Part B Fee Schedules

Fee Schedule 28270-29358

CPT/HCPC Code	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
28270	004	90	2	X	769.35	637.56
28270	003	90	2	X	778.36	644.28
28270	002	90	2	X	817.19	675.22
28270	001	90	2	X	826.64	682.75
28272	004	90	2	X	608.96	506.89
28272	002	90	2	X	745.67	618.38
28272	003	90	2	X	737.30	614.05
28272	001	90	2	X	703.03	583.27
28280	003	90	2	X	890.03	X
28280	002	90	2	X	903.66	X
28280	004	90	2	X	823.62	X
28280	001	90	2	X	830.68	X
28285	004	90	2	X	926.52	X
28285	001	90	2	X	1,025.14	X
28285	003	90	2	X	930.40	X
28285	002	90	2	X	1,011.50	X
28286	003	90	2	X	795.48	X
28286	002	90	2	X	989.96	X
28286	004	90	2	X	862.60	X
28286	001	90	2	X	936.92	X
28288	001	90	2	X	888.95	X
28288	003	90	2	X	823.00	X
28288	002	90	2	X	876.18	X
28288	004	90	2	X	812.97	X
28289	003	90	2	X	868.74	896.76
28289	002	90	2	X	868.74	896.76
28289	004	90	2	X	868.74	896.76
28289	001	90	2	X	950.58	983.33
28291	002	90	2	X	1,097.28	729.52
28291	003	90	2	X	1,097.28	729.52
28291	004	90	2	X	1,097.28	729.52
28291	001	90	2	X	1,218.55	792.42
28292	004	90	2	X	1,441.77	X
28292	002	90	2	X	1,555.11	X
28292	003	90	2	X	1,460.04	X
28292	001	90	2	X	1,578.00	X
28295	003	90	2	X	1,399.43	810.94
28295	002	90	2	X	1,399.43	810.94
28295	001	90	2	X	1,564.18	882.35
28295	004	90	2	X	1,399.43	810.94
28296	001	90	2	X	2,078.53	X
28296	004	90	2	X	1,901.39	X
28296	003	90	2	X	1,925.04	X
28296	002	90	2	X	2,048.73	X
28297	003	90	2	X	1,953.58	X
28297	002	90	2	X	2,081.97	X
28297	001	90	2	X	1,960.44	X
28297	004	90	2	X	1,929.55	X
28298	002	90	2	X	1,900.10	X
28298	003	90	2	X	1,788.21	X
28298	001	90	2	X	1,926.95	X
28298	004	90	2	X	1,765.51	X
28299	002	90	2	X	2,128.79	X
28299	003	90	2	X	2,045.48	X
28299	004	90	2	X	2,019.70	X
28299	001	90	2	X	1,958.74	X
28300	004	90	2	X	1,805.99	X
28300	001	90	2	X	1,842.61	X
28300	003	90	2	X	1,716.31	X
28300	002	90	2	X	1,818.01	X
28302	002	90	2	X	2,126.06	X
28302	003	90	2	X	1,993.96	X
28302	004	90	2	X	1,969.80	X
28302	001	90	2	X	2,158.02	X
28304	003	90	2	X	1,651.55	X
28304	002	90	2	X	1,747.27	X
28304	001	90	2	X	1,770.41	X
28304	004	90	2	X	1,632.01	X
28305	002	90	2	X	2,309.36	X
28305	003	90	2	X	2,173.65	X
28305	001	90	2	X	2,342.08	X
28305	004	90	2	X	2,146.97	X
28306	001	90	2	X	1,345.00	X
28306	004	90	2	X	1,245.89	X
28306	002	90	2	X	1,240.43	X
28306	003	90	2	X	1,355.60	X
28307	001	90	2	X	1,430.90	X
28307	003	90	2	X	1,321.12	X
28307	002	90	2	X	1,738.60	X
28307	004	90	2	X	1,305.17	X
28308	001	90	2	X	1,344.96	X
28308	004	90	2	X	1,183.31	X
28308	003	90	2	X	1,175.90	X
28308	002	90	2	X	1,248.32	X
28309	002	90	2	X	1,857.59	X
28309	003	90	2	X	1,744.27	X
28309	004	90	2	X	1,723.81	X
28309	001	90	2	X	1,884.93	X
28310	001	90	2	X	1,231.85	X
28310	004	90	2	X	1,174.15	X
28310	003	90	2	X	1,007.07	X
28310	002	90	2	X	1,114.35	X
28312	001	90	2	X	1,044.31	X
28312	003	90	2	X	968.65	X
28312	002	90	2	X	1,029.66	X
28312	004	90	2	X	925.74	X
28313	004	90	2	X	814.63	X
28313	003	90	2	X	798.55	X
28313	002	90	2	X	841.38	X
28313	001	90	2	X	851.74	X
28315	004	90	2	X	889.49	X
28315	001	90	2	X	1,034.92	X
28315	002	90	2	X	1,021.12	X
28315	003	90	2	X	963.70	X
28320	001	90	2	X	2,081.38	X
28320	003	90	2	X	1,925.54	X
28320	002	90	2	X	1,972.87	X
28320	004	90	2	X	1,902.07	X
28322	004	90	2	X	1,368.04	X
28322	001	90	2	X	1,476.66	X
28322	003	90	2	X	1,383.91	X
28322	002	90	2	X	1,458.58	X
28340	002	90	2	X	1,540.91	X
28340	003	90	2	X	1,523.91	X
28340	004	90	2	X	1,423.66	X
28340	001	90	2	X	1,565.01	X
28341	004	90	2	X	1,696.99	X
28341	003	90	2	X	1,717.83	X
28341	002	90	2	X	1,831.47	X
28341	001	90	2	X	1,858.85	X
28344	003	90	2	X	853.73	X
28344	002	90	2	X	915.66	X
28344	001	90	2	X	930.69	X
28344	004	90	2	X	843.58	X
28345	004	90	2	X	1,193.29	X
28345	001	90	2	X	1,310.24	X
28345	003	90	2	X	1,207.91	X
28345	002	90	2	X	1,290.34	X
28360	001	90	2	X	1,310.24	X
28360	002	90	2	X	1,290.34	X
28360	003	90	2	X	1,207.91	X
28360	004	90	2	X	1,193.29	X
28400	004	90	2	X	682.02	X
28400	002	90	2	X	611.31	X
28400	003	90	2	X	733.36	X
28400	001	90	2	X	681.43	X
28405	001	90	2	X	1,101.21	X
28405	004	90	2	X	902.87	X
28405	002	90	2	X	1,246.35	X
28405	003	90	2	X	1,002.07	X
28406	004	90	2	X	1,320.89	X
28406	002	90	2	X	1,464.65	X
28406	003	90	2	X	1,342.33	X
28406	001	90	2	X	1,458.04	X
28415	001	90	2	X	2,672.68	X
28415	003	90	2	X	2,308.82	X
28415	002	90	2	X	2,634.56	X
28415	004	90	2	X	2,296.56	X
28420	002	90	2	X	3,147.48	X
28420	003	90	2	X	3,109.28	X
28420	001	90	2	X	3,295.34	X
28420	004	90	2	X	2,926.80	X
28430	004	90	2	X	624.75	X
28430	001	90	2	X	649.17	X
28430	003	90	2	X	633.95	X
28430	002	90	2	X	531.52	X
28435	001	90	2	X	808.13	X
28435	004	90	2	X	732.82	X
28435	003	90	2	X	881.49	X
28435	002	90	2	X	898.78	X
28436	004	90	2	X	955.59	X
28436	002	90	2	X	1,037.25	X
28436	003	90	2	X	967.13	X
28436	001	90	2	X	1,054.20	X
28445	002	90	2	X	2,123.38	X
28445	003	90	2	X	1,978.72	X
28445	004	90	2	X	1,955.01	X
28445	001	90	2	X	2,158.37	X
28446	001	90	2	X	2,170.79	X
28446	003	90	2	X	1,919.88	X
28446	002	90	2	X	1,919.88	X
28446	004	90	2	X	1,919.88	X
28450	004	90	2	X	426.91	X
28450	002	90	2	X	446.97	X
28450	003	90	2	X	424.01	X
28450	001	90	2	X	450.52	X
28455	001	90	2	X	672.72	X
28455	003	90	2	X	620.35	X
28455	002	90	2	X	646.06	X
28455	004	90	2	X	669.83	X
28456	002	90	2	X	348.41	X
28456	003	90	2	X	525.86	X
28456	001	90	2	X	573.47	X
28456	004	90	2	X	519.62	X
28465	004	90	2	X	1,335.84	X
28465	001	90	2	X	1,451.43	X
28465	002	90	2	X	1,423.98	X
28465	003	90	2	X	1,345.71	X
28470	001	90	2	X	427.50	329.14
28470	004	90	2	X	389.70	299.51
28470	003	90	2	X	422.64	324.66
28470	002	90	2	X	429.92	330.67
28475	001	90	2	X	605.69	477.45
28475	003	90	2	X	561.24	441.76
28475	002	90	2	X	596.95	470.52
28475	004	90	2	X	554.54	437.18
28476	004	90	2	X	717.07	X
28476	002	90	2	X	776.73	X
28476	003	90	2	X	725.95	X
28476	001	90	2	X	788.98	X
28485	001	90	2	X	1,193.51	X
28485	004	90	2	X	978.95	X
28485	002	90	2	X	1,034.27	X
28485	003	90	2	X	976.09	X
28490	002	90	2	X	231.19	180.54
28490	003	90	2	X	222.45	173.40
28490	001	90	2	X	236.13	183.96
28490	004	90	2	X	217.74	169.89
28495	002	90	2	X	301.94	X
28495	003	90	2	X	301.32	X
28495	001	90	2	X	306.02	X
28495	004	90	2	X	285.36	X
28496	002	90	2	X	507.38	X
28496	003	90	2	X	474.21	X
28496	004	90	2	X	468.51	X
28496	001	90	2	X	515.33	X
28505	004	90	2	X	868.07	X
28505	002	90	2	X	774.61	X
28505	003	90	2	X	847.08	X
28505	001	90	2	X	888.85	X
28510	001	90	2	X	234.34	182.74
28510	004	90	2	X	216.63	169.16
28510	003	90	2	X	218.49	171.00
28510	002	90	2	X	226.42	176.73
28515	003	90	2	X	295.04	233.19
28515	002	90	2	X	285.97	225.66
28515	001	90	2	X	289.71	228.58
28515	004	90	2	X	271.09	214.47
28525	001	90	2	X	638.73	X
28525	004	90	2	X	618.12	X
28525	003	90	2	X	620.79	X
28525	002	90	2	X	600.97	X
28530	004	90	2	X	216.63	X
28530	001	90	2	X	236.13	X
28530	002	90	2	X	232.91	X
28530	003	90	2	X	219.33	X
28531	003	90	2	X	441.31	X
28531	002	90	2	X	473.60	X
28531	004	90	2	X	436.11	X
28531	001	90	2	X	481.34	X
28540	003	90	2	X	382.32	X
28540	002	90	2	X	392.68	X
28540	001	90	2	X	396.46	X
28540	004	90	2	X	400.48	X
28545	001	90	2	X	405.02	X
28545	002	90	2	X	400.12	X
28545	003	90	2	X	379.82	X
28545	004	90	2	X	375.41	X
28546	002	90	2	X	678.91	X
28546	003	90	2	X	633.03	X
28546	001	90	2	X	689.92	X
28546	004	90	2	X	625.57	X
28555	004	90	2	X	1,250.42	X
28555	003	90	2	X	1,250.81	X
28555	002	90	2	X	1,350.40	X
28555	001	90	2	X	1,370.79	X
28570	003	90	2	X	346.06	X
28570	002	90	2	X	409.20	X
28570	004	90	2	X	341.78	X
28570	001	90	2	X	482.65	X
28575	001	90	2	X	690.47	X
28575	004	90	2	X	627.46	X
28575	003	90	2	X	635.09	X
28575	002	90	2	X	679.68	X
28576	004	90	2	X	715.85	X
28576	001	90	2	X	782.35	X
28576	003	90	2	X	724.28	X
28576	002	90	2	X	771.06	X
28585	001	90	2	X	1,451.28	X
28585	004	90	2	X	1,619.16	X
28585	002	90	2	X	1,466.82	X
28585	003	90	2	X	877.09	X
28600	004	90	2	X	261.93	X
28600	001	90	2	X	278.26	X
28600	002	90	2	X	277.36	X
28600	003	90	2	X	264.88	X
28605	002	90	2	X	560.23	X
28605	003	90	2	X	510.88	X
28605	001	90	2	X	569.02	X
28605	004	90	2	X	517.54	X
28606	001	90	2	X	956.59	X
28606	004	90	2	X	879.94	X
28606	003	90	2	X	890.29	X
28606	002	90	2	X	954.81	X
28615	002	90	2	X	1,214.46	X
28615	003	90	2	X	1,132.90	X
28615	004	90	2	X	1,119.33	X
28615	001	90	2	X	1,234.17	X
28630	003	10	2	X	275.00	X
28630	002	10	2	X	291.29	X
28630	001	10	2	X	296.92	X
28630	004	10	2	X	288.34	X
28635	001	10	2	X	392.15	X
28635	003	10	2	X	364.49	X
28635	002	10	2	X	353.96	X
28635	004	10	2	X	360.11	X
28636	001	10	2	X	641.83	X
28636	004	10	2	X	581.70	X
28636	002	10	2	X	631.43	X
28636	003	10	2	X	588.72	X
28645	004	90	2	X	781.09	X
28645	001	90	2	X	850.41	X
28645	003	90	2	X	790.48	X
28645	002	90	2	X	838.76	X
28660	003	10	2	X	209.83	X
28660	002	10	2	X	205.49	X
28660	004	10	2	X	225.48	X
28660	001	10	2	X	219.73	X
28665	002	10	2	X	325.82	X
28665	003	10	2	X	309.74	X
28665	001	10	2	X	329.72	X
28665	004	10	2	X	306.24	X
28666	001	10	2	X	613.58	X
28666	004	10	2	X	556.26	X
28666	003	10	2	X	562.98	X
28666	002	10	2	X	603.66	X
28675	004	90	2	X	654.47	X
28675	002	90	2	X	677.93	X
28675	003	90	2	X	633.01	X
28675	001	90	2	X	700.24	X
28705	001	90	2	X	3,603.44	X
28705	004	90	2	X	3,261.33	X
28705	002	90	2	X	2,862.45	X
28705	003	90	2	X	3,301.23	X
28715	002	90	2	X	2,949.79	X
28715	003	90	2	X	2,823.13	X
28715	001	90	2	X	2,997.79	X
28715	004	90	2	X	2,750.24	X
28725	003	90	2	X	2,267.92	X
28725	002	90	2	X	2,423.67	X
28725	004	90	2	X	2,241.04	X
28725	001	90	2	X	2,312.26	X
28730	002	90	2	X	2,255.03	X
28730	003	90	2	X	1,971.52	X
28730	001	90	2	X	2,180.67	X
28730	004	90	2	X	2,084.94	X
28735	002	90	2	X	2,249.80	X
28735	003	90	2	X	2,209.80	X
28735	004	90	2	X	2,183.18	X
28735	001	90	2	X	2,398.95	X
28737	002	90	2	X	1,997.03	X
28737	003	90	2	X	1,967.79	X
28737	004	90	2	X	1,943.88	X
28737	001	90	2	X	2,142.47	X
28740	002	90	2	X	1,341.63	X
28740	003	90	2	X	1,298.64	X
28740	004	90	2	X	1,281.86	X
28740	001	90	2	X	1,361.62	X
28750	001	90	2	X	1,451.95	X
28750	004	90	2	X	1,369.40	X
28750	003	90	2	X	1,439.08	X
28750	002	90	2	X	1,452.12	X
28755	001	90	2	X	969.65	X
28755	003	90	2	X	950.25	X
28755	002	90	2	X	956.03	X
28755	004	90	2	X	889.18	X
28760	004	90	2	X	1,464.34	X
28760	001	90	2	X	1,298.11	X
28760	003	90	2	X	1,256.88	X
28760	002	90	2	X	1,356.00	X
28800	004	90	2	X	1,809.71	X
28800	001	90	2	X	1,875.45	X
28800	002	90	2	X	1,859.29	X
28800	003	90	2	X	1,787.25	X
28805	004	90	2	X	1,661.42	X
28805	002	90	2	X	1,690.23	X
28805	003	90	2	X	1,573.41	X
28805	001	90	2	X	1,841.91	X
28810	004	90	2	X	1,052.85	X
28810	001	90	2	X	1,157.76	X
28810	002	90	2	X	1,179.15	X
28810	003	90	2	X	1,081.04	X
28820	004	0	2	X	682.51	X
28820	001	0	2	X	840.70	X
28820	003	0	2	X	690.47	X
28820	002	0	2	X	738.02	X
28825	004	0	2	X	612.62	X
28825	001	0	2	X	778.24	X
28825	002	0	2	X	676.68	X
28825	003	0	2	X	619.80	X
28890	003	90	2	X	639.77	401.07
28890	001	90	2	X	745.08	452.89
28890	002	90	2	X	639.77	401.07
28890	004	90	2	X	639.77	401.07
28899		YYY	2	X	#	X
29000	003	0	2	X	548.34	X
29000	002	0	2	X	487.20	X
29000	001	0	2	X	482.60	X
29000	004	0	2	X	295.52	X
29010	003	0	2	X	491.98	X
29010	002	0	2	X	527.91	X
29010	004	0	2	X	485.97	X
29010	001	0	2	X	689.92	X
29015	003	0	2	X	528.74	X
29015	002	0	2	X	697.16	X
29015	001	0	2	X	573.86	X
29015	004	0	2	X	522.39	X
29035	003	0	2	X	618.12	X
29035	002	0	2	X	712.81	X
29035	004	0	2	X	415.05	X
29035	001	0	2	X	459.71	X
29040	001	0	2	X	512.64	X
29040	003	0	2	X	472.35	X
29040	002	0	2	X	504.85	X
29040	004	0	2	X	466.70	X
29044	001	0	2	X	516.07	X
29044	004	0	2	X	467.49	X
29044	003	0	2	X	473.04	X
29044	002	0	2	X	507.62	X
29046	001	0	2	X	566.94	X
29046	003	0	2	X	520.85	X
29046	002	0	2	X	557.93	X
29046	004	0	2	X	514.60	X
29049	001	0	2	X	152.71	X
29049	004	0	2	X	130.54	X
29049	002	0	2	X	150.82	X
29049	003	0	2	X	143.12	X
29055	004	0	2	X	468.98	X
29055	002	0	2	X	453.35	X
29055	003	0	2	X	328.78	X
29055	001	0	2	X	353.78	X
29058	001	0	2	X	229.08	X
29058	004	0	2	X	318.86	X
29058	003	0	2	X	214.56	X
29058	002	0	2	X	226.26	X
29065	003	0	2	X	308.15	241.19
29065	002	0	2	X	318.76	250.02
29065	004	0	2	X	291.16	228.19
29065	001	0	2	X	317.19	249.25
29075	004	0	2	X	186.47	148.72
29075	001	0	2	X	232.45	185.99
29075	003	0	2	X	224.06	178.81
29075	002	0	2	X	248.97	198.66
29085	004	0	2	X	117.10	97.70
29085	001	0	2	X	124.64	103.23
29085	003	0	2	X	118.09	98.00
29085	002	0	2	X	123.21	102.49
29086	004	0	2	X	116.30	92.71
29086	001	0	2	X	132.51	104.77
29086	003	0	2	X	116.30	92.71
29086	002	0	2	X	116.30	92.71
29105	001	0	2	X	163.23	135.70
29105	004	0	2	X	150.50	125.21
29105	002	0	2	X	161.39	134.10
29105	003	0	2	X	150.03	124.32
29125	001	0	2	X	113.21	93.16
29125	003	0	2	X	110.91	91.57
29125	002	0	2	X	111.70	91.99
29125	004	0	2	X	104.33	85.99
29126	004	0	2	X	102.97	86.92
29126	002	0	2	X	119.46	100.39
29126	003	0	2	X	132.65	111.73
29126	001	0	2	X	137.54	115.92
29130	001	0	2	X	76.87	67.65
29130	002	0	2	X	76.03	66.99
29130	003	0	2	X	93.55	82.46
29130	004	0	2	X	94.06	83.04
29131	001	0	2	X	190.31	X
29131	004	0	2	X	103.20	X
29131	003	0	2	X	187.43	X
29131	002	0	2	X	179.29	X
29200	004	0	2	X	81.28	70.42
29200	001	0	2	X	84.66	72.96
29200	002	0	2	X	85.24	73.50
29200	003	0	2	X	81.65	70.34
29240	002	0	2	X	104.55	X
29240	003	0	2	X	101.77	X
29240	004	0	2	X	97.88	X
29240	001	0	2	X	102.41	X
29260	001	0	2	X	81.07	69.88
29260	004	0	2	X	77.75	67.13
29260	002	0	2	X	80.89	69.94
29260	003	0	2	X	77.78	67.10
29280	004	0	2	X	77.00	X
29280	001	0	2	X	82.31	X
29280	002	0	2	X	81.43	X
29280	003	0	2	X	77.88	X
29305	001	0	2	X	607.05	X
29305	003	0	2	X	502.39	X
29305	002	0	2	X	607.12	X
29305	004	0	2	X	434.11	X
29325	001	0	2	X	512.58	X
29325	004	0	2	X	468.18	X
29325	002	0	2	X	505.02	X
29325	003	0	2	X	483.87	X
29345	002	0	2	X	384.76	310.68
29345	003	0	2	X	303.86	245.74
29345	001	0	2	X	378.56	305.70
29345	004	0	2	X	288.72	233.19
29355	003	0	2	X	292.51	236.55
29355	002	0	2	X	328.65	265.62
29355	001	0	2	X	315.87	255.89
29355	004	0	2	X	267.75	216.92
29358	003	0	2	X	380.46	X
29358	002	0	2	X	439.43	X
29358	004	0	2	X	375.81	X
29358	001	0	2	X	442.54	X

Fee Schedule 28270-29358

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