PART B FEE SCHEDULES

Fee Schedule L1680-L5999

CPT/HCPC Code	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
L1680			X	2,409.11	X
L1681			X	2,854.83	X
L1685			X	2,458.53	X
L1686			X	2,270.23	X
L1690			X	3,619.50	X
L1700			X	3,019.41	X
L1710			X	3,534.63	X
L1720			X	2,605.44	X
L1730			X	2,237.78	X
L1755			X	3,551.27	X
L1810			X	194.74	X
L1812			X	139.45	X
L1820			X	301.74	X
L1830			X	183.54	X
L1831			X	502.04	X
L1832			X	1,398.37	X
L1833			X	1,001.59	X
L1834			X	1,534.88	X
L1836			X	232.61	X
L1840			X	2,044.42	X
L1843	XXX		X	1,048.76	X
L1844			X	3,209.86	X
L1845			X	1,921.67	X
L1846			X	2,180.52	X
L1847			X	1,076.49	X
L1848			X	850.27	X
L1850			X	600.94	X
L1851			X	1,265.02	X
L1852			X	1,312.77	X
L1860			X	2,121.66	X
L1900			X	533.41	X
L1902			X	184.33	X
L1904			X	1,108.47	X
L1906			X	237.74	X
L1907			X	959.81	X
L1910			X	540.12	X
L1920			X	691.25	X
L1930			X	467.68	X
L1932			X	1,466.41	X
L1940			X	977.82	X
L1945			X	2,337.85	X
L1950			X	1,550.07	X
L1951			X	1,432.55	X
L1960			X	1,169.11	X
L1970			X	1,406.95	X
L1971			X	799.52	X
L1980			X	725.66	X
L1990			X	881.39	X
L2000			X	2,088.00	X
L2005			X	5,915.33	X
L2006			X	*	X
L2010			X	1,947.78	X
L2020			X	2,452.60	X
L2030			X	2,226.38	X
L2034			X	*	X
L2035	XXX		X	339.82	X
L2036			X	3,801.53	X
L2037			X	3,546.60	X
L2038			X	3,602.78	X
L2040			X	436.95	X
L2050			X	941.87	X
L2060			X	1,147.92	X
L2070			X	294.75	X
L2080			X	711.20	X
L2090			X	866.96	X
L2106			X	1,344.35	X
L2108			X	2,340.71	X
L2112			X	1,076.63	X
L2114			X	1,350.41	X
L2116			X	1,553.79	X
L2126			X	2,599.11	X
L2128			X	3,680.52	X
L2132			X	1,995.44	X
L2134			X	2,129.33	X
L2136			X	2,541.42	X
L2180			X	237.20	X
L2182			X	196.50	X
L2184			X	268.61	X
L2186			X	372.63	X
L2188			X	713.64	X
L2190			X	184.43	X
L2192			X	809.66	X
L2200			X	94.03	X
L2210			X	136.05	X
L2220			X	161.92	X
L2230			X	151.69	X
L2232			X	*	X
L2240			X	187.77	X
L2250			X	761.33	X
L2260			X	396.31	X
L2265			X	232.78	X
L2270			X	109.22	X
L2275	XXX		X	*	X
L2280			X	900.17	X
L2300			X	564.42	X
L2310			X	282.60	X
L2320			X	406.79	X
L2330			X	851.64	X
L2335			X	525.79	X
L2340			X	1,138.29	X
L2350			X	1,965.85	X
L2360			X	102.29	X
L2370			X	662.90	X
L2375			X	280.05	X
L2380			X	243.39	X
L2385			X	264.88	X
L2387			X	*	X
L2390			X	221.63	X
L2395			X	309.34	X
L2397			X	*	X
L2405			X	115.80	X
L2415			X	367.23	X
L2425			X	449.25	X
L2430	XXX		X	190.93	X
L2492			X	268.58	X
L2500			X	642.56	X
L2510			X	1,441.75	X
L2520			X	951.02	X
L2525			X	2,566.02	X
L2526			X	1,464.28	X
L2530			X	464.62	X
L2540			X	835.89	X
L2550			X	567.84	X
L2570			X	941.75	X
L2580			X	917.62	X
L2600			X	502.54	X
L2610			X	532.25	X
L2620			X	598.50	X
L2622			X	678.48	X
L2624			X	654.73	X
L2627			X	3,572.68	X
L2628			X	3,514.30	X
L2630			X	489.64	X
L2640			X	664.47	X
L2650			X	282.93	X
L2660			X	368.52	X
L2670			X	357.41	X
L2680			X	331.06	X
L2750			X	165.27	X
L2755	XXX		X	253.68	X
L2760			X	120.16	X
L2768			X	229.20	X
L2780			X	133.76	X
L2785			X	63.00	X
L2795			X	170.61	X
L2800			X	262.29	X
L2810			X	205.89	X
L2820			X	171.76	X
L2830			X	185.73	X
L2840			X	109.86	X
L2850			X	122.46	X
L2861			X	*	X
L2999			X	#	X
L3000			X	*	X
L3001			X	*	X
L3002			X	*	X
L3003			X	*	X
L3010			X	*	X
L3020			X	*	X
L3030			X	*	X
L3031			X	*	X
L3040			X	*	X
L3050			X	*	X
L3060			X	*	X
L3070			X	*	X
L3080			X	*	X
L3090			X	*	X
L3100			X	*	X
L3140			X	*	X
L3150			X	*	X
L3160			X	*	X
L3170			X	*	X
L3201			X	*	X
L3202			X	*	X
L3203			X	*	X
L3204			X	*	X
L3206			X	*	X
L3207			X	*	X
L3208			X	*	X
L3209			X	*	X
L3211			X	*	X
L3212			X	#	X
L3213			X	*	X
L3214			X	*	X
L3215			X	263.18	X
L3216			X	*	X
L3217			X	*	X
L3219			X	270.13	X
L3221			X	*	X
L3222			X	*	X
L3224	XXX		X	*	X
L3225	XXX		X	*	X
L3230			X	*	X
L3250			X	*	X
L3251			X	*	X
L3252			X	*	X
L3253			X	*	X
L3254			X	*	X
L3255			X	*	X
L3257			X	*	X
L3260			X	*	X
L3265			X	*	X
L3300			X	*	X
L3310			X	*	X
L3320			X	*	X
L3330			X	262.17	X
L3332			X	*	X
L3334			X	*	X
L3340			X	*	X
L3350			X	*	X
L3360			X	*	X
L3370			X	*	X
L3380			X	98.27	X
L3390			X	*	X
L3400			X	*	X
L3410			X	*	X
L3420			X	*	X
L3430			X	*	X
L3440			X	*	X
L3450			X	*	X
L3455			X	*	X
L3460			X	*	X
L3465			X	*	X
L3470			X	*	X
L3480			X	*	X
L3485			X	*	X
L3500			X	*	X
L3510			X	*	X
L3520			X	*	X
L3530			X	*	X
L3540			X	*	X
L3550			X	*	X
L3560			X	*	X
L3570			X	*	X
L3580			X	*	X
L3590			X	*	X
L3595			X	*	X
L3600			X	*	X
L3610			X	*	X
L3620			X	*	X
L3630			X	*	X
L3640			X	*	X
L3649			X	#	X
L3650			X	131.46	X
L3660			X	198.88	X
L3670			X	262.69	X
L3671	XXX	9	X	*	X
L3674			X	1,657.06	X
L3675			X	298.96	X
L3677			X	*	X
L3678			X	*	X
L3702	XXX	9	X	*	X
L3710			X	302.34	X
L3720			X	1,349.09	X
L3730			X	1,744.12	X
L3740			X	2,067.85	X
L3760	XXX		X	*	X
L3761			X	629.83	X
L3762			X	170.55	X
L3763	XXX	9	X	*	X
L3764	XXX	9	X	*	X
L3765	XXX	9	X	*	X
L3766	XXX	9	X	*	X
L3806			X	*	X
L3807			X	*	X
L3808			X	*	X
L3809			X	336.42	X
L3891			X	*	X
L3900			X	2,738.88	X
L3901			X	3,110.26	X
L3904			X	5,666.03	X
L3905	XXX	9	X	*	X
L3906			X	827.08	X
L3908			X	130.15	X
L3912			X	225.48	X
L3913	XXX	9	X	*	X
L3915			X	*	X
L3916			X	715.14	X
L3917			X	163.99	X
L3918			X	142.17	X
L3919	XXX	9	X	*	X
L3921	XXX	9	X	*	X
L3923	XXX		X	*	X
L3924			X	129.85	X
L3925			X	73.52	X
L3927			X	*	X
L3929			X	130.31	X
L3930			X	123.42	X
L3931			X	266.84	X
L3933	XXX	9	X	*	X
L3935	XXX	9	X	*	X
L3956	XXX		X	*	X
L3960			X	1,423.20	X
L3961	XXX	9	X	*	X
L3962			X	1,388.22	X
L3967	XXX	9	X	*	X
L3971	XXX	9	X	*	X
L3973	XXX	9	X	*	X
L3975	XXX	9	X	*	X
L3976	XXX	9	X	*	X
L3977	XXX	9	X	*	X
L3978	XXX	9	X	*	X
L3980			X	619.56	X
L3981			X	1,347.57	X
L3982			X	722.29	X
L3984			X	665.94	X
L3995			X	68.95	X
L3999			X	#	X
L4000			X	2,721.89	X
L4002			X	*	X
L4010			X	1,326.94	X
L4020			X	1,855.71	X
L4030			X	998.33	X
L4040			X	814.64	X
L4045			X	648.60	X
L4050			X	816.25	X
L4055			X	528.60	X
L4060			X	628.35	X
L4070			X	556.45	X
L4080			X	228.19	X
L4090			X	180.11	X
L4100			X	236.44	X
L4110			X	178.19	X
L4130			X	999.02	X
L4205			X	*	X
L4210			X	*	X
L4350			X	197.89	X
L4360			X	608.35	X
L4361			X	435.77	X
L4370			X	402.38	X
L4386			X	276.41	X
L4387			X	234.38	X
L4392			X	46.89	X
L4394			X	34.21	X
L4396			X	333.99	X
L4397			X	248.04	X
L4398			X	153.77	X
L4631			X	2,456.11	X
L5000			X	1,174.07	X
L5010			X	2,564.54	X
L5020			X	4,174.59	X
L5050			X	4,834.26	X
L5060			X	5,818.14	X
L5100			X	5,036.10	X
L5105			X	7,993.32	X
L5150			X	7,397.33	X
L5160			X	8,045.89	X
L5200			X	7,008.58	X
L5210			X	5,111.57	X
L5220			X	5,810.21	X
L5230			X	8,013.43	X
L5250			X	10,929.55	X
L5270			X	10,833.85	X
L5280			X	10,725.44	X
L5301			X	4,121.55	X
L5312			X	5,130.49	X
L5321			X	5,899.87	X
L5331			X	8,348.55	X
L5341			X	9,072.26	X
L5400			X	2,535.22	X
L5410			X	1,110.80	X
L5420			X	3,201.91	X
L5430			X	1,413.31	X
L5450			X	904.16	X
L5460			X	1,332.56	X
L5500			X	2,705.36	X
L5505			X	3,663.83	X
L5510			X	3,066.73	X
L5520			X	3,029.22	X
L5530			X	3,834.40	X
L5535			X	3,778.79	X
L5540			X	3,990.23	X
L5560			X	4,094.12	X
L5570			X	4,256.44	X
L5580			X	4,969.09	X
L5585			X	5,389.61	X
L5590			X	5,063.87	X
L5595			X	8,900.91	X
L5600			X	9,708.38	X
L5610			X	4,361.27	X
L5611			X	3,393.95	X
L5613			X	5,162.34	X
L5614	XXX		X	*	X
L5616			X	2,860.98	X
L5617			X	*	X
L5618			X	666.57	X
L5620			X	585.68	X
L5622			X	894.45	X
L5624			X	853.28	X
L5626			X	1,199.41	X
L5628			X	1,136.11	X
L5629			X	867.53	X
L5630			X	945.35	X
L5631			X	1,130.53	X
L5632			X	467.67	X
L5634			X	640.82	X
L5636			X	536.74	X
L5637			X	716.93	X
L5638			X	1,025.15	X
L5639			X	2,404.94	X
L5640			X	1,464.20	X
L5642			X	1,310.80	X
L5643			X	3,278.62	X
L5644			X	1,244.25	X
L5645			X	1,680.76	X
L5646			X	1,154.19	X
L5647			X	1,675.58	X
L5648			X	1,386.89	X
L5649			X	4,210.26	X
L5650			X	1,028.30	X
L5651			X	2,529.73	X
L5652			X	918.39	X
L5653			X	1,225.96	X
L5654			X	698.63	X
L5655			X	591.55	X
L5656			X	833.21	X
L5658			X	811.51	X
L5661			X	1,410.10	X
L5665			X	1,078.58	X
L5666			X	160.32	X
L5668			X	213.99	X
L5670			X	651.48	X
L5671			X	892.86	X
L5672			X	796.01	X
L5673			X	1,163.30	X
L5676			X	763.35	X
L5677			X	1,038.64	X
L5678			X	83.69	X
L5679			X	969.40	X
L5680			X	729.56	X
L5681			X	2,248.12	X
L5682			X	1,317.40	X
L5683			X	2,248.12	X
L5684			X	101.37	X
L5685			X	*	X
L5686			X	136.78	X
L5688			X	128.56	X
L5690			X	249.18	X
L5692			X	289.21	X
L5694			X	382.12	X
L5695			X	400.91	X
L5696			X	438.12	X
L5697			X	177.92	X
L5698			X	221.34	X
L5699			X	392.74	X
L5700	XXX		X	*	X
L5701	XXX		X	*	X
L5702	XXX		X	*	X
L5703	XXX	9	X	*	X
L5704	XXX		X	*	X
L5705	XXX		X	*	X
L5706	XXX		X	*	X
L5707	XXX		X	*	X
L5710			X	757.61	X
L5711			X	1,149.28	X
L5712			X	907.69	X
L5714			X	936.05	X
L5716			X	1,535.27	X
L5718			X	1,918.91	X
L5722			X	2,002.51	X
L5724			X	3,179.54	X
L5726			X	4,175.15	X
L5728			X	5,201.63	X
L5780			X	2,507.94	X
L5781			X	6,988.73	X
L5782			X	*	X
L5785			X	1,094.42	X
L5790			X	1,514.60	X
L5795			X	2,261.68	X
L5810			X	1,052.19	X
L5811			X	1,536.31	X
L5812			X	1,190.77	X
L5814			X	7,227.00	X
L5816			X	1,791.41	X
L5818			X	2,022.88	X
L5822			X	3,924.64	X
L5824			X	3,230.41	X
L5826	XXX		X	6,137.81	X
L5828			X	6,157.87	X
L5830			X	4,375.42	X
L5840	XXX		X	*	X
L5845			X	*	X
L5848			X	1,878.26	X
L5850			X	279.70	X
L5855	XXX		X	*	X
L5856			X	39,525.87	X
L5857			X	14,025.26	X
L5858	XXX	9	X	29,409.62	X
L5859			X	*	X
L5910			X	768.36	X
L5920			X	1,117.66	X
L5925	XXX		X	*	X
L5930			X	*	X
L5940			X	1,056.59	X
L5950			X	1,785.04	X
L5960			X	2,138.22	X
L5961			X	7,152.27	X
L5962	XXX		X	*	X
L5964	XXX		X	*	X
L5966	XXX		X	*	X
L5968			X	6,815.11	X
L5969			X	21,491.01	X
L5970			X	462.42	X
L5971	XXX	9	X	*	X
L5972			X	742.42	X
L5973			X	27,452.54	X
L5974			X	626.38	X
L5975			X	869.45	X
L5976			X	1,179.67	X
L5978			X	614.75	X
L5979	XXX		X	*	X
L5980			X	7,810.24	X
L5981	XXX		X	*	X
L5982			X	1,217.80	X
L5984			X	1,206.93	X
L5985			X	*	X
L5986			X	1,341.90	X
L5987			X	13,998.68	X
L5988			X	3,746.51	X
L5990			X	3,197.02	X
L5991			X	12,717.52	X
L5999			X	#	X

Fee Schedule L1680-L5999

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