NEW JERSEY MEDICARE CARRIER - 12402
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
NORTHERN NJ
******
**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**518.39*492.47*566.34
#**G0186**442.71*420.57*483.66
**G0339**3357.39*3189.52*3667.95
**G0340**2525.00*2398.75*2758.56
**G0398**155.88*148.09*170.30
**G0398*TC*113.82*108.13*124.35
**G0398*26*42.06*39.96*45.95
**G0399**106.83*101.49*116.71
**G0399*TC*60.38*57.36*65.96
**G0399*26*46.84*44.50*51.18
**G0400**110.63*105.10*120.87
**G0400*TC*67.01*63.66*73.21
**G0400*26*43.62*41.44*47.66
**G0460**923.38*877.21*1008.79
#**G0460**131.02*124.47*143.14
**G0465**923.38*877.21*1008.79
#**G0465**131.02*124.47*143.14
**G0498**171.36*162.79*187.21
**G6017**88.12*83.71*96.27
**0042T**259.23*246.27*283.21
**0054T**250.59*238.06*273.77
**0055T**250.59*238.06*273.77
**0071T**632.69*601.06*691.22
**0072T**632.69*601.06*691.22
**0075T**1043.05*990.90*1139.54
**0075T*TC*1043.05*990.90*1139.54
**0075T*26*1047.78*995.39*1144.70
**0095T**688.28*653.87*751.95
**0098T**769.59*731.11*840.78
**0100T**2108.66*2003.23*2303.71
**0101T**353.31*335.64*385.99
#**0101T**249.93*237.43*273.04
**0102T**353.31*335.64*385.99
#**0102T**249.93*237.43*273.04
**0106T**39.13*37.17*42.75
**0107T**39.13*37.17*42.75
**0108T**39.13*37.17*42.75
**0109T**39.13*37.17*42.75
**0110T**39.13*37.17*42.75
**0164T**753.09*715.44*822.76
**0165T**771.39*732.82*842.74
**0184T**911.94*866.34*996.29
**0198T**97.20*92.34*106.19
#**0198T**34.78*33.04*38.00
**0200T**2049.61*1947.13*2239.20
#**0200T**439.94*417.94*480.63
**0201T**3074.42*2920.70*3358.81
#**0201T**659.91*626.91*720.95
**0207T**121.71*115.62*132.96
**0208T**44.43*42.21*48.54
**0209T**53.79*51.10*58.77
**0210T**33.89*32.20*37.03
**0211T**52.62*49.99*57.49
**0212T**40.27*38.26*44.00
#**0212T**34.42*32.70*37.61
**0213T**218.50*207.58*238.72
#**0213T**115.12*109.36*125.76
**0214T**109.19*103.73*119.29
#**0214T**63.93*60.73*69.84
**0215T**109.58*104.10*119.72
#**0215T**65.10*61.85*71.13
**0216T**201.78*191.69*220.44
#**0216T**99.17*94.21*108.34
**0217T**102.44*97.32*111.92
#**0217T**54.85*52.11*59.93
**0218T**102.44*97.32*111.92
#**0218T**56.02*53.22*61.20
**0219T**1457.74*1384.85*1592.58
**0220T**1432.54*1360.91*1565.05
**0221T**1748.43*1661.01*1910.16
**0222T**423.64*402.46*462.83
**0232T**923.38*877.21*1008.79
#**0232T**131.02*124.47*143.14
**0234T**9960.55*9462.52*10881.90
#**0234T**625.14*593.88*682.96
**0235T**9960.55*9462.52*10881.90
#**0235T**625.14*593.88*682.96
**0236T**10127.18*9620.82*11063.94
#**0236T**723.50*687.33*790.43
**0237T**10127.18*9620.82*11063.94
#**0237T**723.50*687.33*790.43
**0238T**10127.18*9620.82*11063.94
#**0238T**723.50*687.33*790.43
**0266T**978.01*929.11*1068.48
**0267T**170.24*161.73*185.99
**0268T**365.51*347.23*399.31
**0269T**928.37*881.95*1014.24
**0270T**170.24*161.73*185.99
**0271T**365.51*347.23*399.31
**0272T**63.90*60.71*69.82
**0273T**81.00*76.95*88.49
**0274T**1226.64*1165.31*1340.11
**0278T**15.83*15.04*17.30
**0308T**1549.43*1471.96*1692.75
**0329T**97.20*92.34*106.19
#**0329T**34.78*33.04*38.00
**0330T**38.21*36.30*41.75
**0331T**211.37*200.80*230.92
**0332T**360.90*342.86*394.29
**0347T**154.14*146.43*168.39
**0348T**37.81*35.92*41.31
**0349T**40.22*38.21*43.94
**0350T**41.00*38.95*44.79
**0351T**195.51*185.73*213.59
**0352T**46.92*44.57*51.26
**0353T**195.51*185.73*213.59
**0354T**46.92*44.57*51.26
**0358T**31.55*29.97*34.47
**0362T**101.37*96.30*110.75
#**0362T**71.33*67.76*77.92
**0378T**27.00*25.65*29.50
**0394T**288.40*273.98*315.08
**0395T**693.95*659.25*758.14
**0397T**51.11*48.55*55.83
**0398T*26*1746.88*1659.54*1908.47
**0408T**555.32*527.55*606.68
**0409T**386.20*366.89*421.92
**0410T**402.24*382.13*439.45
**0411T**402.24*382.13*439.45
**0412T**255.33*242.56*278.94
**0413T**521.50*495.43*569.74
**0414T**402.57*382.44*439.81
**0415T**334.80*318.06*365.77
**0416T**374.50*355.78*409.15
**0417T**94.29*89.58*103.02
**0418T**63.90*60.71*69.82
**0419T**506.59*481.26*553.45
#**0419T**402.04*381.94*439.23
**0420T**716.15*680.34*782.39
#**0420T**587.02*557.67*641.32
**0421T**1830.19*1738.68*1999.48
#**0421T**757.72*719.83*827.80
**0437T**232.08*220.48*253.55
**0439T**81.84*77.75*89.41
**0440T**282.94*268.79*309.11
#**0440T**130.79*124.25*142.89
**0441T**282.94*268.79*309.11
#**0441T**130.79*124.25*142.89
**0442T**282.94*268.79*309.11
#**0442T**130.79*124.25*142.89
**0449T**849.94*807.44*928.56
**0464T**77.45*73.58*84.62
**0472T**75.94*72.14*82.96
**0473T**63.90*60.71*69.82
**0479T**68.98*65.53*75.36
**0480T**177.82*168.93*194.27
#**0480T**34.49*32.77*37.69
**0483T**1276.64*1212.81*1394.73
**0484T**1654.36*1571.64*1807.39
**0485T**26.49*25.17*28.95
**0485T*TC*10.29*9.78*11.25
**0485T*26*16.54*15.71*18.07
**0486T**52.97*50.32*57.87
**0486T*TC*20.24*19.23*22.11
**0486T*26*32.73*31.09*35.75
**0488T**69.42*65.95*75.84
#**0488T**54.21*51.50*59.23
**0505T**12855.61*12212.83*14044.75
#**0505T**585.81*556.52*640.00
**0507T**27.04*25.69*29.54
**0507T*TC*23.75*22.56*25.94
**0507T*26*3.28*3.12*3.59
**0510T**680.16*646.15*743.07
#**0510T**469.49*446.02*512.92
**0512T**353.31*335.64*385.99
#**0512T**249.93*237.43*273.04
**0513T**105.99*100.69*115.79
#**0513T**74.98*71.23*81.91
**0515T**555.32*527.55*606.68
**0516T**513.01*487.36*560.46
**0517T**365.51*347.23*399.31
**0518T**255.33*242.56*278.94
**0519T**366.79*348.45*400.72
**0520T**513.01*487.36*560.46
**0521T**63.90*60.71*69.82
**0521T*TC*42.09*39.99*45.99
**0521T*26*21.82*20.73*23.84
**0522T**75.94*72.14*82.96
**0522T*TC*42.87*40.73*46.84
**0522T*26*33.07*31.42*36.13
**0523T**171.51*162.93*187.37
**0524T**1906.23*1810.92*2082.56
#**0524T**189.27*179.81*206.78
**0525T**513.40*487.73*560.89
**0526T**402.24*382.13*439.45
**0527T**349.20*331.74*381.50
**0528T**75.94*72.14*82.96
**0528T*TC*42.87*40.73*46.84
**0528T*26*33.07*31.42*36.13
**0529T**63.90*60.71*69.82
**0529T*TC*42.09*39.99*45.99
**0529T*26*21.82*20.73*23.84
**0530T**686.15*651.84*749.62
**0531T**521.50*495.43*569.74
**0532T**366.79*348.45*400.72
**0540T**194.66*184.93*212.67
**0543T**1654.36*1571.64*1807.39
**0544T**1910.92*1815.37*2087.68
**0545T**1910.92*1815.37*2087.68
**0546T**81.09*77.04*88.60
**0552T**7.54*7.16*8.23
**0553T**2836.79*2694.95*3099.19
#**0553T**417.60*396.72*456.23
**0565T**688.99*654.54*752.72
#**0565T**572.34*543.72*625.28
**0566T**112.00*106.40*122.36
#**0566T**64.01*60.81*69.93
**0569T**1910.92*1815.37*2087.68
**0570T**446.04*423.74*487.30
**0571T**601.40*571.33*657.03
**0572T**488.97*464.52*534.20
**0573T**375.01*356.26*409.70
**0574T**433.46*411.79*473.56
**0575T**75.94*72.14*82.96
**0576T**63.90*60.71*69.82
**0577T**210.59*200.06*230.07
**0578T**31.60*30.02*34.52
**0579T**24.92*23.67*27.22
**0580T**234.32*222.60*255.99
**0581T**2635.58*2503.80*2879.37
#**0581T**226.92*215.57*247.91
**0582T**1913.83*1818.14*2090.86
#**0582T**423.15*401.99*462.29
**0583T**1522.66*1446.53*1663.51
#**0583T**149.05*141.60*162.84
**0587T**495.97*471.17*541.85
#**0587T**322.75*306.61*352.60
**0588T**410.57*390.04*448.55
#**0588T**252.56*239.93*275.92
**0589T**53.05*50.40*57.96
#**0589T**41.73*39.64*45.59
**0590T**63.07*59.92*68.91
#**0590T**43.18*41.02*47.17
**0596T**672.69*639.06*734.92
#**0596T**140.24*133.23*153.21
**0597T**672.69*639.06*734.92
#**0597T**140.24*133.23*153.21
**0598T**176.09*167.29*192.38
**0599T**116.87*111.03*127.68
**0600T**4122.96*3916.81*4504.33
#**0600T**777.99*739.09*849.95
**0601T**1576.41*1497.59*1722.23
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**223.61*212.43*244.29
**0611T**47.50*45.13*51.90
**0614T**401.71*381.62*438.86
**0615T**52.46*49.84*57.32
**0616T**734.02*697.32*801.92
**0617T**822.05*780.95*898.09
**0618T**995.83*946.04*1087.95
**0619T**731.95*695.35*799.65
#**0619T**524.15*497.94*572.63
**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**295.43*280.66*322.76
#**0627T**108.17*102.76*118.17
**0628T**88.63*84.20*96.83
#**0628T**32.45*30.83*35.45
**0629T**295.43*280.66*322.76
#**0629T**108.17*102.76*118.17
**0630T**88.63*84.20*96.83
#**0630T**32.45*30.83*35.45
**0631T**95.23*90.47*104.04
**0632T**615.60*584.82*672.54
**0633T**230.77*219.23*252.11
*C*0633T*TC*124.79*118.55*136.33
**0633T*26*63.50*60.33*69.38
**0634T**230.77*219.23*252.11
**0634T*TC*167.27*158.91*182.75
**0634T*26*63.50*60.33*69.38
**0635T**230.77*219.23*252.11
**0635T*TC*167.27*158.91*182.75
**0635T*26*63.50*60.33*69.38
**0636T**230.77*219.23*252.11
**0636T*TC*167.27*158.91*182.75
**0636T*26*63.50*60.33*69.38
**0637T**230.77*219.23*252.11
**0637T*TC*167.27*158.91*182.75
**0637T*26*63.50*60.33*69.38
**0638T**230.77*219.23*252.11
**0638T*TC*167.27*158.91*182.75
**0638T*26*63.50*60.33*69.38
**0639T**95.23*90.47*104.04
**0640T**27.04*25.69*29.54
**0640T*TC*23.89*22.70*26.11
**0640T*26*3.28*3.12*3.59
**0644T**1336.43*1269.61*1460.05
#**0644T**254.60*241.87*278.15
**0646T**1910.92*1815.37*2087.68
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**67.82*64.43*74.09
**0652T**327.96*311.56*358.29
#**0652T**132.89*126.25*145.19
**0653T**430.08*408.58*469.87
#**0653T**149.96*142.46*163.83
**0654T**153.75*146.06*167.97
**0655T**1830.19*1738.68*1999.48
#**0655T**757.72*719.83*827.80
**0658T**111.14*105.58*121.42
**0659T**3107.60*2952.22*3395.05
#**0659T**460.18*437.17*502.75
**0671T**1142.23*1085.12*1247.89
**0673T**3984.55*3785.32*4353.12
#**0673T**391.85*372.26*428.10
**0699T**125.78*119.49*137.41
#**0699T**100.04*95.04*109.30
**0707T**423.00*401.85*462.13
#**0707T**314.93*299.18*344.06
**0714T**1623.01*1541.86*1773.14
#**0714T**395.66*375.88*432.26
**0730T**298.21*283.30*325.80
#**0730T**265.43*252.16*289.98
**0738T**77.27*73.41*84.42
**0739T**1830.19*1738.68*1999.48
#**0739T**757.72*719.83*827.80
**0740T**23.31*22.14*25.46
**0741T**55.35*52.58*60.47
**0742T**108.27*102.86*118.29
**0742T*TC*87.71*83.32*95.82
**0742T*26*20.56*19.53*22.46
**0743T**61.20*58.14*66.86
**0744T**947.11*899.75*1034.71
**0745T**300.85*285.81*328.68
**0746T**245.13*232.87*267.80
**0747T**1163.37*1105.20*1270.98
**0748T**201.55*191.47*220.19
**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**4.82*4.58*5.27
**0765T**8.71*8.27*9.51
**0771T**28.43*27.01*31.06
**0772T**28.43*27.01*31.06
**0773T**26.62*25.29*29.08
**0774T**26.62*25.29*29.08
**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**509.84*484.35*557.00
**0779T*TC*481.76*457.67*526.32
**0779T*26*28.08*26.68*30.68
**0780T**26.62*25.29*29.08
**0783T**16.73*15.89*18.27
**0784T**2459.97*2336.97*2687.52
#**0784T**354.05*336.35*386.80
**0785T**275.03*261.28*300.47
#**0785T**159.94*151.94*174.73
**0786T**835.28*793.52*912.55
#**0786T**330.45*313.93*361.02
**0787T**275.03*261.28*300.47
#**0787T**159.94*151.94*174.73
**0788T**20.45*19.43*22.34
#**0788T**19.67*18.69*21.49
**0789T**28.40*26.98*31.03
#**0789T**24.59*23.36*26.86
**0790T**2089.56*1985.08*2282.84
**0791T**10.04*9.54*10.97
**0793T**615.60*584.82*672.54
**0794T**130.35*123.83*142.40
**0795T**769.52*731.04*840.70
**0796T**513.01*487.36*560.46
**0797T**513.01*487.36*560.46
**0798T**810.54*770.01*885.51
**0799T**540.36*513.34*590.34
**0800T**540.36*513.34*590.34
**0801T**1053.37*1000.70*1150.81
**0802T**526.68*500.35*575.40
**0803T**526.68*500.35*575.40
**0804T**88.77*84.33*96.98
**0804T*TC*49.50*47.03*54.08
**0804T*26*39.27*37.31*42.91
**0805T**3435.90*3264.11*3753.73
#**0805T**347.24*329.88*379.36
**0806T**4581.19*4352.13*5004.95
#**0806T**462.99*439.84*505.82
**0807T**48.67*46.24*53.18
**0807T*TC*32.72*31.08*35.74
**0807T*26*15.95*15.15*17.42
**0808T**48.67*46.24*53.18
**0808T*TC*32.72*31.08*35.74
**0808T*26*15.95*15.15*17.42
**0810T**1254.36*1191.64*1370.39
**0811T**23.31*22.14*25.46
**0813T**3028.61*2877.18*3308.76
#**0813T**195.49*185.72*213.58
**0814T**528.75*502.31*577.66
#**0814T**393.67*373.99*430.09
**0818T**410.57*390.04*448.55
#**0818T**252.56*239.93*275.92
**0820T**159.40*151.43*174.14
#**0820T**138.72*131.78*151.55
**0821T**159.40*151.43*174.14
#**0821T**138.72*131.78*151.55
**0822T**135.49*128.72*148.03
#**0822T**117.91*112.01*128.81
**0823T**769.52*731.04*840.70
**0824T**810.54*770.01*885.51
**0825T**1053.37*1000.70*1150.81
**0826T**75.94*72.14*82.96
**0826T*TC*42.87*40.73*46.84
**0826T*26*33.07*31.42*36.13
**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**27.04*25.69*29.54
**0859T*TC*23.75*22.56*25.94
**0859T*26*3.28*3.12*3.59
**0864T**353.31*335.64*385.99
#**0864T**249.93*237.43*273.04
**10011**489.83*465.34*535.14
#**10011**115.69*109.91*126.40
**10012**268.13*254.72*292.93
#**10012**76.19*72.38*83.24
**15847**388.68*369.25*424.64
**21088**1970.56*1872.03*2152.83
**21742**1254.24*1191.53*1370.26
**21743**1438.72*1366.78*1571.80
**32855**482.92*458.77*527.59
**32856**485.39*461.12*530.29
**33928**3539.29*3362.33*3866.68
**33929**1325.76*1259.47*1448.39
**33933**586.30*556.99*640.54
**33944**547.29*519.93*597.92
**34841**2281.93*2167.83*2493.00
**34842**2507.71*2382.32*2739.67
**34843**2733.48*2596.81*2986.33
**34844**2959.27*2811.31*3233.01
**34845**2281.93*2167.83*2493.00
**34846**2507.71*2382.32*2739.67
**34847**2733.48*2596.81*2986.33
**34848**2959.27*2811.31*3233.01
**43496**2352.97*2235.32*2570.62
**43647**845.63*803.35*923.85
**43648**597.65*567.77*652.94
#**43648**265.27*252.01*289.81
**43881**770.18*731.67*841.42
#**43881**702.69*667.56*767.69
**43882**823.22*782.06*899.37
#**43882**750.59*713.06*820.02
**47143**458.86*435.92*501.31
**47144**544.89*517.65*595.30
**47145**516.23*490.42*563.98
**48551**361.89*343.80*395.37
**50323**435.07*413.32*475.32
**50325**298.03*283.13*325.60
**53451**829.89*788.40*906.66
**53452**414.94*394.19*453.32
**53453**705.48*670.21*770.74
**53454**63.53*60.35*69.40
#**53454**38.17*36.26*41.70
**63043**633.83*602.14*692.46
**63044**575.14*546.38*628.34
**64596**2459.97*2336.97*2687.52
#**64596**354.05*336.35*386.80
**64597**737.99*701.09*806.25
#**64597**106.21*100.90*116.04
**64598**275.03*261.28*300.47
#**64598**159.94*151.94*174.73
**65757**132.57*125.94*144.83
**66983**734.02*697.32*801.92
**66987**839.37*797.40*917.01
**66988**701.35*666.28*766.22
*C*70170**293.72*279.03*320.88
*C*70170*TC*278.12*264.21*303.84
**70555**233.47*221.80*255.07
**70555*TC*106.62*101.29*116.48
*C*70557**790.64*751.11*863.78
*C*70557*TC*626.11*594.80*684.02
*C*70558**390.02*370.52*426.10
*C*70558*TC*208.67*198.24*227.98
*C*70559**377.76*358.87*412.70
*C*70559*TC*208.67*198.24*227.98
*C*74190**649.60*617.12*709.69
*C*74190*TC*626.11*594.80*684.02
**74235**163.42*155.25*178.54
**74235*TC*102.83*97.69*112.34
**74300**96.51*91.68*105.43
**74300*TC*82.36*78.24*89.98
**74301**29.66*28.18*32.41
**74301*TC*19.15*18.19*20.92
**74328**175.06*166.31*191.26
**74328*TC*150.31*142.79*164.21
**74329**160.67*152.64*175.54
**74329*TC*135.53*128.75*148.06
**74330**262.59*249.46*286.88
**74330*TC*233.53*221.85*255.13
**74340**86.58*82.25*94.59
**74340*TC*59.40*56.43*64.89
**74355**86.58*82.25*94.59
**74355*TC*47.75*45.36*52.16
**74360**86.58*82.25*94.59
**74360*TC*57.54*54.66*62.86
**74363**175.06*166.31*191.26
**74363*TC*130.86*124.32*142.97
*C*74445**182.15*173.04*199.00
*C*74445*TC*124.79*118.55*136.33
*C*74450**294.83*280.09*322.10
*C*74450*TC*278.12*264.21*303.84
*C*74470**652.51*619.88*712.86
*C*74470*TC*626.11*594.80*684.02
**74742**233.47*221.80*255.07
**74742*TC*202.25*192.14*220.96
*C*74775**309.69*294.21*338.34
*C*74775*TC*278.12*264.21*303.84
*C*75801**758.75*720.81*828.93
*C*75801*TC*713.11*677.45*779.07
*C*75803**1877.84*1783.95*2051.54
*C*75803*TC*1817.96*1727.06*1986.12
*C*75805**3659.78*3476.79*3998.31
*C*75805*TC*3618.40*3437.48*3953.10
*C*75807**3674.30*3490.59*4014.18
*C*75807*TC*3618.40*3437.48*3953.10
*C*75810**3669.24*3485.78*4008.65
*C*75810*TC*3618.40*3437.48*3953.10
**75894**1036.12*984.31*1131.96
**75894*TC*959.77*911.78*1048.55
*C*75898**3715.74*3529.95*4059.44
*C*75898*TC*3618.40*3437.48*3953.10
**75970**505.08*479.83*551.80
**75970*TC*465.04*441.79*508.06
**76125**44.75*42.51*48.89
**76125*TC*30.60*29.07*33.43
**76390**233.39*221.72*254.98
**76390*TC*178.36*169.44*194.86
**76390*26*55.03*52.28*60.12
**76932**95.15*90.39*103.95
**76932*TC*56.62*53.79*61.86
**76940**172.71*164.07*188.68
**76940*TC*65.68*62.40*71.76
**76941**128.16*121.75*140.01
**76941*TC*59.38*56.41*64.87
**76945**94.04*89.34*102.74
**76945*TC*59.82*56.83*65.35
*C*76975**321.88*305.79*351.66
*C*76975*TC*278.12*264.21*303.84
**76998**175.06*166.31*191.26
**76998*TC*125.24*118.98*136.83
**77013**483.62*459.44*528.36
**77013*TC*289.63*275.15*316.42
**77022**535.48*508.71*585.02
**77022*TC*323.13*306.97*353.02
**77371**1551.95*1474.35*1695.50
**77520**1059.98*1006.98*1158.03
**77522**1059.98*1006.98*1158.03
**77523**1217.13*1156.27*1329.71
**77525**1374.26*1305.55*1501.38
*C*78282**484.25*460.04*529.05
*C*78282*TC*468.11*444.70*511.41
**78414**514.99*489.24*562.63
**78414*TC*492.47*467.85*538.03
*C*78429**1859.73*1766.74*2031.75
*C*78429*TC*1775.82*1687.03*1940.08
*C*78430**1855.80*1763.01*2027.46
*C*78430*TC*1775.82*1687.03*1940.08
*C*78431**2774.86*2636.12*3031.54
*C*78431*TC*2681.31*2547.24*2929.33
*C*78432**2304.48*2189.26*2517.65
*C*78432*TC*2204.58*2094.35*2408.50
*C*78433**2433.28*2311.62*2658.36
*C*78433*TC*2323.95*2207.75*2538.91
**78434**818.87*777.93*894.62
**78434*TC*788.07*748.67*860.97
*C*78459**1689.78*1605.29*1846.08
*C*78459*TC*1611.97*1531.37*1761.08
*C*78491**1852.30*1759.69*2023.64
*C*78491*TC*1775.82*1687.03*1940.08
*C*78492**1865.82*1772.53*2038.41
*C*78492*TC*1775.82*1687.03*1940.08
*C*78608**1849.35*1756.88*2020.41
*C*78608*TC*1775.82*1687.03*1940.08
*C*78811**1687.64*1603.26*1843.75
*C*78811*TC*1611.97*1531.37*1761.08
*C*78812**1871.46*1777.89*2044.57
*C*78812*TC*1775.82*1687.03*1940.08
*C*78813**1873.55*1779.87*2046.85
*C*78813*TC*1775.82*1687.03*1940.08
*C*78814**1884.10*1789.90*2058.39
*C*78814*TC*1775.82*1687.03*1940.08
*C*78815**1896.45*1801.63*2071.87
*C*78815*TC*1775.82*1687.03*1940.08
*C*78816**1897.45*1802.58*2072.97
*C*78816*TC*1775.82*1687.03*1940.08
**79300**237.04*225.19*258.97
**79300*TC*169.93*161.43*185.64
**79445**237.04*225.19*258.97
**79445*TC*121.09*115.04*132.30
**86485**6.24*5.93*6.82
**90867**341.56*324.48*373.15
#**90867**150.20*142.69*164.09
**90868**226.45*215.13*247.40
#**90868**114.59*108.86*125.19
**90869**311.41*295.84*340.22
#**90869**178.86*169.92*195.41
**92978**275.00*261.25*300.44
**92978*TC*175.38*166.61*191.60
**92979**165.58*157.30*180.90
**92979*TC*86.53*82.20*94.53
*C*93315**759.98*721.98*830.28
*C*93315*TC*626.11*594.80*684.02
**93317**238.82*226.88*260.91
**93317*TC*145.73*138.44*159.21
*C*93318**733.69*697.01*801.56
*C*93318*TC*626.11*594.80*684.02
**93571**273.85*260.16*299.18
**93571*TC*198.05*188.15*216.37
**93572**162.94*154.79*178.01
**93572*TC*107.73*102.34*117.69
**93600**3557.81*3379.92*3886.91
**93600*TC*3435.43*3263.66*3753.21
**93602**3557.81*3379.92*3886.91
**93602*TC*3437.68*3265.80*3755.67
**93603**3557.81*3379.92*3886.91
**93603*TC*3437.68*3265.80*3755.67
**93609**2134.69*2027.96*2332.15
**93609*TC*1847.64*1755.26*2018.55
**93610**3557.81*3379.92*3886.91
**93610*TC*3388.21*3218.80*3701.62
**93612**3557.81*3379.92*3886.91
**93612*TC*3390.80*3221.26*3704.45
**93619**7115.62*6759.84*7773.82
**93619*TC*6710.25*6374.74*7330.95
**93620**7115.62*6759.84*7773.82
**93620*TC*6465.27*6142.01*7063.31
**93621**7115.62*6759.84*7773.82
**93621*TC*7029.12*6677.66*7679.31
**93622**7115.62*6759.84*7773.82
**93622*TC*6937.18*6590.32*7578.87
**93623**2134.69*2027.96*2332.15
**93623*TC*2061.85*1958.76*2252.57
**93624**3557.81*3379.92*3886.91
**93624*TC*3306.35*3141.03*3612.18
**93631**7115.62*6759.84*7773.82
**93631*TC*6701.82*6366.73*7321.74
**93640**1133.95*1077.25*1238.84
**93640*TC*809.51*769.03*884.38
**93641**1133.95*1077.25*1238.84
**93641*TC*809.51*769.03*884.38
**93662**481.65*457.57*526.21
**93662*TC*407.04*386.69*444.69
**94642**37.33*35.46*40.78
**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**986.03*936.73*1077.24
**95965*TC*552.69*525.06*603.82
**96020**392.66*373.03*428.98
**96547**864.84*821.60*944.84
#**96547**148.17*140.76*161.87
**96548**432.42*410.80*472.42
#**96548**74.08*70.38*80.94
**97151**53.82*51.13*58.80
#**97151**47.18*44.82*51.54
**97152**45.74*43.45*49.97
#**97152**40.11*38.10*43.82
**97153**36.38*34.56*39.74
#**97153**31.51*29.93*34.42
**97154**4.98*4.73*5.44
#**97154**4.48*4.26*4.90
**97155**36.38*34.56*39.74
#**97155**31.51*29.93*34.42
**97156**38.35*36.43*41.89
#**97156**33.28*31.62*36.36
**97157**11.26*10.70*12.31
#**97157**10.09*9.59*11.03
**97158**5.80*5.51*6.34
#**97158**5.21*4.95*5.69
**98978**55.35*52.58*60.47
# - 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.