*193.79*222.86
**0635T*TC*145.06*137.81*158.48
**0635T*26*58.93*55.98*64.38
**0636T**203.99*193.79*222.86
**0636T*TC*145.06*137.81*158.48
**0636T*26*58.93*55.98*64.38
**0637T**203.99*193.79*222.86
**0637T*TC*145.06*137.81*158.48
**0637T*26*58.93*55.98*64.38
**0638T**203.99*193.79*222.86
**0638T*TC*145.06*137.81*158.48
**0638T*26*58.93*55.98*64.38
**0639T**83.43*79.26*91.15
**0640T**23.64*22.46*25.83
**0640T*TC*20.75*19.71*22.67
**0640T*26*3.02*2.87*3.30
**0644T**1175.85*1117.06*1284.62
#**0644T**238.02*226.12*260.04
**0646T**1772.14*1683.53*1936.06
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**60.43*57.41*66.02
**0652T**291.22*276.66*318.16
#**0652T**122.12*116.01*133.41
**0653T**380.74*361.70*415.96
#**0653T**137.91*131.01*150.66
**0654T**141.58*134.50*154.68
**0655T**1626.72*1545.38*1777.19
#**0655T**697.00*662.15*761.47
**0658T**96.37*91.55*105.28
**0659T**2725.04*2588.79*2977.11
#**0659T**430.01*408.51*469.79
**0671T**1032.31*980.69*1127.79
**0673T**3477.95*3304.05*3799.66
#**0673T**363.45*345.28*397.07
**0699T**113.62*107.94*124.13
#**0699T**91.30*86.74*99.75
**0707T**376.20*357.39*411.00
#**0707T**282.52*268.39*308.65
**0714T**1424.87*1353.63*1556.67
#**0714T**360.89*342.85*394.28
**0730T**271.85*258.26*297.00
#**0730T**243.50*231.33*266.03
**0738T**71.07*67.52*77.65
**0739T**1626.72*1545.38*1777.19
#**0739T**697.00*662.15*761.47
**0740T**20.26*19.25*22.14
**0741T**48.01*45.61*52.45
**0742T**95.17*90.41*103.97
**0742T*TC*76.07*72.27*83.11
**0742T*26*19.10*18.15*20.87
**0743T**54.03*51.33*59.03
**0744T**882.24*838.13*963.85
**0745T**260.99*247.94*285.13
**0746T**225.77*214.48*246.65
**0747T**1009.17*958.71*1102.52
**0748T**184.60*175.37*201.68
**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**4.35*4.13*4.75
**0765T**8.08*7.68*8.83
**0771T**26.39*25.07*28.83
**0772T**26.39*25.07*28.83
**0773T**23.64*22.46*25.83
**0774T**23.64*22.46*25.83
**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**443.61*421.43*484.64
**0779T*TC*417.66*396.78*456.30
**0779T*26*25.94*24.64*28.34
**0780T**23.64*22.46*25.83
**0783T**14.53*13.80*15.87
**0784T**2151.33*2043.76*2350.32
#**0784T**325.72*309.43*355.84
**0785T**245.50*233.23*268.21
#**0785T**145.73*138.44*159.21
**0786T**742.26*705.15*810.92
#**0786T**304.63*289.40*332.81
**0787T**245.50*233.23*268.21
#**0787T**145.73*138.44*159.21
**0788T**18.85*17.91*20.60
#**0788T**18.17*17.26*19.85
**0789T**26.23*24.92*28.66
#**0789T**22.72*21.58*24.82
**0790T**1928.48*1832.06*2106.87
**0791T**9.13*8.67*9.97
**0793T**570.26*541.75*623.01
**0794T**130.35*123.83*142.40
**0795T**708.92*673.47*774.49
**0796T**472.61*448.98*516.33
**0797T**472.61*448.98*516.33
**0798T**748.88*711.44*818.16
**0799T**499.25*474.29*545.43
**0800T**499.25*474.29*545.43
**0801T**971.87*923.28*1061.77
**0802T**485.93*461.63*530.87
**0803T**485.93*461.63*530.87
**0804T**79.33*75.36*86.66
**0804T*TC*42.94*40.79*46.91
**0804T*26*36.39*34.57*39.76
**0805T**3000.98*2850.93*3278.57
#**0805T**323.44*307.27*353.36
**0806T**4001.31*3801.24*4371.43
#**0806T**431.26*409.70*471.16
**0807T**43.19*41.03*47.18
**0807T*TC*28.39*26.97*31.02
**0807T*26*14.80*14.06*16.17
**0808T**43.19*41.03*47.18
**0808T*TC*28.39*26.97*31.02
**0808T*26*14.80*14.06*16.17
**0810T**1139.45*1082.48*1244.85
**0811T**20.26*19.25*22.14
**0813T**2636.57*2504.74*2880.45
#**0813T**180.55*171.52*197.25
**0814T**470.25*446.74*513.75
#**0814T**353.14*335.48*385.80
**0818T**368.69*350.26*402.80
#**0818T**231.71*220.12*253.14
**0820T**148.23*140.82*161.94
#**0820T**130.30*123.79*142.36
**0821T**148.23*140.82*161.94
#**0821T**130.30*123.79*142.36
**0822T**125.99*119.69*137.64
#**0822T**110.76*105.22*121.00
**0823T**708.92*673.47*774.49
**0824T**748.88*711.44*818.16
**0825T**971.87*923.28*1061.77
**0826T**67.85*64.46*74.13
**0826T*TC*37.19*35.33*40.63
**0826T*26*30.66*29.13*33.50
**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**23.64*22.46*25.83
**0859T*TC*20.62*19.59*22.53
**0859T*26*3.02*2.87*3.30
**0864T**317.36*301.49*346.71
#**0864T**227.74*216.35*248.80
**10011**431.94*410.34*471.89
#**10011**107.61*102.23*117.56
**10012**237.91*226.01*259.91
#**10012**71.52*67.94*78.13
**15847**354.90*337.16*387.73
**21088**1657.76*1574.87*1811.10
**21742**1158.90*1100.96*1266.10
**21743**1330.81*1264.27*1453.91
**32855**406.28*385.97*443.87
**32856**451.40*428.83*493.15
**33928**3303.03*3137.88*3608.56
**33929**1237.23*1175.37*1351.68
**33933**551.14*523.58*602.12
**33944**460.40*437.38*502.99
**34841**2145.63*2038.35*2344.10
**34842**2371.43*2252.86*2590.79
**34843**2597.20*2467.34*2837.44
**34844**2822.98*2681.83*3084.10
**34845**2145.63*2038.35*2344.10
**34846**2371.43*2252.86*2590.79
**34847**2597.20*2467.34*2837.44
**34848**2822.98*2681.83*3084.10
**43496**2164.93*2056.68*2365.18
**43647**711.41*675.84*777.22
**43648**547.98*520.58*598.67
#**43648**246.17*233.86*268.94
**43881**700.73*665.69*765.54
#**43881**641.81*609.72*701.18
**43882**744.37*707.15*813.22
#**43882**680.99*646.94*743.98
**47143**429.53*408.05*469.26
**47144**510.06*484.56*557.24
**47145**483.20*459.04*527.90
**48551**406.27*385.96*443.85
**50323**545.98*518.68*596.48
**50325**272.28*258.67*297.47
**53451**762.36*724.24*832.88
**53452**381.18*362.12*416.44
**53453**647.98*615.58*707.92
**53454**57.32*54.45*62.62
#**53454**35.33*33.56*38.59
**63043**580.47*551.45*634.17
**63044**531.82*505.23*581.01
**64596**2151.33*2043.76*2350.32
#**64596**325.72*309.43*355.84
**64597**645.40*613.13*705.10
#**64597**97.72*92.83*106.75
**64598**245.50*233.23*268.21
#**64598**145.73*138.44*159.21
**65757**120.54*114.51*131.69
**66983**666.50*633.18*728.16
**66987**769.48*731.01*840.66
**66988**639.97*607.97*699.17
*C*70170**255.60*242.82*279.24
*C*70170*TC*241.12*229.06*263.42
**70555**233.47*221.80*255.07
**70555*TC*115.61*109.83*126.30
*C*70557**694.42*659.70*758.66
*C*70557*TC*542.80*515.66*593.01
*C*70558**348.04*330.64*380.24
*C*70558*TC*180.92*171.87*197.65
*C*70559**337.73*320.84*368.97
*C*70559*TC*180.92*171.87*197.65
*C*74190**564.67*536.44*616.91
*C*74190*TC*542.80*515.66*593.01
**74235**145.90*138.61*159.40
**74235*TC*89.66*85.18*97.96
**74300**84.74*80.50*92.58
**74300*TC*71.61*68.03*78.23
**74301**26.09*24.79*28.51
**74301*TC*16.32*15.50*17.83
**74328**175.06*166.31*191.26
**74328*TC*152.15*144.54*166.22
**74329**141.99*134.89*155.12
**74329*TC*118.75*112.81*129.73
**74330**262.59*249.46*286.88
**74330*TC*235.65*223.87*257.45
**74340**86.58*82.25*94.59
**74340*TC*61.33*58.26*67.00
**74355**86.58*82.25*94.59
**74355*TC*50.55*48.02*55.22
**74360**86.58*82.25*94.59
**74360*TC*59.67*56.69*65.19
**74363**175.06*166.31*191.26
**74363*TC*133.99*127.29*146.38
*C*74445**161.44*153.37*176.38
*C*74445*TC*108.21*102.80*118.22
*C*74450**256.62*243.79*280.36
*C*74450*TC*241.12*229.06*263.42
*C*74470**567.37*539.00*619.85
*C*74470*TC*542.80*515.66*593.01
**74742**233.47*221.80*255.07
**74742*TC*204.51*194.28*223.42
*C*74775**270.42*256.90*295.44
*C*74775*TC*241.12*229.06*263.42
*C*75801**660.54*627.51*721.64
*C*75801*TC*618.22*587.31*675.41
*C*75803**1631.56*1549.98*1782.48
*C*75803*TC*1576.00*1497.20*1721.78
*C*75805**3175.19*3016.43*3468.89
*C*75805*TC*3136.80*2979.96*3426.95
*C*75807**3188.95*3029.50*3483.93
*C*75807*TC*3136.80*2979.96*3426.95
*C*75810**3184.53*3025.30*3479.10
*C*75810*TC*3136.80*2979.96*3426.95
**75894**905.77*860.48*989.55
**75894*TC*834.97*793.22*912.20
*C*75898**3227.04*3065.69*3525.54
*C*75898*TC*3136.80*2979.96*3426.95
**75970**442.09*419.99*482.99
**75970*TC*404.75*384.51*442.19
**76125**39.79*37.80*43.47
**76125*TC*26.66*25.33*29.13
**76390**205.97*195.67*225.02
**76390*TC*154.67*146.94*168.98
**76390*26*51.30*48.74*56.05
**76932**84.89*80.65*92.75
**76932*TC*49.26*46.80*53.82
**76940**157.52*149.64*172.09
**76940*TC*58.07*55.17*63.45
**76941**115.68*109.90*126.39
**76941*TC*51.98*49.38*56.79
**76945**83.90*79.71*91.67
**76945*TC*52.21*49.60*57.04
*C*76975**281.56*267.48*307.60
*C*76975*TC*241.12*229.06*263.42
**76998**175.06*166.31*191.26
**76998*TC*128.74*122.30*140.65
**77013**424.14*402.93*463.37
**77013*TC*243.42*231.25*265.94
**77022**473.80*450.11*517.63
**77022*TC*276.49*262.67*302.07
**77371**1242.72*1180.58*1357.67
**77520**925.16*878.90*1010.74
**77522**925.16*878.90*1010.74
**77523**1062.32*1009.20*1160.58
**77525**1199.44*1139.47*1310.39
*C*78282**420.98*399.93*459.92
*C*78282*TC*405.83*385.54*443.37
**78414**514.99*489.24*562.63
**78414*TC*494.10*469.40*539.81
*C*78429**1617.62*1536.74*1767.25
*C*78429*TC*1539.48*1462.51*1681.89
*C*78430**1613.93*1533.23*1763.21
*C*78430*TC*1539.48*1462.51*1681.89
*C*78431**2411.36*2290.79*2634.41
*C*78431*TC*2324.44*2208.22*2539.45
*C*78432**2004.13*1903.92*2189.51
*C*78432*TC*1911.16*1815.60*2087.94
*C*78433**2116.37*2010.55*2312.13
*C*78433*TC*2014.65*1913.92*2201.01
**78434**711.60*676.02*777.42
**78434*TC*682.97*648.82*746.14
*C*78459**1469.85*1396.36*1605.81
*C*78459*TC*1397.43*1327.56*1526.69
*C*78491**1610.56*1530.03*1759.53
*C*78491*TC*1539.48*1462.51*1681.89
*C*78492**1623.02*1541.87*1773.15
*C*78492*TC*1539.48*1462.51*1681.89
*C*78608**1607.85*1527.46*1756.58
*C*78608*TC*1539.48*1462.51*1681.89
*C*78811**1467.81*1394.42*1603.58
*C*78811*TC*1397.43*1327.56*1526.69
*C*78812**1628.38*1546.96*1779.00
*C*78812*TC*1539.48*1462.51*1681.89
*C*78813**1630.40*1548.88*1781.21
*C*78813*TC*1539.48*1462.51*1681.89
*C*78814**1640.16*1558.15*1791.87
*C*78814*TC*1539.48*1462.51*1681.89
*C*78815**1651.62*1569.04*1804.40
*C*78815*TC*1539.48*1462.51*1681.89
*C*78816**1652.64*1570.01*1805.51
*C*78816*TC*1539.48*1462.51*1681.89
**79300**237.04*225.19*258.97
**79300*TC*174.04*165.34*190.14
**79445**237.04*225.19*258.97
**79445*TC*129.00*122.55*140.93
**86485**5.22*4.96*5.70
**90867**303.28*288.12*331.34
#**90867**137.39*130.52*150.10
**90868**203.28*193.12*222.09
#**90868**105.77*100.48*115.55
**90869**280.08*266.08*305.99
#**90869**162.02*153.92*177.01
**92978**253.91*241.21*277.39
**92978*TC*161.29*153.23*176.21
**92979**148.54*141.11*162.28
**92979*TC*75.04*71.29*81.98
*C*93315**667.11*633.75*728.81
*C*93315*TC*542.80*515.66*593.01
**93317**213.52*202.84*233.27
**93317*TC*127.02*120.67*138.77
*C*93318**642.79*610.65*702.25
*C*93318*TC*542.80*515.66*593.01
**93571**243.80*231.61*266.35
**93571*TC*173.32*164.65*189.35
**93572**146.22*138.91*159.75
**93572*TC*94.88*90.14*103.66
**93600**3557.81*3379.92*3886.91
**93600*TC*3444.35*3272.13*3762.95
**93602**3557.81*3379.92*3886.91
**93602*TC*3446.35*3274.03*3765.13
**93603**3557.81*3379.92*3886.91
**93603*TC*3446.35*3274.03*3765.13
**93609**2134.69*2027.96*2332.15
**93609*TC*1868.51*1775.08*2041.34
**93610**3557.81*3379.92*3886.91
**93610*TC*3400.37*3230.35*3714.90
**93612**3557.81*3379.92*3886.91
**93612*TC*3402.69*3232.56*3717.44
**93619**7115.62*6759.84*7773.82
**93619*TC*6739.68*6402.70*7363.11
**93620**7115.62*6759.84*7773.82
**93620*TC*6512.46*6186.84*7114.87
**93621**7115.62*6759.84*7773.82
**93621*TC*7035.40*6683.63*7686.17
**93622**7115.62*6759.84*7773.82
**93622*TC*6950.14*6602.63*7593.02
**93623**2134.69*2027.96*2332.15
**93623*TC*2068.13*1964.72*2259.43
**93624**3557.81*3379.92*3886.91
**93624*TC*3323.95*3157.75*3631.41
**93631**7115.62*6759.84*7773.82
**93631*TC*6730.24*6393.73*7352.79
**93640**1133.95*1077.25*1238.84
**93640*TC*961.76*913.67*1050.72
**93641**1133.95*1077.25*1238.84
**93641*TC*832.91*791.26*909.95
**93662**427.23*405.87*466.75
**93662*TC*358.15*340.24*391.28
**94642**29.27*27.81*31.98
**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**935.22*888.46*1021.73
**95965*TC*535.21*508.45*584.72
**95967**475.55*451.77*519.54
**96020**344.97*327.72*376.88
**96547**756.41*718.59*826.38
#**96547**135.14*128.38*147.64
**96548**378.21*359.30*413.20
#**96548**67.57*64.19*73.82
**97151**50.03*47.53*54.66
#**97151**44.28*42.07*48.38
**97152**42.52*40.39*46.45
#**97152**37.64*35.76*41.12
**97153**33.86*32.17*37.00
#**97153**29.63*28.15*32.37
**97154**4.62*4.39*5.05
#**97154**4.19*3.98*4.58
**97155**33.86*32.17*37.00
#**97155**29.63*28.15*32.37
**97156**35.71*33.92*39.01
#**97156**31.32*29.75*34.21
**97157**10.44*9.92*11.41
#**97157**9.43*8.96*10.30
**97158**5.38*5.11*5.88
#**97158**4.87*4.63*5.32
**98978**48.01*45.61*52.45
# - 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.