PENNSYLVANIA MEDICARE CARRIER - 12502
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**433.67*411.99*473.79
#**G0186**373.81*355.12*408.39
**G0339**2585.37*2456.10*2824.52
**G0340**1944.59*1847.36*2124.46
**G0398**127.96*121.56*139.79
**G0398*TC*90.10*85.60*98.44
**G0398*26*37.86*35.97*41.37
**G0399**89.58*85.10*97.87
**G0399*TC*47.83*45.44*52.26
**G0399*26*42.06*39.96*45.95
**G0400**92.17*87.56*100.69
**G0400*TC*53.07*50.42*57.98
**G0400*26*39.09*37.14*42.71
**G0460**743.55*706.37*812.33
#**G0460**116.84*111.00*127.65
**G0465**743.55*706.37*812.33
#**G0465**116.84*111.00*127.65
**G0498**136.90*130.06*149.57
**G6017**74.12*70.41*80.97
**0042T**215.42*204.65*235.35
**0054T**222.87*211.73*243.49
**0055T**222.87*211.73*243.49
**0071T**552.92*525.27*604.06
**0072T**552.92*525.27*604.06
**0075T**938.93*891.98*1025.78
**0075T*TC*938.93*891.98*1025.78
**0075T*26*938.93*891.98*1025.78
**0095T**604.21*574.00*660.10
**0098T**676.59*642.76*739.17
**0100T**1820.27*1729.26*1988.65
**0101T**298.73*283.79*326.36
#**0101T**216.96*206.11*237.03
**0102T**298.73*283.79*326.36
#**0102T**216.96*206.11*237.03
**0106T**31.29*29.73*34.19
**0107T**31.29*29.73*34.19
**0108T**31.29*29.73*34.19
**0109T**31.29*29.73*34.19
**0110T**31.29*29.73*34.19
**0164T**660.24*627.23*721.31
**0165T**676.52*642.69*739.09
**0184T**793.06*753.41*866.42
**0198T**80.17*76.16*87.58
#**0198T**30.80*29.26*33.65
**0200T**1663.68*1580.50*1817.58
#**0200T**390.50*370.98*426.63
**0201T**2495.52*2370.74*2726.35
#**0201T**585.75*556.46*639.93
**0207T**121.71*115.62*132.96
**0208T**35.18*33.42*38.43
**0209T**42.58*40.45*46.52
**0210T**26.85*25.51*29.34
**0211T**41.66*39.58*45.52
**0212T**35.09*33.34*38.34
#**0212T**30.46*28.94*33.28
**0213T**183.08*173.93*200.02
#**0213T**101.30*96.24*110.68
**0214T**92.91*88.26*101.50
#**0214T**57.12*54.26*62.40
**0215T**93.22*88.56*101.84
#**0215T**58.05*55.15*63.42
**0216T**168.15*159.74*183.70
#**0216T**87.00*82.65*95.05
**0217T**86.66*82.33*94.68
#**0217T**49.02*46.57*53.56
**0218T**86.66*82.33*94.68
#**0218T**49.94*47.44*54.56
**0219T**1266.92*1203.57*1384.11
**0220T**1245.05*1182.80*1360.22
**0221T**1531.41*1454.84*1673.07
**0222T**376.52*357.69*411.34
**0232T**743.55*706.37*812.33
#**0232T**116.84*111.00*127.65
**0234T**7949.51*7552.03*8684.83
#**0234T**565.61*537.33*617.93
**0235T**7949.51*7552.03*8684.83
#**0235T**565.61*537.33*617.93
**0236T**8093.02*7688.37*8841.63
#**0236T**655.13*622.37*715.73
**0237T**8093.02*7688.37*8841.63
#**0237T**655.13*622.37*715.73
**0238T**8093.02*7688.37*8841.63
#**0238T**655.13*622.37*715.73
**0266T**864.55*821.32*944.52
**0267T**153.02*145.37*167.18
**0268T**321.32*305.25*351.04
**0269T**818.19*777.28*893.87
**0270T**153.02*145.37*167.18
**0271T**321.32*305.25*351.04
**0272T**52.88*50.24*57.78
**0273T**68.16*64.75*74.46
**0274T**1066.55*1013.22*1165.20
**0278T**13.88*13.19*15.17
**0308T**1335.24*1268.48*1458.75
**0329T**80.17*76.16*87.58
#**0329T**30.80*29.26*33.65
**0330T**38.21*36.30*41.75
**0331T**171.66*163.08*187.54
**0332T**293.10*278.45*320.22
**0347T**136.88*130.04*149.55
**0348T**31.03*29.48*33.90
**0349T**32.84*31.20*35.88
**0350T**33.45*31.78*36.55
**0351T**159.01*151.06*173.72
**0352T**41.44*39.37*45.28
**0353T**159.01*151.06*173.72
**0354T**41.44*39.37*45.28
**0358T**24.99*23.74*27.30
**0362T**87.39*83.02*95.47
#**0362T**63.63*60.45*69.52
**0378T**24.00*22.80*26.22
**0394T**233.98*222.28*255.62
**0395T**569.90*541.41*622.62
**0397T**45.41*43.14*49.61
**0398T*26*1746.88*1659.54*1908.47
**0408T**491.15*466.59*536.58
**0409T**339.26*322.30*370.65
**0410T**352.39*334.77*384.99
**0411T**352.39*334.77*384.99
**0412T**221.12*210.06*241.57
**0413T**459.14*436.18*501.61
**0414T**353.72*336.03*386.43
**0415T**294.84*280.10*322.12
**0416T**325.84*309.55*355.98
**0417T**79.21*75.25*86.54
**0418T**52.88*50.24*57.78
**0419T**427.87*406.48*467.45
#**0419T**345.17*327.91*377.10
**0420T**609.67*579.19*666.07
#**0420T**507.53*482.15*554.47
**0421T**1517.07*1441.22*1657.40
#**0421T**668.79*635.35*730.65
**0437T**205.38*195.11*224.38
**0439T**67.86*64.47*74.14
**0440T**234.99*223.24*256.73
#**0440T**114.65*108.92*125.26
**0441T**234.99*223.24*256.73
#**0441T**114.65*108.92*125.26
**0442T**234.99*223.24*256.73
#**0442T**114.65*108.92*125.26
**0449T**726.53*690.20*793.73
**0464T**63.18*60.02*69.02
**0472T**63.60*60.42*69.48
**0473T**52.88*50.24*57.78
**0479T**60.80*57.76*66.42
**0480T**146.90*139.56*160.49
#**0480T**30.40*28.88*33.21
**0483T**1147.23*1089.87*1253.35
**0484T**1487.85*1413.46*1625.48
**0485T**22.41*21.29*24.48
**0485T*TC*8.18*7.77*8.94
**0485T*26*14.54*13.81*15.88
**0486T**44.82*42.58*48.97
**0486T*TC*16.05*15.25*17.54
**0486T*26*28.77*27.33*31.43
**0488T**60.44*57.42*66.03
#**0488T**48.40*45.98*52.88
**0505T**10285.27*9771.01*11236.66
#**0505T**552.62*524.99*603.74
**0507T**21.72*20.63*23.72
**0507T*TC*18.82*17.88*20.56
**0507T*26*2.90*2.76*3.17
**0510T**573.24*544.58*626.27
#**0510T**406.61*386.28*444.22
**0512T**298.73*283.79*326.36
#**0512T**216.96*206.11*237.03
**0513T**89.62*85.14*97.91
#**0513T**65.09*61.84*71.12
**0515T**491.15*466.59*536.58
**0516T**453.31*430.64*495.24
**0517T**321.32*305.25*351.04
**0518T**221.12*210.06*241.57
**0519T**322.18*306.07*351.98
**0520T**453.31*430.64*495.24
**0521T**52.88*50.24*57.78
**0521T*TC*33.33*31.66*36.41
**0521T*26*19.56*18.58*21.37
**0522T**63.60*60.42*69.48
**0522T*TC*33.94*32.24*37.08
**0522T*26*29.66*28.18*32.41
**0523T**144.19*136.98*157.53
**0524T**1528.81*1452.37*1670.23
#**0524T**170.77*162.23*186.56
**0525T**453.62*430.94*495.58
**0526T**352.39*334.77*384.99
**0527T**306.79*291.45*335.17
**0528T**63.60*60.42*69.48
**0528T*TC*33.94*32.24*37.08
**0528T*26*29.66*28.18*32.41
**0529T**52.88*50.24*57.78
**0529T*TC*33.33*31.66*36.41
**0529T*26*19.56*18.58*21.37
**0530T**603.10*572.95*658.89
**0531T**459.14*436.18*501.61
**0532T**322.18*306.07*351.98
**0540T**170.51*161.98*186.28
**0543T**1487.85*1413.46*1625.48
**0544T**1708.38*1622.96*1866.40
**0545T**1708.38*1622.96*1866.40
**0546T**68.16*64.75*74.46
**0552T**6.32*6.00*6.90
**0553T**2291.74*2177.15*2503.72
#**0553T**378.26*359.35*413.25
**0565T**584.97*555.72*639.08
#**0565T**492.71*468.07*538.28
**0566T**94.93*90.18*103.71
#**0566T**56.97*54.12*62.24
**0569T**1708.38*1622.96*1866.40
**0570T**401.17*381.11*438.28
**0571T**531.12*504.56*580.24
**0572T**432.53*410.90*472.54
**0573T**329.69*313.21*360.19
**0574T**382.59*363.46*417.98
**0575T**63.60*60.42*69.48
**0576T**52.88*50.24*57.78
**0577T**182.96*173.81*199.88
**0578T**28.30*26.89*30.92
**0579T**19.75*18.76*21.57
**0580T**203.90*193.71*222.77
**0581T**2107.52*2002.14*2302.46
#**0581T**202.38*192.26*221.10
**0582T**1547.67*1470.29*1690.83
#**0582T**368.61*350.18*402.71
**0583T**1522.66*1446.53*1663.51
#**0583T**126.85*120.51*138.59
**0587T**421.82*400.73*460.84
#**0587T**284.82*270.58*311.17
**0588T**346.75*329.41*378.82
#**0588T**221.78*210.69*242.29
**0589T**46.33*44.01*50.61
#**0589T**37.38*35.51*40.84
**0590T**54.40*51.68*59.43
#**0590T**38.66*36.73*42.24
**0596T**672.69*639.06*734.92
#**0596T**127.82*121.43*139.64
**0597T**672.69*639.06*734.92
#**0597T**127.82*121.43*139.64
**0598T**140.72*133.68*153.73
**0599T**93.80*89.11*102.48
**0600T**3345.74*3178.45*3655.22
#**0600T**700.02*665.02*764.77
**0601T**1397.88*1327.99*1527.19
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**185.03*175.78*202.15
**0611T**37.64*35.76*41.12
**0614T**353.15*335.49*385.81
**0615T**45.14*42.88*49.31
**0616T**633.34*601.67*691.92
**0617T**707.11*671.75*772.51
**0618T**855.78*812.99*934.94
**0619T**622.24*591.13*679.80
#**0619T**457.67*434.79*500.01
**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**243.82*231.63*266.37
#**0627T**95.70*90.92*104.56
**0628T**73.14*69.48*79.90
#**0628T**28.71*27.27*31.36
**0629T**243.82*231.63*266.37
#**0629T**95.70*90.92*104.56
**0630T**73.14*69.48*79.90
#**0630T**28.71*27.27*31.36
**0631T**76.82*72.98*83.93
**0632T**549.31*521.84*600.12
**0633T**189.41*179.94*206.93
*C*0633T*TC*98.74*93.80*107.87
**0633T*26*57.03*54.18*62.31
**0634T**189.41*179.94*206.93
**0634T*TC*132.38*125.76*144.62
**0634T*26*57.03*54.18*62.31
**0635T**189.41*179.94*206.93
**0635T*TC*132.38*125.76*144.62
**0635T*26*57.03*54.18*62.31
**0636T**189.41*179.94*206.93
**0636T*TC*132.38*125.76*144.62
**0636T*26*57.03*54.18*62.31
**0637T**189.41*179.94*206.93
**0637T*TC*132.38*125.76*144.62
**0637T*26*57.03*54.18*62.31
**0638T**189.41*179.94*206.93
**0638T*TC*132.38*125.76*144.62
**0638T*26*57.03*54.18*62.31
**0639T**76.82*72.98*83.93
**0640T**21.72*20.63*23.72
**0640T*TC*18.95*18.00*20.70
**0640T*26*2.90*2.76*3.17
**0644T**1086.66*1032.33*1187.18
#**0644T**230.98*219.43*252.34
**0646T**1708.38*1622.96*1866.40
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**56.50*53.68*61.73
**0652T**271.36*257.79*296.46
#**0652T**117.07*111.22*127.90
**0653T**353.86*336.17*386.60
#**0653T**132.30*125.69*144.54
**0654T**135.94*129.14*148.51
**0655T**1517.07*1441.22*1657.40
#**0655T**668.79*635.35*730.65
**0658T**87.94*83.54*96.07
**0659T**2511.03*2385.48*2743.30
#**0659T**417.04*396.19*455.62
**0671T**976.86*928.02*1067.22
**0673T**3192.53*3032.90*3487.84
#**0673T**350.86*333.32*383.32
**0699T**107.48*102.11*117.43
#**0699T**87.12*82.76*95.17
**0707T**351.01*333.46*383.48
#**0707T**265.54*252.26*290.10
**0714T**1314.70*1248.97*1436.32
#**0714T**343.92*326.72*375.73
**0730T**255.11*242.35*278.70
#**0730T**229.44*217.97*250.67
**0738T**68.26*64.85*74.58
**0739T**1517.07*1441.22*1657.40
#**0739T**668.79*635.35*730.65
**0740T**18.51*17.58*20.22
**0741T**43.82*41.63*47.87
**0742T**87.93*83.53*96.06
**0742T*TC*69.43*65.96*75.85
**0742T*26*18.50*17.58*20.22
**0743T**50.10*47.60*54.74
**0744T**853.14*810.48*932.05
**0745T**238.22*226.31*260.26
**0746T**217.16*206.30*237.25
**0747T**921.08*875.03*1006.28
**0748T**176.40*167.58*192.72
**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**4.10*3.90*4.49
**0765T**7.82*7.43*8.54
**0771T**25.50*24.23*27.86
**0772T**25.50*24.23*27.86
**0773T**22.04*20.94*24.08
**0774T**22.04*20.94*24.08
**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**406.11*385.80*443.67
**0779T*TC*381.09*362.04*416.35
**0779T*26*25.02*23.77*27.34
**0780T**22.04*20.94*24.08
**0783T**13.27*12.61*14.50
**0784T**1978.34*1879.42*2161.33
#**0784T**312.66*297.03*341.58
**0785T**229.75*218.26*251.00
#**0785T**138.72*131.78*151.55
**0786T**692.04*657.44*756.06
#**0786T**292.74*278.10*319.82
**0787T**229.75*218.26*251.00
#**0787T**138.72*131.78*151.55
**0788T**18.13*17.22*19.80
#**0788T**17.51*16.63*19.12
**0789T**25.20*23.94*27.53
#**0789T**21.89*20.80*23.92
**0790T**1855.99*1763.19*2027.67
**0791T**8.69*8.26*9.50
**0793T**549.31*521.84*600.12
**0794T**130.35*123.83*142.40
**0795T**679.96*645.96*742.85
**0796T**453.31*430.64*495.24
**0797T**453.31*430.64*495.24
**0798T**719.85*683.86*786.44
**0799T**479.90*455.91*524.30
**0800T**479.90*455.91*524.30
**0801T**933.21*886.55*1019.53
**0802T**466.61*443.28*509.77
**0803T**466.61*443.28*509.77
**0804T**74.38*70.66*81.26
**0804T*TC*39.19*37.23*42.81
**0804T*26*35.20*33.44*38.46
**0805T**2756.34*2618.52*3011.30
#**0805T**313.35*297.68*342.33
**0806T**3675.12*3491.36*4015.06
#**0806T**417.80*396.91*456.45
**0807T**40.22*38.21*43.94
**0807T*TC*25.92*24.62*28.31
**0807T*26*14.30*13.59*15.63
**0808T**40.22*38.21*43.94
**0808T*TC*25.92*24.62*28.31
**0808T*26*14.30*13.59*15.63
**0810T**1082.89*1028.75*1183.06
**0811T**18.51*17.58*20.22
**0813T**2414.40*2293.68*2637.73
#**0813T**173.52*164.84*189.57
**0814T**438.76*416.82*479.34
#**0814T**331.92*315.32*362.62
**0818T**346.75*329.41*378.82
#**0818T**221.78*210.69*242.29
**0820T**143.74*136.55*157.03
#**0820T**127.38*121.01*139.16
**0821T**143.74*136.55*157.03
#**0821T**127.38*121.01*139.16
**0822T**122.18*116.07*133.48
#**0822T**108.27*102.86*118.29
**0823T**679.96*645.96*742.85
**0824T**719.85*683.86*786.44
**0825T**933.21*886.55*1019.53
**0826T**63.60*60.42*69.48
**0826T*TC*33.94*32.24*37.08
**0826T*26*29.66*28.18*32.41
**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**21.72*20.63*23.72
**0859T*TC*18.82*17.88*20.56
**0859T*26*2.90*2.76*3.17
**0864T**298.73*283.79*326.36
#**0864T**216.96*206.11*237.03
**10011**400.14*380.13*437.15
#**10011**104.22*99.01*113.86
**10012**221.54*210.46*242.03
#**10012**69.72*66.23*76.16
**15847**338.17*321.26*369.45
**21088**1692.77*1608.13*1849.35
**21742**1114.33*1058.61*1217.40
**21743**1280.11*1216.10*1398.52
**32855**414.85*394.11*453.23
**32856**435.98*414.18*476.31
**33928**3199.36*3039.39*3495.30
**33929**1198.42*1138.50*1309.28
**33933**543.13*515.97*593.37
**33944**470.15*446.64*513.64
**34841**2078.82*1974.88*2271.11
**34842**2304.60*2189.37*2517.78
**34843**2530.41*2403.89*2764.47
**34844**2756.17*2618.36*3011.11
**34845**2078.82*1974.88*2271.11
**34846**2304.60*2189.37*2517.78
**34847**2530.41*2403.89*2764.47
**34848**2756.17*2618.36*3011.11
**43496**2069.92*1966.42*2261.38
**43647**726.42*690.10*793.62
**43648**519.07*493.12*567.09
#**43648**236.00*224.20*257.83
**43881**666.77*633.43*728.44
#**43881**614.81*584.07*671.68
**43882**701.98*666.88*766.91
#**43882**646.04*613.74*705.80
**47143**413.82*393.13*452.10
**47144**491.41*466.84*536.87
**47145**465.55*442.27*508.61
**48551**414.85*394.11*453.23
**50323**557.53*529.65*609.10
**50325**278.02*264.12*303.74
**53451**730.72*694.18*798.31
**53452**365.36*347.09*399.15
**53453**621.00*589.95*678.44
**53454**54.15*51.44*59.16
#**53454**34.10*32.40*37.26
**63043**552.67*525.04*603.80
**63044**516.85*491.01*564.66
**64596**1978.34*1879.42*2161.33
#**64596**312.66*297.03*341.58
**64597**593.50*563.83*648.40
#**64597**93.80*89.11*102.48
**64598**229.75*218.26*251.00
#**64598**138.72*131.78*151.55
**65757**114.56*108.83*125.15
**66983**633.34*601.67*691.92
**66987**736.76*699.92*804.91
**66988**610.63*580.10*667.12
*C*70170**234.01*222.31*255.66
*C*70170*TC*220.01*209.01*240.36
**70555**233.47*221.80*255.07
**70555*TC*119.30*113.34*130.34
*C*70557**641.16*609.10*700.47
*C*70557*TC*495.26*470.50*541.08
*C*70558**325.91*309.61*356.05
*C*70558*TC*165.09*156.84*180.37
*C*70559**316.64*300.81*345.93
*C*70559*TC*165.09*156.84*180.37
*C*74190**516.48*490.66*564.26
*C*74190*TC*495.26*470.50*541.08
**74235**136.39*129.57*149.01
**74235*TC*81.97*77.87*89.55
**74300**78.17*74.26*85.40
**74300*TC*65.48*62.21*71.54
**74301**24.09*22.89*26.32
**74301*TC*14.63*13.90*15.99
**74328**175.06*166.31*191.26
**74328*TC*152.94*145.29*167.08
**74329**131.57*124.99*143.74
**74329*TC*109.14*103.68*119.23
**74330**262.59*249.46*286.88
**74330*TC*236.55*224.72*258.43
**74340**86.58*82.25*94.59
**74340*TC*62.13*59.02*67.87
**74355**86.58*82.25*94.59
**74355*TC*51.72*49.13*56.50
**74360**86.58*82.25*94.59
**74360*TC*60.59*57.56*66.19
**74363**175.06*166.31*191.26
**74363*TC*135.28*128.52*147.80
*C*74445**150.27*142.76*164.17
*C*74445*TC*98.74*93.80*107.87
*C*74450**235.01*223.26*256.75
*C*74450*TC*220.01*209.01*240.36
*C*74470**519.10*493.15*567.12
*C*74470*TC*495.26*470.50*541.08
**74742**233.47*221.80*255.07
**74742*TC*205.45*195.18*224.46
*C*74775**248.36*235.94*271.33
*C*74775*TC*220.01*209.01*240.36
*C*75801**604.91*574.66*660.86
*C*75801*TC*564.07*535.87*616.25
*C*75803**1491.71*1417.12*1629.69
*C*75803*TC*1437.96*1366.06*1570.97
*C*75805**2899.18*2754.22*3167.35
*C*75805*TC*2862.03*2718.93*3126.77
*C*75807**2912.70*2767.07*3182.13
*C*75807*TC*2862.03*2718.93*3126.77
*C*75810**2908.61*2763.18*3177.66
*C*75810*TC*2862.03*2718.93*3126.77
**75894**831.40*789.83*908.30
**75894*TC*763.13*724.97*833.72
*C*75898**2949.03*2801.58*3221.82
*C*75898*TC*2862.03*2718.93*3126.77
**75970**406.26*385.95*443.84
**75970*TC*370.00*351.50*404.23
**76125**37.07*35.22*40.50
**76125*TC*24.38*23.16*26.63
**76390**190.82*181.28*208.47
**76390*TC*141.15*134.09*154.20
**76390*26*49.67*47.19*54.27
**76932**79.30*75.34*86.64
**76932*TC*44.97*42.72*49.13
**76940**149.53*142.05*163.36
**76940*TC*53.35*50.68*58.28
**76941**109.13*103.67*119.22
**76941*TC*47.56*45.18*51.96
**76945**78.39*74.47*85.64
**76945*TC*47.76*45.37*52.18
*C*76975**259.01*246.06*282.97
*C*76975*TC*220.01*209.01*240.36
**76998**175.06*166.31*191.26
**76998*TC*130.28*123.77*142.34
**77013**390.90*371.36*427.06
**77013*TC*215.52*204.74*235.45
**77022**440.01*418.01*480.71
**77022*TC*248.90*236.46*271.93
**77371**1158.85*1100.91*1266.05
**77520**816.55*775.72*892.08
**77522**816.55*775.72*892.08
**77523**937.53*890.65*1024.25
**77525**1058.51*1005.58*1156.42
*C*78282**385.10*365.85*420.73
*C*78282*TC*370.29*351.78*404.55
**78414**514.99*489.24*562.63
**78414*TC*494.77*470.03*540.53
*C*78429**1480.50*1406.48*1617.45
*C*78429*TC*1404.63*1334.40*1534.56
*C*78430**1476.88*1403.04*1613.50
*C*78430*TC*1404.63*1334.40*1534.56
*C*78431**2205.06*2094.81*2409.03
*C*78431*TC*2120.84*2014.80*2317.02
*C*78432**1833.95*1742.25*2003.59
*C*78432*TC*1743.76*1656.57*1905.06
*C*78433**1936.86*1840.02*2116.02
*C*78433*TC*1838.18*1746.27*2008.21
**78434**650.72*618.18*710.91
**78434*TC*622.96*591.81*680.58
*C*78459**1345.28*1278.02*1469.72
*C*78459*TC*1275.03*1211.28*1392.97
*C*78491**1473.53*1399.85*1609.83
*C*78491*TC*1404.63*1334.40*1534.56
*C*78492**1485.53*1411.25*1622.94
*C*78492*TC*1404.63*1334.40*1534.56
*C*78608**1470.92*1397.37*1606.98
*C*78608*TC*1404.63*1334.40*1534.56
*C*78811**1343.26*1276.10*1467.52
*C*78811*TC*1275.03*1211.28*1392.97
*C*78812**1490.78*1416.24*1628.68
*C*78812*TC*1404.63*1334.40*1534.56
*C*78813**1492.80*1418.16*1630.88
*C*78813*TC*1404.63*1334.40*1534.56
*C*78814**1502.24*1427.13*1641.20
*C*78814*TC*1404.63*1334.40*1534.56
*C*78815**1513.31*1437.64*1653.29
*C*78815*TC*1404.63*1334.40*1534.56
*C*78816**1514.38*1438.66*1654.46
*C*78816*TC*1404.63*1334.40*1534.56
**79300**237.04*225.19*258.97
**79300*TC*175.45*166.68*191.68
**79445**237.04*225.19*258.97
**79445*TC*132.16*125.55*144.38
**86485**5.36*5.09*5.85
**90867**282.51*268.38*308.64
#**90867**131.16*124.60*143.29
**90868**191.18*181.62*208.86
#**90868**101.95*96.85*111.38
**90869**263.95*250.75*288.36
#**90869**153.53*145.85*167.73
**92978**228.29*216.88*249.41
**92978*TC*138.77*131.83*151.60
**92979**139.41*132.44*152.31
**92979*TC*68.35*64.93*74.67
*C*93315**615.66*584.88*672.61
*C*93315*TC*495.26*470.50*541.08
**93317**199.83*189.84*218.32
**93317*TC*116.06*110.26*126.80
*C*93318**592.13*562.52*646.90
*C*93318*TC*495.26*470.50*541.08
**93571**227.38*216.01*248.41
**93571*TC*159.24*151.28*173.97
**93572**137.29*130.43*149.99
**93572*TC*87.66*83.28*95.77
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.39*3275.97*3767.37
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.24*3277.73*3769.39
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.24*3277.73*3769.39
**93609**2134.69*2027.96*2332.15
**93609*TC*1877.93*1784.03*2051.63
**93610**3557.81*3379.92*3886.91
**93610*TC*3405.79*3235.50*3720.83
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.94*3237.54*3723.17
**93615**46.17*43.86*50.44
**93615*TC*12.53*11.90*13.69
**93616**77.69*73.81*84.88
**93616*TC*23.13*21.97*25.27
**93619**7115.62*6759.84*7773.82
**93619*TC*6752.95*6415.30*7377.60
**93620**7115.62*6759.84*7773.82
**93620*TC*6533.75*6207.06*7138.12
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.24*6686.33*7689.28
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.00*6608.20*7599.43
**93623**2134.69*2027.96*2332.15
**93623*TC*2061.85*1958.76*2252.57
**93624**3557.81*3379.92*3886.91
**93624*TC*3331.74*3165.15*3639.92
**93631**7115.62*6759.84*7773.82
**93631*TC*6742.73*6405.59*7366.43
**93640**1133.95*1077.25*1238.84
**93640*TC*967.77*919.38*1057.29
**93641**1133.95*1077.25*1238.84
**93641*TC*843.45*801.28*921.47
**93662**394.29*374.58*430.77
**93662*TC*327.54*311.16*357.83
**94642**38.57*36.64*42.14
**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
**95824**60.96*57.91*66.60
**95824*TC*24.59*23.36*26.86
**95965**914.83*869.09*999.45
**95965*TC*529.38*502.91*578.35
**96020**344.38*327.16*376.23
**96547**695.73*660.94*760.08
#**96547**128.88*122.44*140.81
**96548**347.87*330.48*380.05
#**96548**64.44*61.22*70.40
**97151**48.49*46.07*52.98
#**97151**43.25*41.09*47.25
**97152**41.22*39.16*45.03
#**97152**36.76*34.92*40.16
**97153**32.86*31.22*35.90
#**97153**29.00*27.55*31.68
**97154**4.47*4.25*4.89
#**97154**4.08*3.88*4.46
**97155**32.86*31.22*35.90
#**97155**29.00*27.55*31.68
**97156**34.68*32.95*37.89
#**97156**30.66*29.13*33.50
**97157**10.10*9.60*11.04
#**97157**9.17*8.71*10.02
**97158**5.20*4.94*5.68
#**97158**4.74*4.50*5.18
**98978**43.82*41.63*47.87
# - 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.