NEW JERSEY MEDICARE CARRIER - 12402
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**495.64*470.86*541.49
#**G0186**424.22*403.01*463.46
**G0339**3187.66*3028.28*3482.52
**G0340**2397.40*2277.53*2619.16
**G0398**148.34*140.92*162.06
**G0398*TC*107.48*102.11*117.43
**G0398*26*40.86*38.82*44.64
**G0399**102.15*97.04*111.60
**G0399*TC*57.04*54.19*62.32
**G0399*26*45.47*43.20*49.68
**G0400**105.63*100.35*115.40
**G0400*TC*63.30*60.14*69.16
**G0400*26*42.33*40.21*46.24
**G0460**875.39*831.62*956.36
#**G0460**127.66*121.28*139.47
**G0465**875.39*831.62*956.36
#**G0465**127.66*121.28*139.47
**G0498**162.19*154.08*177.19
**G6017**84.38*80.16*92.18
**0042T**247.28*234.92*270.16
**0054T**245.48*233.21*268.19
**0055T**245.48*233.21*268.19
**0071T**613.12*582.46*669.83
**0072T**613.12*582.46*669.83
**0075T**1023.91*972.71*1118.62
**0075T*TC*1023.91*972.71*1118.62
**0075T*26*1025.68*974.40*1120.56
**0095T**672.28*638.67*734.47
**0098T**752.09*714.49*821.66
**0100T**2031.36*1929.79*2219.26
**0101T**338.72*321.78*370.05
#**0101T**241.16*229.10*263.47
**0102T**338.72*321.78*370.05
#**0102T**241.16*229.10*263.47
**0106T**37.05*35.20*40.48
**0107T**37.05*35.20*40.48
**0108T**37.05*35.20*40.48
**0109T**37.05*35.20*40.48
**0110T**37.05*35.20*40.48
**0164T**735.26*698.50*803.28
**0165T**753.22*715.56*822.89
**0184T**882.71*838.57*964.36
**0198T**92.56*87.93*101.12
#**0198T**33.65*31.97*36.77
**0200T**1946.83*1849.49*2126.91
#**0200T**427.80*406.41*467.37
**0201T**2920.25*2774.24*3190.38
#**0201T**641.70*609.62*701.06
**0207T**121.71*115.62*132.96
**0208T**41.96*39.86*45.84
**0209T**50.79*48.25*55.49
**0210T**32.02*30.42*34.98
**0211T**49.69*47.21*54.29
**0212T**38.83*36.89*42.42
#**0212T**33.30*31.64*36.39
**0213T**209.07*198.62*228.41
#**0213T**111.50*105.93*121.82
**0214T**104.88*99.64*114.59
#**0214T**62.18*59.07*67.93
**0215T**105.25*99.99*114.99
#**0215T**63.28*60.12*69.14
**0216T**192.81*183.17*210.65
#**0216T**95.98*91.18*104.86
**0217T**98.25*93.34*107.34
#**0217T**53.34*50.67*58.27
**0218T**98.25*93.34*107.34
#**0218T**54.44*51.72*59.48
**0219T**1416.99*1346.14*1548.06
**0220T**1391.92*1322.32*1520.67
**0221T**1701.01*1615.96*1858.35
**0222T**414.49*393.77*452.84
**0232T**875.39*831.62*956.36
#**0232T**127.66*121.28*139.47
**0234T**9422.50*8951.38*10294.09
#**0234T**612.81*582.17*669.50
**0235T**9422.50*8951.38*10294.09
#**0235T**612.81*582.17*669.50
**0236T**9583.13*9103.97*10469.57
#**0236T**709.01*673.56*774.59
**0237T**9583.13*9103.97*10469.57
#**0237T**709.01*673.56*774.59
**0238T**9583.13*9103.97*10469.57
#**0238T**709.01*673.56*774.59
**0266T**952.54*904.91*1040.65
**0267T**166.50*158.18*181.91
**0268T**355.42*337.65*388.30
**0269T**903.43*858.26*987.00
**0270T**166.50*158.18*181.91
**0271T**355.42*337.65*388.30
**0272T**60.91*57.86*66.54
**0273T**77.51*73.63*84.67
**0274T**1191.87*1132.28*1302.12
**0278T**15.29*14.53*16.71
**0308T**1492.00*1417.40*1630.01
**0329T**92.56*87.93*101.12
#**0329T**33.65*31.97*36.77
**0330T**38.21*36.30*41.75
**0331T**200.70*190.67*219.27
**0332T**342.64*325.51*374.34
**0347T**150.17*142.66*164.06
**0348T**36.00*34.20*39.33
**0349T**38.25*36.34*41.79
**0350T**38.98*37.03*42.58
**0351T**185.64*176.36*202.81
**0352T**45.38*43.11*49.58
**0353T**185.64*176.36*202.81
**0354T**45.38*43.11*49.58
**0358T**29.81*28.32*32.57
**0362T**97.61*92.73*106.64
#**0362T**69.27*65.81*75.68
**0378T**26.18*24.87*28.60
**0394T**273.77*260.08*299.09
**0395T**660.52*627.49*721.61
**0397T**49.54*47.06*54.12
**0398T*26*1746.88*1659.54*1908.47
**0408T**540.92*513.87*590.95
**0409T**375.41*356.64*410.14
**0410T**390.70*371.17*426.85
**0411T**390.70*371.17*426.85
**0412T**247.19*234.83*270.05
**0413T**507.28*481.92*554.21
**0414T**391.38*371.81*427.58
**0415T**325.73*309.44*355.86
**0416T**363.07*344.92*396.66
**0417T**90.18*85.67*98.52
**0418T**60.91*57.86*66.54
**0419T**485.79*461.50*530.73
#**0419T**387.12*367.76*422.92
**0420T**688.54*654.11*752.23
#**0420T**566.68*538.35*619.10
**0421T**1747.18*1659.82*1908.79
#**0421T**735.11*698.35*803.10
**0437T**225.87*214.58*246.77
**0439T**78.21*74.30*85.45
**0440T**270.17*256.66*295.16
#**0440T**126.59*120.26*138.30
**0441T**270.17*256.66*295.16
#**0441T**126.59*120.26*138.30
**0442T**270.17*256.66*295.16
#**0442T**126.59*120.26*138.30
**0449T**816.85*776.01*892.41
**0464T**73.60*69.92*80.41
**0472T**72.58*68.95*79.29
**0473T**60.91*57.86*66.54
**0479T**66.70*63.37*72.88
**0480T**169.42*160.95*185.09
#**0480T**33.35*31.68*36.43
**0483T**1249.70*1187.22*1365.30
**0484T**1619.71*1538.72*1769.53
**0485T**25.37*24.10*27.72
**0485T*TC*9.74*9.25*10.64
**0485T*26*15.98*15.18*17.46
**0486T**50.74*48.20*55.43
**0486T*TC*19.13*18.17*20.90
**0486T*26*31.60*30.02*34.52
**0488T**67.00*63.65*73.20
#**0488T**52.64*50.01*57.51
**0505T**12250.64*11638.11*13383.83
#**0505T**573.52*544.84*626.57
**0507T**25.64*24.36*28.01
**0507T*TC*22.45*21.33*24.53
**0507T*26*3.19*3.03*3.48
**0510T**652.73*620.09*713.10
#**0510T**453.93*431.23*495.91
**0512T**338.72*321.78*370.05
#**0512T**241.16*229.10*263.47
**0513T**101.62*96.54*111.02
#**0513T**72.35*68.73*79.04
**0515T**540.92*513.87*590.95
**0516T**499.57*474.59*545.78
**0517T**355.42*337.65*388.30
**0518T**247.19*234.83*270.05
**0519T**356.59*338.76*389.57
**0520T**499.57*474.59*545.78
**0521T**60.91*57.86*66.54
**0521T*TC*39.75*37.76*43.42
**0521T*26*21.16*20.10*23.12
**0522T**72.58*68.95*79.29
**0522T*TC*40.49*38.47*44.24
**0522T*26*32.09*30.49*35.06
**0523T**164.49*156.27*179.71
**0524T**1805.58*1715.30*1972.60
#**0524T**185.31*176.04*202.45
**0525T**499.94*474.94*546.18
**0526T**390.70*371.17*426.85
**0527T**339.50*322.53*370.91
**0528T**72.58*68.95*79.29
**0528T*TC*40.49*38.47*44.24
**0528T*26*32.09*30.49*35.06
**0529T**60.91*57.86*66.54
**0529T*TC*39.75*37.76*43.42
**0529T*26*21.16*20.10*23.12
**0530T**667.16*633.80*728.87
**0531T**507.28*481.92*554.21
**0532T**356.59*338.76*389.57
**0540T**188.12*178.71*205.52
**0543T**1619.71*1538.72*1769.53
**0544T**1867.51*1774.13*2040.25
**0545T**1867.51*1774.13*2040.25
**0546T**77.53*73.65*84.70
**0552T**7.22*6.86*7.89
**0553T**2692.52*2557.89*2941.57
#**0553T**409.56*389.08*447.44
**0565T**662.64*629.51*723.94
#**0565T**552.56*524.93*603.67
**0566T**107.55*102.17*117.50
#**0566T**62.27*59.16*68.03
**0569T**1867.51*1774.13*2040.25
**0570T**436.66*414.83*477.05
**0571T**585.54*556.26*639.70
**0572T**476.34*452.52*520.40
**0573T**364.66*346.43*398.39
**0574T**422.03*400.93*461.07
**0575T**72.58*68.95*79.29
**0576T**60.91*57.86*66.54
**0577T**202.88*192.74*221.65
**0578T**30.70*29.17*33.55
**0579T**23.55*22.37*25.73
**0580T**227.18*215.82*248.19
**0581T**2494.82*2370.08*2725.59
#**0581T**221.80*210.71*242.32
**0582T**1815.85*1725.06*1983.82
#**0582T**409.12*388.66*446.96
**0583T**1522.66*1446.53*1663.51
#**0583T**143.33*136.16*156.58
**0587T**476.78*452.94*520.88
#**0587T**313.32*297.65*342.30
**0588T**394.00*374.30*430.45
#**0588T**244.90*232.66*267.56
**0589T**51.27*48.71*56.02
#**0589T**40.59*38.56*44.34
**0590T**60.78*57.74*66.40
#**0590T**42.01*39.91*45.90
**0596T**672.69*639.06*734.92
#**0596T**136.80*129.96*149.45
**0597T**672.69*639.06*734.92
#**0597T**136.80*129.96*149.45
**0598T**166.57*158.24*181.98
**0599T**110.64*105.11*120.88
**0600T**3914.68*3718.95*4276.79
#**0600T**758.07*720.17*828.20
**0601T**1537.44*1460.57*1679.66
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**213.20*202.54*232.92
**0611T**44.89*42.65*49.05
**0614T**390.60*371.07*426.73
**0615T**50.45*47.93*55.12
**0616T**706.67*671.34*772.04
**0617T**791.19*751.63*864.37
**0618T**958.26*910.35*1046.90
**0619T**703.21*668.05*768.26
#**0619T**507.06*481.71*553.97
**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**281.64*267.56*307.69
#**0627T**104.92*99.67*114.62
**0628T**84.49*80.27*92.31
#**0628T**31.48*29.91*34.40
**0629T**281.64*267.56*307.69
#**0629T**104.92*99.67*114.62
**0630T**84.49*80.27*92.31
#**0630T**31.48*29.91*34.40
**0631T**90.34*85.82*98.69
**0632T**601.20*571.14*656.81
**0633T**219.61*208.63*239.92
*C*0633T*TC*117.80*111.91*128.70
**0633T*26*61.69*58.61*67.40
**0634T**219.61*208.63*239.92
**0634T*TC*157.92*150.02*172.52
**0634T*26*61.69*58.61*67.40
**0635T**219.61*208.63*239.92
**0635T*TC*157.92*150.02*172.52
**0635T*26*61.69*58.61*67.40
**0636T**219.61*208.63*239.92
**0636T*TC*157.92*150.02*172.52
**0636T*26*61.69*58.61*67.40
**0637T**219.61*208.63*239.92
**0637T*TC*157.92*150.02*172.52
**0637T*26*61.69*58.61*67.40
**0638T**219.61*208.63*239.92
**0638T*TC*157.92*150.02*172.52
**0638T*26*61.69*58.61*67.40
**0639T**90.34*85.82*98.69
**0640T**25.64*24.36*28.01
**0640T*TC*22.59*21.46*24.68
**0640T*26*3.19*3.03*3.48
**0644T**1270.57*1207.04*1388.10
#**0644T**249.67*237.19*272.77
**0646T**1867.51*1774.13*2040.25
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**64.76*61.52*70.75
**0652T**312.95*297.30*341.90
#**0652T**128.87*122.43*140.79
**0653T**409.82*389.33*447.73
#**0653T**145.48*138.21*158.94
**0654T**149.28*141.82*163.09
**0655T**1747.18*1659.82*1908.79
#**0655T**735.11*698.35*803.10
**0658T**104.91*99.66*114.61
**0659T**2949.69*2802.21*3222.54
#**0659T**451.36*428.79*493.11
**0671T**1097.89*1043.00*1199.45
**0673T**3772.45*3583.83*4121.40
#**0673T**382.06*362.96*417.40
**0699T**120.87*114.83*132.05
#**0699T**96.57*91.74*105.50
**0707T**403.94*383.74*441.30
#**0707T**301.96*286.86*329.89
**0714T**1540.54*1463.51*1683.04
#**0714T**382.31*363.19*417.67
**0730T**288.61*274.18*315.31
#**0730T**257.42*244.55*281.23
**0738T**74.81*71.07*81.73
**0739T**1747.18*1659.82*1908.79
#**0739T**735.11*698.35*803.10
**0740T**22.06*20.96*24.10
**0741T**52.27*49.66*57.11
**0742T**102.79*97.65*112.30
**0742T*TC*82.82*78.68*90.48
**0742T*26*19.97*18.97*21.82
**0743T**58.23*55.32*63.62
**0744T**928.31*881.89*1014.17
**0745T**284.13*269.92*310.41
**0746T**237.31*225.44*259.26
**0747T**1098.65*1043.72*1200.28
**0748T**195.37*185.60*213.44
**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**4.63*4.40*5.06
**0765T**8.46*8.04*9.25
**0771T**27.70*26.32*30.27
**0772T**27.70*26.32*30.27
**0773T**25.38*24.11*27.73
**0774T**25.38*24.11*27.73
**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**481.88*457.79*526.46
**0779T*TC*454.66*431.93*496.72
**0779T*26*27.22*25.86*29.74
**0780T**25.38*24.11*27.73
**0783T**15.82*15.03*17.28
**0784T**2330.67*2214.14*2546.26
#**0784T**343.34*326.17*375.10
**0785T**263.16*250.00*287.50
#**0785T**154.55*146.82*168.84
**0786T**797.45*757.58*871.22
#**0786T**321.05*305.00*350.75
**0787T**263.16*250.00*287.50
#**0787T**154.55*146.82*168.84
**0788T**19.83*18.84*21.67
#**0788T**19.10*18.15*20.87
**0789T**27.73*26.34*30.29
#**0789T**23.87*22.68*26.08
**0790T**2029.04*1927.59*2216.73
**0791T**9.68*9.20*10.58
**0793T**601.20*571.14*656.81
**0794T**130.35*123.83*142.40
**0795T**749.36*711.89*818.67
**0796T**499.57*474.59*545.78
**0797T**499.57*474.59*545.78
**0798T**790.61*751.08*863.74
**0799T**527.07*500.72*575.83
**0800T**527.07*500.72*575.83
**0801T**1026.64*975.31*1121.61
**0802T**513.32*487.65*560.80
**0803T**513.32*487.65*560.80
**0804T**84.84*80.60*92.69
**0804T*TC*46.74*44.40*51.06
**0804T*26*38.10*36.20*41.63
**0805T**3253.84*3091.15*3554.82
#**0805T**339.12*322.16*370.48
**0806T**4338.46*4121.54*4739.77
#**0806T**452.16*429.55*493.98
**0807T**46.44*44.12*50.74
**0807T*TC*30.91*29.36*33.76
**0807T*26*15.52*14.74*16.95
**0808T**46.44*44.12*50.74
**0808T*TC*30.91*29.36*33.76
**0808T*26*15.52*14.74*16.95
**0810T**1208.38*1147.96*1320.15
**0811T**22.06*20.96*24.10
**0813T**2864.17*2720.96*3129.10
#**0813T**190.59*181.06*208.22
**0814T**504.93*479.68*551.63
#**0814T**377.45*358.58*412.37
**0818T**394.00*374.30*430.45
#**0818T**244.90*232.66*267.56
**0820T**154.88*147.14*169.21
#**0820T**135.37*128.60*147.89
**0821T**154.88*147.14*169.21
#**0821T**135.37*128.60*147.89
**0822T**131.65*125.07*143.83
#**0822T**115.06*109.31*125.71
**0823T**749.36*711.89*818.67
**0824T**790.61*751.08*863.74
**0825T**1026.64*975.31*1121.61
**0826T**72.58*68.95*79.29
**0826T*TC*40.49*38.47*44.24
**0826T*26*32.09*30.49*35.06
**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**25.64*24.36*28.01
**0859T*TC*22.45*21.33*24.53
**0859T*26*3.19*3.03*3.48
**0864T**338.72*321.78*370.05
#**0864T**241.16*229.10*263.47
**10011**465.79*442.50*508.88
#**10011**112.73*107.09*123.15
**10012**255.78*242.99*279.44
#**10012**74.64*70.91*81.55
**15847**376.48*357.66*411.31
**21088**1901.72*1806.63*2077.62
**21742**1222.85*1161.71*1335.97
**21743**1404.74*1334.50*1534.68
**32855**466.04*442.74*509.15
**32856**475.28*451.52*519.25
**33928**3470.92*3297.37*3791.98
**33929**1300.04*1235.04*1420.30
**33933**570.95*542.40*623.76
**33944**528.17*501.76*577.02
**34841**2228.10*2116.70*2434.21
**34842**2453.87*2331.18*2680.86
**34843**2679.66*2545.68*2927.53
**34844**2905.43*2760.16*3174.18
**34845**2228.10*2116.70*2434.21
**34846**2453.87*2331.18*2680.86
**34847**2679.66*2545.68*2927.53
**34848**2905.43*2760.16*3174.18
**43496**2274.24*2160.53*2484.61
**43647**816.08*775.28*891.57
**43648**576.56*547.73*629.89
#**43648**256.76*243.92*280.51
**43881**742.91*705.76*811.62
#**43881**678.83*644.89*741.62
**43882**792.42*752.80*865.72
#**43882**723.43*687.26*790.35
**47143**447.22*424.86*488.59
**47144**531.09*504.54*580.22
**47145**503.13*477.97*549.67
**48551**349.25*331.79*381.56
**50323**419.88*398.89*458.72
**50325**287.61*273.23*314.21
**53451**804.60*764.37*879.03
**53452**402.30*382.19*439.52
**53453**683.94*649.74*747.20
**53454**61.02*57.97*66.67
#**53454**37.09*35.24*40.53
**63043**618.45*587.53*675.66
**63044**557.71*529.82*609.29
**64596**2330.67*2214.14*2546.26
#**64596**343.34*326.17*375.10
**64597**699.20*664.24*763.88
#**64597**103.00*97.85*112.53
**64598**263.16*250.00*287.50
#**64598**154.55*146.82*168.84
**65757**127.93*121.53*139.76
**66983**706.67*671.34*772.04
**66987**812.07*771.47*887.19
**66988**676.70*642.87*739.30
*C*70170**277.65*263.77*303.34
*C*70170*TC*262.49*249.37*286.78
**70555**233.47*221.80*255.07
**70555*TC*110.17*104.66*120.36
*C*70557**750.22*712.71*819.62
*C*70557*TC*590.88*561.34*645.54
*C*70558**372.57*353.94*407.03
*C*70558*TC*196.95*187.10*215.17
*C*70559**361.38*343.31*394.81
*C*70559*TC*196.95*187.10*215.17
*C*74190**613.75*583.06*670.52
*C*74190*TC*590.88*561.34*645.54
**74235**156.49*148.67*170.97
**74235*TC*97.62*92.74*106.65
**74300**91.61*87.03*100.08
**74300*TC*77.85*73.96*85.05
**74301**28.22*26.81*30.83
**74301*TC*18.00*17.10*19.67
**74328**175.06*166.31*191.26
**74328*TC*151.05*143.50*165.03
**74329**153.22*145.56*167.39
**74329*TC*128.84*122.40*140.76
**74330**262.59*249.46*286.88
**74330*TC*234.37*222.65*256.05
**74340**86.58*82.25*94.59
**74340*TC*60.16*57.15*65.72
**74355**86.58*82.25*94.59
**74355*TC*48.86*46.42*53.38
**74360**86.58*82.25*94.59
**74360*TC*58.34*55.42*63.73
**74363**175.06*166.31*191.26
**74363*TC*132.08*125.48*144.30
*C*74445**173.49*164.82*189.54
*C*74445*TC*117.80*111.91*128.70
*C*74450**278.71*264.77*304.49
*C*74450*TC*262.49*249.37*286.78
*C*74470**616.57*585.74*673.60
*C*74470*TC*590.88*561.34*645.54
**74742**233.47*221.80*255.07
**74742*TC*203.14*192.98*221.93
*C*74775**293.16*278.50*320.28
*C*74775*TC*262.49*249.37*286.78
*C*75801**717.49*681.62*783.86
*C*75801*TC*672.98*639.33*735.23
*C*75803**1773.79*1685.10*1937.87
*C*75803*TC*1715.61*1629.83*1874.30
*C*75805**3454.86*3282.12*3774.44
*C*75805*TC*3414.67*3243.94*3730.53
*C*75807**3469.14*3295.68*3790.03
*C*75807*TC*3414.67*3243.94*3730.53
*C*75810**3464.40*3291.18*3784.86
*C*75810*TC*3414.67*3243.94*3730.53
**75894**983.80*934.61*1074.80
**75894*TC*909.24*863.78*993.35
*C*75898**3509.75*3334.26*3834.40
*C*75898*TC*3414.67*3243.94*3730.53
**75970**479.79*455.80*524.17
**75970*TC*440.77*418.73*481.54
**76125**42.79*40.65*46.75
**76125*TC*29.03*27.58*31.72
**76390**222.02*210.92*242.56
**76390*TC*168.37*159.95*183.94
**76390*26*53.65*50.97*58.62
**76932**91.10*86.55*99.53
**76932*TC*53.61*50.93*58.57
**76940**167.63*159.25*183.14
**76940*TC*63.25*60.09*69.10
**76941**123.27*117.11*134.68
**76941*TC*56.58*53.75*61.81
**76945**90.02*85.52*98.35
**76945*TC*56.85*54.01*62.11
*C*76975**304.90*289.66*333.11
*C*76975*TC*262.49*249.37*286.78
**76998**175.06*166.31*191.26
**76998*TC*126.39*120.07*138.08
**77013**458.72*435.78*501.15
**77013*TC*269.83*256.34*294.79
**77022**509.75*484.26*556.90
**77022*TC*303.31*288.14*331.36
**77371**1424.47*1353.25*1556.24
**77520**1006.44*956.12*1099.54
**77522**1006.44*956.12*1099.54
**77523**1155.64*1097.86*1262.54
**77525**1304.84*1239.60*1425.54
*C*78282**457.52*434.64*499.84
*C*78282*TC*441.78*419.69*482.64
**78414**514.99*489.24*562.63
**78414*TC*493.14*468.48*538.75
*C*78429**1757.44*1669.57*1920.01
*C*78429*TC*1675.85*1592.06*1830.87
*C*78430**1753.59*1665.91*1915.80
*C*78430*TC*1675.85*1592.06*1830.87
*C*78431**2621.21*2490.15*2863.67
*C*78431*TC*2530.35*2403.83*2764.40
*C*78432**2177.57*2068.69*2378.99
*C*78432*TC*2080.46*1976.44*2272.91
*C*78433**2299.39*2184.42*2512.08
*C*78433*TC*2193.12*2083.46*2395.98
**78434**773.53*734.85*845.08
**78434*TC*743.60*706.42*812.38
*C*78459**1596.87*1517.03*1744.58
*C*78459*TC*1521.22*1445.16*1661.93
*C*78491**1750.15*1662.64*1912.04
*C*78491*TC*1675.85*1592.06*1830.87
*C*78492**1763.25*1675.09*1926.35
*C*78492*TC*1675.85*1592.06*1830.87
*C*78608**1747.32*1659.95*1908.94
*C*78608*TC*1675.85*1592.06*1830.87
*C*78811**1594.80*1515.06*1742.32
*C*78811*TC*1521.22*1445.16*1661.93
*C*78812**1768.82*1680.38*1932.44
*C*78812*TC*1675.85*1592.06*1830.87
*C*78813**1770.88*1682.34*1934.69
*C*78813*TC*1675.85*1592.06*1830.87
*C*78814**1781.12*1692.06*1945.87
*C*78814*TC*1675.85*1592.06*1830.87
*C*78815**1793.11*1703.45*1958.97
*C*78815*TC*1675.85*1592.06*1830.87
*C*78816**1794.10*1704.40*1960.06
*C*78816*TC*1675.85*1592.06*1830.87
**79300**237.04*225.19*258.97
**79300*TC*171.63*163.05*187.51
**79445**237.04*225.19*258.97
**79445*TC*124.15*117.94*135.63
**86485**6.01*5.71*6.57
**90867**326.06*309.76*356.22
#**90867**145.48*138.21*158.94
**90868**217.18*206.32*237.27
#**90868**110.97*105.42*121.23
**90869**298.69*283.76*326.32
#**90869**172.27*163.66*188.21
**92978**262.95*249.80*287.27
**92978*TC*165.59*157.31*180.91
**92979**158.85*150.91*173.55
**92979*TC*81.61*77.53*89.16
*C*93315**720.89*684.85*787.58
*C*93315*TC*590.88*561.34*645.54
**93317**228.85*217.41*250.02
**93317*TC*138.30*131.39*151.10
*C*93318**695.50*660.73*759.84
*C*93318*TC*590.88*561.34*645.54
**93571**261.87*248.78*286.10
**93571*TC*187.80*178.41*205.17
**93572**156.33*148.51*170.79
**93572*TC*102.37*97.25*111.84
**93600**3557.81*3379.92*3886.91
**93600*TC*3438.38*3266.46*3756.43
**93602**3557.81*3379.92*3886.91
**93602*TC*3440.57*3268.54*3758.82
**93603**3557.81*3379.92*3886.91
**93603*TC*3440.57*3268.54*3758.82
**93609**2134.69*2027.96*2332.15
**93609*TC*1854.53*1761.80*2026.07
**93610**3557.81*3379.92*3886.91
**93610*TC*3392.24*3222.63*3706.02
**93612**3557.81*3379.92*3886.91
**93612*TC*3394.78*3225.04*3708.80
**93619**7115.62*6759.84*7773.82
**93619*TC*6719.96*6383.96*7341.55
**93620**7115.62*6759.84*7773.82
**93620*TC*6480.80*6156.76*7080.27
**93621**7115.62*6759.84*7773.82
**93621*TC*7031.18*6679.62*7681.56
**93622**7115.62*6759.84*7773.82
**93622*TC*6941.45*6594.38*7583.54
**93623**2134.69*2027.96*2332.15
**93623*TC*2064.12*1960.91*2255.05
**93624**3557.81*3379.92*3886.91
**93624*TC*3311.98*3146.38*3618.34
**93631**7115.62*6759.84*7773.82
**93631*TC*6710.67*6375.14*7331.41
**93640**1133.95*1077.25*1238.84
**93640*TC*817.14*776.28*892.72
**93641**1133.95*1077.25*1238.84
**93641*TC*817.14*776.28*892.72
**93662**460.60*437.57*503.21
**93662*TC*388.24*368.83*424.15
**94642**36.01*34.21*39.34
**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**960.47*912.45*1049.32
**95965*TC*540.52*513.49*590.51
**96020**380.12*361.11*415.28
**96547**819.25*778.29*895.03
#**96547**142.94*135.79*156.16
**96548**409.63*389.15*447.52
#**96548**71.47*67.90*78.09
**97151**52.29*49.68*57.13
#**97151**46.03*43.73*50.29
**97152**44.44*42.22*48.55
#**97152**39.12*37.16*42.73
**97153**35.36*33.59*38.63
#**97153**30.75*29.21*33.59
**97154**4.85*4.61*5.30
#**97154**4.38*4.16*4.78
**97155**35.36*33.59*38.63
#**97155**30.75*29.21*33.59
**97156**37.27*35.41*40.72
#**97156**32.49*30.87*35.50
**97157**10.93*10.38*11.94
#**97157**9.83*9.34*10.74
**97158**5.64*5.36*6.16
#**97158**5.09*4.84*5.57
**98978**52.27*49.66*57.11
# - 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.