PENNSYLVANIA MEDICARE CARRIER - 12502
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
METROPOLITAN PHILADELPHIA
******
**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**478.21*454.30*522.45
#**G0186**410.21*389.70*448.16
**G0339**2999.62*2849.64*3277.09
**G0340**2256.37*2143.55*2465.08
**G0398**142.40*135.28*155.57
**G0398*TC*102.43*97.31*111.91
**G0398*26*39.96*37.96*43.65
**G0399**98.51*93.58*107.62
**G0399*TC*54.41*51.69*59.44
**G0399*26*44.44*42.22*48.55
**G0400**101.74*96.65*111.15
**G0400*TC*60.37*57.35*65.95
**G0400*26*41.37*39.30*45.20
**G0460**837.79*795.90*915.29
#**G0460**125.89*119.60*137.54
**G0465**837.79*795.90*915.29
#**G0465**125.89*119.60*137.54
**G0498**155.01*147.26*169.35
**G6017**81.55*77.47*89.09
**0042T**237.84*225.95*259.84
**0054T**244.86*232.62*267.51
**0055T**244.86*232.62*267.51
**0071T**601.26*571.20*656.88
**0072T**601.26*571.20*656.88
**0075T**1019.08*968.13*1113.35
**0075T*TC*1019.08*968.13*1113.35
**0075T*26*1019.67*968.69*1113.99
**0095T**668.92*635.47*730.79
**0098T**748.79*711.35*818.05
**0100T**1974.61*1875.88*2157.26
**0101T**327.74*311.35*358.05
#**0101T**234.86*223.12*256.59
**0102T**327.74*311.35*358.05
#**0102T**234.86*223.12*256.59
**0106T**35.44*33.67*38.72
**0107T**35.44*33.67*38.72
**0108T**35.44*33.67*38.72
**0109T**35.44*33.67*38.72
**0110T**35.44*33.67*38.72
**0164T**731.17*694.61*798.80
**0165T**749.16*711.70*818.46
**0184T**864.70*821.47*944.69
**0198T**88.88*84.44*97.11
#**0198T**32.79*31.15*35.82
**0200T**1867.00*1773.65*2039.70
#**0200T**420.77*399.73*459.69
**0201T**2800.50*2660.48*3059.55
#**0201T**631.15*599.59*689.53
**0207T**121.71*115.62*132.96
**0208T**40.00*38.00*43.70
**0209T**48.41*45.99*52.89
**0210T**30.54*29.01*33.36
**0211T**47.36*44.99*51.74
**0212T**37.71*35.82*41.19
#**0212T**32.45*30.83*35.45
**0213T**201.94*191.84*220.62
#**0213T**109.05*103.60*119.14
**0214T**101.73*96.64*111.14
#**0214T**61.07*58.02*66.72
**0215T**102.08*96.98*111.53
#**0215T**62.12*59.01*67.86
**0216T**185.98*176.68*203.18
#**0216T**93.79*89.10*102.47
**0217T**95.14*90.38*103.94
#**0217T**52.38*49.76*57.22
**0218T**95.14*90.38*103.94
#**0218T**53.43*50.76*58.37
**0219T**1400.02*1330.02*1529.52
**0220T**1374.11*1305.40*1501.21
**0221T**1680.23*1596.22*1835.65
**0222T**412.48*391.86*450.64
**0232T**837.79*795.90*915.29
#**0232T**125.89*119.60*137.54
**0234T**8996.92*8547.07*9829.13
#**0234T**609.39*578.92*665.76
**0235T**8996.92*8547.07*9829.13
#**0235T**609.39*578.92*665.76
**0236T**9153.36*8695.69*10000.04
#**0236T**704.49*669.27*769.66
**0237T**9153.36*8695.69*10000.04
#**0237T**704.49*669.27*769.66
**0238T**9153.36*8695.69*10000.04
#**0238T**704.49*669.27*769.66
**0266T**940.77*893.73*1027.79
**0267T**165.10*156.85*180.38
**0268T**350.41*332.89*382.82
**0269T**891.50*846.93*973.97
**0270T**165.10*156.85*180.38
**0271T**350.41*332.89*382.82
**0272T**58.55*55.62*63.96
**0273T**74.80*71.06*81.72
**0274T**1176.52*1117.69*1285.34
**0278T**14.87*14.13*16.25
**0308T**1449.70*1377.22*1583.80
**0329T**88.88*84.44*97.11
#**0329T**32.79*31.15*35.82
**0330T**38.21*36.30*41.75
**0331T**192.30*182.69*210.09
**0332T**328.22*311.81*358.58
**0347T**148.23*140.82*161.94
**0348T**34.59*32.86*37.79
**0349T**36.71*34.87*40.10
**0350T**37.41*35.54*40.87
**0351T**177.81*168.92*194.26
**0352T**44.22*42.01*48.31
**0353T**177.81*168.92*194.26
**0354T**44.22*42.01*48.31
**0358T**28.43*27.01*31.06
**0362T**94.85*90.11*103.63
#**0362T**67.86*64.47*74.14
**0378T**25.60*24.32*27.97
**0394T**262.25*249.14*286.51
**0395T**634.34*602.62*693.01
**0397T**48.40*45.98*52.88
**0398T*26*1746.88*1659.54*1908.47
**0408T**534.28*507.57*583.71
**0409T**369.95*351.45*404.17
**0410T**384.68*365.45*420.27
**0411T**384.68*365.45*420.27
**0412T**242.50*230.38*264.94
**0413T**500.29*475.28*546.57
**0414T**385.78*366.49*421.46
**0415T**321.34*305.27*351.06
**0416T**356.77*338.93*389.77
**0417T**86.97*82.62*95.01
**0418T**58.55*55.62*63.96
**0419T**470.41*446.89*513.92
#**0419T**376.47*357.65*411.30
**0420T**668.96*635.51*730.84
#**0420T**552.94*525.29*604.08
**0421T**1684.27*1600.06*1840.07
#**0421T**720.69*684.66*787.36
**0437T**222.69*211.56*243.29
**0439T**75.55*71.77*82.54
**0440T**260.44*247.42*284.53
#**0440T**123.74*117.55*135.18
**0441T**260.44*247.42*284.53
#**0441T**123.74*117.55*135.18
**0442T**260.44*247.42*284.53
#**0442T**123.74*117.55*135.18
**0449T**792.20*752.59*865.48
**0464T**70.55*67.02*77.07
**0472T**69.95*66.45*76.42
**0473T**58.55*55.62*63.96
**0479T**64.99*61.74*71.00
**0480T**162.79*154.65*177.85
#**0480T**32.50*30.88*35.51
**0483T**1241.47*1179.40*1356.31
**0484T**1609.23*1528.77*1758.09
**0485T**24.49*23.27*26.76
**0485T*TC*9.33*8.86*10.19
**0485T*26*15.55*14.77*16.99
**0486T**48.98*46.53*53.51
**0486T*TC*18.27*17.36*19.96
**0486T*26*30.72*29.18*33.56
**0488T**65.22*61.96*71.25
#**0488T**51.55*48.97*56.32
**0505T**11770.26*11181.75*12859.01
#**0505T**602.66*572.53*658.41
**0507T**24.57*23.34*26.84
**0507T*TC*21.42*20.35*23.40
**0507T*26*3.15*2.99*3.44
**0510T**633.41*601.74*692.00
#**0510T**444.13*421.92*485.21
**0512T**327.74*311.35*358.05
#**0512T**234.86*223.12*256.59
**0513T**98.32*93.40*107.41
#**0513T**70.46*66.94*76.98
**0515T**534.28*507.57*583.71
**0516T**493.30*468.64*538.94
**0517T**350.41*332.89*382.82
**0518T**242.50*230.38*264.94
**0519T**351.50*333.93*384.02
**0520T**493.30*468.64*538.94
**0521T**58.55*55.62*63.96
**0521T*TC*37.90*36.01*41.41
**0521T*26*20.66*19.63*22.57
**0522T**69.95*66.45*76.42
**0522T*TC*38.60*36.67*42.17
**0522T*26*31.35*29.78*34.25
**0523T**159.52*151.54*174.27
**0524T**1726.59*1640.26*1886.30
#**0524T**183.97*174.77*200.99
**0525T**493.66*468.98*539.33
**0526T**384.68*365.45*420.27
**0527T**334.65*317.92*365.61
**0528T**69.95*66.45*76.42
**0528T*TC*38.60*36.67*42.17
**0528T*26*31.35*29.78*34.25
**0529T**58.55*55.62*63.96
**0529T*TC*37.90*36.01*41.41
**0529T*26*20.66*19.63*22.57
**0530T**657.69*624.81*718.53
**0531T**500.29*475.28*546.57
**0532T**351.50*333.93*384.02
**0540T**183.35*174.18*200.31
**0543T**1609.23*1528.77*1758.09
**0544T**1851.63*1759.05*2022.91
**0545T**1851.63*1759.05*2022.91
**0546T**74.72*70.98*81.63
**0552T**6.99*6.64*7.64
**0553T**2581.12*2452.06*2819.87
#**0553T**407.56*387.18*445.26
**0565T**644.67*612.44*704.31
#**0565T**539.86*512.87*589.80
**0566T**104.36*99.14*114.01
#**0566T**61.25*58.19*66.92
**0569T**1851.63*1759.05*2022.91
**0570T**433.76*412.07*473.88
**0571T**578.07*549.17*631.55
**0572T**470.60*447.07*514.13
**0573T**359.52*341.54*392.77
**0574T**416.72*395.88*455.26
**0575T**69.95*66.45*76.42
**0576T**58.55*55.62*63.96
**0577T**196.92*187.07*215.13
**0578T**30.08*28.58*32.87
**0579T**22.47*21.35*24.55
**0580T**223.23*212.07*243.88
**0581T**2384.23*2265.02*2604.77
#**0581T**220.13*209.12*240.49
**0582T**1739.01*1652.06*1899.87
#**0582T**399.68*379.70*436.66
**0583T**1522.66*1446.53*1663.51
#**0583T**139.32*132.35*152.20
**0587T**463.23*440.07*506.08
#**0587T**307.60*292.22*336.05
**0588T**382.12*363.01*417.46
#**0588T**240.16*228.15*262.37
**0589T**50.01*47.51*54.64
#**0589T**39.85*37.86*43.54
**0590T**59.15*56.19*64.62
#**0590T**41.27*39.21*45.09
**0596T**672.69*639.06*734.92
#**0596T**134.47*127.75*146.91
**0597T**672.69*639.06*734.92
#**0597T**134.47*127.75*146.91
**0598T**158.97*151.02*173.67
**0599T**105.66*100.38*115.44
**0600T**3751.37*3563.80*4098.37
#**0600T**746.03*708.73*815.04
**0601T**1521.35*1445.28*1662.07
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**205.09*194.84*224.07
**0611T**42.85*40.71*46.82
**0614T**385.06*365.81*420.68
**0615T**48.90*46.46*53.43
**0616T**686.14*651.83*749.60
**0617T**768.36*729.94*839.43
**0618T**930.46*883.94*1016.53
**0619T**682.44*648.32*745.57
#**0619T**495.66*470.88*541.51
**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**271.01*257.46*296.08
#**0627T**102.76*97.62*112.26
**0628T**81.30*77.24*88.83
#**0628T**30.83*29.29*33.68
**0629T**271.01*257.46*296.08
#**0629T**102.76*97.62*112.26
**0630T**81.30*77.24*88.83
#**0630T**30.83*29.29*33.68
**0631T**86.54*82.21*94.54
**0632T**595.57*565.79*650.66
**0633T**210.84*200.30*230.35
*C*0633T*TC*112.21*106.60*122.59
**0633T*26*60.38*57.36*65.96
**0634T**210.84*200.30*230.35
**0634T*TC*150.45*142.93*164.37
**0634T*26*60.38*57.36*65.96
**0635T**210.84*200.30*230.35
**0635T*TC*150.45*142.93*164.37
**0635T*26*60.38*57.36*65.96
**0636T**210.84*200.30*230.35
**0636T*TC*150.45*142.93*164.37
**0636T*26*60.38*57.36*65.96
**0637T**210.84*200.30*230.35
**0637T*TC*150.45*142.93*164.37
**0637T*26*60.38*57.36*65.96
**0638T**210.84*200.30*230.35
**0638T*TC*150.45*142.93*164.37
**0638T*26*60.38*57.36*65.96
**0639T**86.54*82.21*94.54
**0640T**24.57*23.34*26.84
**0640T*TC*21.58*20.50*23.58
**0640T*26*3.15*2.99*3.44
**0644T**1220.27*1159.26*1333.15
#**0644T**248.29*235.88*271.26
**0646T**1851.63*1759.05*2022.91
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**62.36*59.24*68.13
**0652T**301.55*286.47*329.44
#**0652T**126.29*119.98*137.98
**0653T**394.31*374.59*430.78
#**0653T**142.64*135.51*155.84
**0654T**146.53*139.20*160.08
**0655T**1684.27*1600.06*1840.07
#**0655T**720.69*684.66*787.36
**0658T**99.94*94.94*109.18
**0659T**2827.76*2686.37*3089.33
#**0659T**449.15*426.69*490.69
**0671T**1064.88*1011.64*1163.39
**0673T**3604.86*3424.62*3938.31
#**0673T**376.94*358.09*411.80
**0699T**117.19*111.33*128.03
#**0699T**94.05*89.35*102.75
**0707T**389.54*370.06*425.57
#**0707T**292.45*277.83*319.50
**0714T**1475.97*1402.17*1612.50
#**0714T**373.25*354.59*407.78
**0730T**280.75*266.71*306.72
#**0730T**251.14*238.58*274.37
**0738T**73.03*69.38*79.79
**0739T**1684.27*1600.06*1840.07
#**0739T**720.69*684.66*787.36
**0740T**21.11*20.05*23.06
**0741T**49.81*47.32*54.42
**0742T**98.46*93.54*107.57
**0742T*TC*78.93*74.98*86.23
**0742T*26*19.54*18.56*21.34
**0743T**55.92*53.12*61.09
**0744T**923.94*877.74*1009.40
**0745T**270.89*257.35*295.95
**0746T**231.45*219.88*252.86
**0747T**1047.33*994.96*1144.20
**0748T**191.63*182.05*209.36
**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**4.50*4.28*4.92
**0765T**8.29*7.88*9.06
**0771T**27.27*25.91*29.80
**0772T**27.27*25.91*29.80
**0773T**24.40*23.18*26.66
**0774T**24.40*23.18*26.66
**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**459.50*436.53*502.01
**0779T*TC*432.93*411.28*472.97
**0779T*26*26.57*25.24*29.03
**0780T**24.40*23.18*26.66
**0783T**15.11*14.35*16.50
**0784T**2228.39*2116.97*2434.52
#**0784T**336.30*319.49*367.41
**0785T**254.38*241.66*277.91
#**0785T**150.98*143.43*164.94
**0786T**768.94*730.49*840.06
#**0786T**315.37*299.60*344.54
**0787T**254.38*241.66*277.91
#**0787T**150.98*143.43*164.94
**0788T**19.41*18.44*21.21
#**0788T**18.71*17.77*20.44
**0789T**27.50*26.13*30.05
#**0789T**23.39*22.22*25.55
**0790T**1989.69*1890.21*2173.74
**0791T**9.41*8.94*10.28
**0793T**595.57*565.79*650.66
**0794T**130.35*123.83*142.40
**0795T**739.96*702.96*808.40
**0796T**493.30*468.64*538.94
**0797T**493.30*468.64*538.94
**0798T**782.24*743.13*854.60
**0799T**521.49*495.42*569.73
**0800T**521.49*495.42*569.73
**0801T**1014.80*964.06*1108.67
**0802T**507.40*482.03*554.33
**0803T**507.40*482.03*554.33
**0804T**81.75*77.66*89.31
**0804T*TC*44.56*42.33*48.68
**0804T*26*37.20*35.34*40.64
**0805T**3110.04*2954.54*3397.72
#**0805T**334.99*318.24*365.98
**0806T**4146.72*3939.38*4530.29
#**0806T**446.65*424.32*487.97
**0807T**44.74*42.50*48.88
**0807T*TC*29.48*28.01*32.21
**0807T*26*15.26*14.50*16.68
**0808T**44.74*42.50*48.88
**0808T*TC*29.48*28.01*32.21
**0808T*26*15.26*14.50*16.68
**0810T**1174.62*1115.89*1283.27
**0811T**21.11*20.05*23.06
**0813T**2733.88*2597.19*2986.77
#**0813T**188.42*179.00*205.85
**0814T**486.93*462.58*531.97
#**0814T**365.56*347.28*399.37
**0818T**382.12*363.01*417.46
#**0818T**240.16*228.15*262.37
**0820T**151.47*143.90*165.49
#**0820T**132.90*126.26*145.20
**0821T**151.47*143.90*165.49
#**0821T**132.90*126.26*145.20
**0822T**128.75*122.31*140.66
#**0822T**112.96*107.31*123.41
**0823T**739.96*702.96*808.40
**0824T**782.24*743.13*854.60
**0825T**1014.80*964.06*1108.67
**0826T**69.95*66.45*76.42
**0826T*TC*38.60*36.67*42.17
**0826T*26*31.35*29.78*34.25
**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**24.57*23.34*26.84
**0859T*TC*21.42*20.35*23.40
**0859T*26*3.15*2.99*3.44
**0864T**327.74*311.35*358.05
#**0864T**234.86*223.12*256.59
**10011**447.04*424.69*488.39
#**10011**110.89*105.35*121.15
**10012**246.39*234.07*269.18
#**10012**73.93*70.23*80.76
**15847**369.27*350.81*403.43
**21088**1692.77*1608.13*1849.35
**21742**1208.74*1148.30*1320.55
**21743**1391.95*1322.35*1520.70
**32855**525.08*498.83*573.65
**32856**472.48*448.86*516.19
**33928**3455.18*3282.42*3774.78
**33929**1293.95*1229.25*1413.64
**33933**608.16*577.75*664.41
**33944**595.10*565.35*650.15
**34841**2301.94*2186.84*2514.87
**34842**2527.69*2401.31*2761.51
**34843**2753.47*2615.80*3008.17
**34844**2979.26*2830.30*3254.85
**34845**2301.94*2186.84*2514.87
**34846**2527.69*2401.31*2761.51
**34847**2753.47*2615.80*3008.17
**34848**2979.26*2830.30*3254.85
**43496**2337.42*2220.55*2553.63
**43647**808.32*767.90*883.09
**43648**581.29*552.23*635.06
#**43648**259.83*246.84*283.87
**43881**776.25*737.44*848.06
#**43881**715.99*680.19*782.22
**43882**819.77*778.78*895.60
#**43882**754.88*717.14*824.71
**47143**459.08*436.13*501.55
**47144**545.13*517.87*595.55
**47145**516.45*490.63*564.22
**48551**525.08*498.83*573.65
**50323**705.70*670.42*770.98
**50325**351.94*334.34*384.49
**53451**788.29*748.88*861.21
**53452**394.14*374.43*430.59
**53453**670.03*636.53*732.01
**53454**59.16*56.20*64.63
#**53454**36.38*34.56*39.74
**63043**615.12*584.36*672.01
**63044**594.60*564.87*649.60
**64596**2228.39*2116.97*2434.52
#**64596**336.30*319.49*367.41
**64597**668.52*635.09*730.35
#**64597**100.89*95.85*110.23
**64598**254.38*241.66*277.91
#**64598**150.98*143.43*164.94
**65757**124.76*118.52*136.30
**66983**686.14*651.83*749.60
**66987**792.87*753.23*866.21
**66988**658.47*625.55*719.38
*C*70170**264.83*251.59*289.33
*C*70170*TC*249.96*237.46*273.08
**70555**233.47*221.80*255.07
**70555*TC*112.75*107.11*123.18
*C*70557**718.09*682.19*784.52
*C*70557*TC*562.62*534.49*614.66
*C*70558**358.91*340.96*392.10
*C*70558*TC*187.57*178.19*204.92
*C*70559**348.89*331.45*381.17
*C*70559*TC*187.57*178.19*204.92
*C*74190**585.07*555.82*639.19
*C*74190*TC*562.62*534.49*614.66
**74235**151.35*143.78*165.35
**74235*TC*93.71*89.02*102.37
**74300**87.73*83.34*95.84
**74300*TC*74.24*70.53*81.11
**74301**27.13*25.77*29.64
**74301*TC*17.13*16.27*18.71
**74328**175.06*166.31*191.26
**74328*TC*151.60*144.02*165.62
**74329**147.70*140.32*161.37
**74329*TC*123.89*117.70*135.36
**74330**262.59*249.46*286.88
**74330*TC*234.97*223.22*256.70
**74340**86.58*82.25*94.59
**74340*TC*60.69*57.66*66.31
**74355**86.58*82.25*94.59
**74355*TC*49.64*47.16*54.23
**74360**86.58*82.25*94.59
**74360*TC*58.85*55.91*64.30
**74363**175.06*166.31*191.26
**74363*TC*132.94*126.29*145.23
*C*74445**166.65*158.32*182.07
*C*74445*TC*112.21*106.60*122.59
*C*74450**265.81*252.52*290.40
*C*74450*TC*249.96*237.46*273.08
*C*74470**587.81*558.42*642.18
*C*74470*TC*562.62*534.49*614.66
**74742**233.47*221.80*255.07
**74742*TC*203.79*193.60*222.64
*C*74775**279.98*265.98*305.88
*C*74775*TC*249.96*237.46*273.08
*C*75801**684.71*650.47*748.04
*C*75801*TC*640.79*608.75*700.06
*C*75803**1690.41*1605.89*1846.77
*C*75803*TC*1633.45*1551.78*1784.55
*C*75805**3290.43*3125.91*3594.80
*C*75805*TC*3251.09*3088.54*3551.82
*C*75807**3304.62*3139.39*3610.30
*C*75807*TC*3251.09*3088.54*3551.82
*C*75810**3300.18*3135.17*3605.45
*C*75810*TC*3251.09*3088.54*3551.82
**75894**945.14*897.88*1032.56
**75894*TC*871.33*827.76*951.92
*C*75898**3345.27*3178.01*3654.71
*C*75898*TC*3251.09*3088.54*3551.82
**75970**461.05*438.00*503.70
**75970*TC*422.70*401.57*461.81
**76125**41.35*39.28*45.17
**76125*TC*27.86*26.47*30.44
**76390**213.02*202.37*232.73
**76390*TC*160.41*152.39*175.25
**76390*26*52.61*49.98*57.48
**76932**88.10*83.70*96.26
**76932*TC*51.22*48.66*55.96
**76940**164.94*156.69*180.19
**76940*TC*62.00*58.90*67.74
**76941**119.63*113.65*130.70
**76941*TC*54.55*51.82*59.59
**76945**87.02*82.67*95.07
**76945*TC*54.68*51.95*59.74
*C*76975**291.36*276.79*318.31
*C*76975*TC*249.96*237.46*273.08
**76998**175.06*166.31*191.26
**76998*TC*126.91*120.56*138.64
**77013**438.81*416.87*479.40
**77013*TC*253.40*240.73*276.84
**77022**489.06*464.61*534.30
**77022*TC*286.84*272.50*313.38
**77371**1399.17*1329.21*1528.59
**77520**947.73*900.34*1035.39
**77522**947.73*900.34*1035.39
**77523**1088.05*1033.65*1188.70
**77525**1228.35*1166.93*1341.97
*C*78282**436.11*414.30*476.45
*C*78282*TC*420.66*399.63*459.57
**78414**514.99*489.24*562.63
**78414*TC*493.65*468.97*539.32
*C*78429**1675.47*1591.70*1830.46
*C*78429*TC*1595.60*1515.82*1743.19
*C*78430**1671.65*1588.07*1826.28
*C*78430*TC*1595.60*1515.82*1743.19
*C*78431**2497.99*2373.09*2729.05
*C*78431*TC*2409.15*2288.69*2631.99
*C*78432**2075.85*1972.06*2267.87
*C*78432*TC*1980.81*1881.77*2164.04
*C*78433**2192.08*2082.48*2394.85
*C*78433*TC*2088.07*1983.67*2281.22
**78434**737.17*700.31*805.36
**78434*TC*707.90*672.51*773.39
*C*78459**1522.43*1446.31*1663.26
*C*78459*TC*1448.38*1375.96*1582.35
*C*78491**1668.26*1584.85*1822.58
*C*78491*TC*1595.60*1515.82*1743.19
*C*78492**1681.03*1596.98*1836.53
*C*78492*TC*1595.60*1515.82*1743.19
*C*78608**1665.55*1582.27*1819.61
*C*78608*TC*1595.60*1515.82*1743.19
*C*78811**1520.44*1444.42*1661.08
*C*78811*TC*1448.38*1375.96*1582.35
*C*78812**1686.64*1602.31*1842.66
*C*78812*TC*1595.60*1515.82*1743.19
*C*78813**1688.68*1604.25*1844.89
*C*78813*TC*1595.60*1515.82*1743.19
*C*78814**1698.69*1613.76*1855.82
*C*78814*TC*1595.60*1515.82*1743.19
*C*78815**1710.42*1624.90*1868.64
*C*78815*TC*1595.60*1515.82*1743.19
*C*78816**1711.37*1625.80*1869.67
*C*78816*TC*1595.60*1515.82*1743.19
**79300**237.04*225.19*258.97
**79300*TC*172.96*164.31*188.96
**79445**237.04*225.19*258.97
**79445*TC*126.26*119.95*137.94
**86485**6.76*6.42*7.38
**90867**314.48*298.76*343.57
#**90867**142.55*135.42*155.73
**90868**210.40*199.88*229.86
#**90868**108.17*102.76*118.17
**90869**289.12*274.66*315.86
#**90869**167.64*159.26*183.15
**92978**253.91*241.21*277.39
**92978*TC*157.50*149.63*172.07
**92979**153.83*146.14*168.06
**92979*TC*77.38*73.51*84.54
*C*93315**689.74*655.25*753.54
*C*93315*TC*562.62*534.49*614.66
**93317**221.47*210.40*241.96
**93317*TC*132.67*126.04*144.95
*C*93318**665.15*631.89*726.67
*C*93318*TC*562.62*534.49*614.66
**93571**252.88*240.24*276.28
**93571*TC*179.57*170.59*196.18
**93572**151.37*143.80*165.37
**93572*TC*97.92*93.02*106.97
**93600**3557.81*3379.92*3886.91
**93600*TC*3439.73*3267.74*3757.90
**93602**3557.81*3379.92*3886.91
**93602*TC*3441.92*3269.82*3760.29
**93603**3557.81*3379.92*3886.91
**93603*TC*3441.92*3269.82*3760.29
**93609**2134.69*2027.96*2332.15
**93609*TC*1857.67*1764.79*2029.51
**93610**3557.81*3379.92*3886.91
**93610*TC*3394.10*3224.40*3708.06
**93612**3557.81*3379.92*3886.91
**93612*TC*3396.68*3226.85*3710.88
**93615**50.55*48.02*55.22
**93615*TC*14.97*14.22*16.35
**93616**84.64*80.41*92.47
**93616*TC*27.04*25.69*29.54
**93619**7115.62*6759.84*7773.82
**93619*TC*6724.37*6388.15*7346.37
**93620**7115.62*6759.84*7773.82
**93620*TC*6487.79*6163.40*7087.91
**93621**7115.62*6759.84*7773.82
**93621*TC*7032.10*6680.50*7682.58
**93622**7115.62*6759.84*7773.82
**93622*TC*6943.37*6596.20*7585.63
**93623**2134.69*2027.96*2332.15
**93623*TC*2071.22*1967.66*2262.81
**93624**3557.81*3379.92*3886.91
**93624*TC*3314.26*3148.55*3620.83
**93631**7115.62*6759.84*7773.82
**93631*TC*6713.85*6378.16*7334.88
**93640**1133.95*1077.25*1238.84
**93640*TC*954.76*907.02*1043.07
**93641**1133.95*1077.25*1238.84
**93641*TC*820.47*779.45*896.37
**93662**443.95*421.75*485.01
**93662*TC*373.32*354.65*407.85
**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**67.56*64.18*73.81
**95824*TC*28.83*27.39*31.50
**95965**946.80*899.46*1034.38
**95965*TC*536.80*509.96*586.45
**96020**404.66*384.43*442.09
**96547**782.99*743.84*855.42
#**96547**139.09*132.14*151.96
**96548**391.49*371.92*427.71
#**96548**69.54*66.06*75.97
**97151**51.13*48.57*55.86
#**97151**45.18*42.92*49.36
**97152**43.46*41.29*47.48
#**97152**38.40*36.48*41.95
**97153**34.58*32.85*37.78
#**97153**30.19*28.68*32.98
**97154**4.77*4.53*5.21
#**97154**4.32*4.10*4.72
**97155**34.58*32.85*37.78
#**97155**30.19*28.68*32.98
**97156**36.46*34.64*39.84
#**97156**31.90*30.31*34.86
**97157**10.69*10.16*11.68
#**97157**9.64*9.16*10.53
**97158**5.54*5.26*6.05
#**97158**5.02*4.77*5.49
**98978**49.81*47.32*54.42
# - 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.