ARKANSAS MEDICARE CARRIER - 07102
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**A2001**1174.20*1115.49*1282.81
**A2002**180.18*171.17*196.85
**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**402.03*381.93*439.22
#**G0186**347.40*330.03*379.53
**G0339**2447.88*2325.49*2674.31
**G0340**1840.79*1748.75*2011.06
**G0398**118.23*112.32*129.17
**G0398*TC*82.00*77.90*89.59
**G0398*26*36.23*34.42*39.58
**G0399**83.40*79.23*91.11
**G0399*TC*43.42*41.25*47.44
**G0399*26*40.25*38.24*43.98
**G0400**85.56*81.28*93.47
**G0400*TC*48.21*45.80*52.67
**G0400*26*37.35*35.48*40.80
**G0460**679.76*645.77*742.64
#**G0460**107.83*102.44*117.81
**G0465**679.76*645.77*742.64
#**G0465**107.83*102.44*117.81
**G0498**124.65*118.42*136.18
**G6017**68.73*65.29*75.08
**0042T**200.35*190.33*218.88
**0054T**197.22*187.36*215.46
**0055T**197.22*187.36*215.46
**0071T**508.74*483.30*555.80
**0072T**508.74*483.30*555.80
**0075T**847.85*805.46*926.28
**0075T*TC*847.85*805.46*926.28
**0075T*26*847.85*805.46*926.28
**0076T**987.28*937.92*1078.61
**0076T*TC*789.82*750.33*862.88
**0076T*26*197.46*187.59*215.73
**0095T**531.33*504.76*580.47
**0098T**594.68*564.95*649.69
**0100T**1701.98*1616.88*1859.41
**0101T**277.44*263.57*303.11
#**0101T**202.82*192.68*221.58
**0102T**277.44*263.57*303.11
#**0102T**202.82*192.68*221.58
**0106T**28.45*27.03*31.08
**0107T**28.45*27.03*31.08
**0108T**28.45*27.03*31.08
**0109T**28.45*27.03*31.08
**0110T**28.45*27.03*31.08
**0164T**580.90*551.86*634.64
**0165T**595.11*565.35*650.15
**0174T**9.17*8.71*10.02
**0184T**728.49*692.07*795.88
**0198T**74.38*70.66*81.26
#**0198T**29.32*27.85*32.03
**0200T**1523.67*1447.49*1664.61
#**0200T**361.79*343.70*395.26
**0201T**2285.51*2171.23*2496.91
#**0201T**542.69*515.56*592.89
**0207T**121.70*115.62*132.96
**0208T**31.99*30.39*34.95
**0209T**38.75*36.81*42.33
**0210T**24.39*23.17*26.65
**0211T**37.90*36.01*41.41
**0212T**33.22*31.56*36.29
#**0212T**29.00*27.55*31.68
**0213T**169.37*160.90*185.04
#**0213T**94.75*90.01*103.51
**0214T**86.20*81.89*94.17
#**0214T**53.54*50.86*58.49
**0215T**86.48*82.16*94.48
#**0215T**54.38*51.66*59.41
**0216T**155.38*147.61*169.75
#**0216T**81.32*77.25*88.84
**0217T**80.34*76.32*87.77
#**0217T**45.99*43.69*50.24
**0218T**80.34*76.32*87.77
#**0218T**46.83*44.49*51.16
**0219T**1129.18*1072.72*1233.63
**0220T**1112.95*1057.30*1215.90
**0221T**1378.15*1309.24*1505.63
**0222T**335.66*318.88*366.71
**0232T**679.76*645.77*742.64
#**0232T**107.83*102.44*117.81
**0234T**7254.38*6891.66*7925.41
#**0234T**515.69*489.91*563.40
**0235T**7254.38*6891.66*7925.41
#**0235T**515.69*489.91*563.40
**0236T**7387.41*7018.04*8070.75
#**0236T**599.44*569.47*654.89
**0237T**7387.41*7018.04*8070.75
#**0237T**599.44*569.47*654.89
**0238T**7387.41*7018.04*8070.75
#**0238T**599.44*569.47*654.89
**0253T**774.87*736.13*846.55
**0266T**786.42*747.10*859.17
**0267T**139.84*132.85*152.78
**0268T**292.25*277.64*319.29
**0269T**743.99*706.79*812.81
**0270T**139.84*132.85*152.78
**0271T**292.25*277.64*319.29
**0272T**49.06*46.61*53.60
**0273T**63.53*60.35*69.40
**0274T**954.13*906.42*1042.38
**0278T**13.14*12.48*14.35
**0308T**1247.97*1185.57*1363.41
**0329T**74.38*70.66*81.26
#**0329T**29.32*27.85*32.03
**0330T**38.21*36.30*41.75
**0331T**157.76*149.87*172.35
**0332T**269.63*256.15*294.57
**0347T**125.37*119.10*136.97
**0348T**28.57*27.14*31.21
**0349T**30.17*28.66*32.96
**0350T**30.73*29.19*33.57
**0351T**146.55*139.22*160.10
**0352T**39.38*37.41*43.02
**0353T**146.55*139.22*160.10
**0354T**39.38*37.41*43.02
**0358T**22.70*21.57*24.81
**0362T**81.72*77.63*89.27
#**0362T**60.03*57.03*65.58
**0378T**22.70*21.57*24.81
**0394T**215.01*204.26*234.90
**0395T**526.06*499.76*574.72
**0397T**43.04*40.89*47.02
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**446.88*424.54*488.22
**0409T**308.81*293.37*337.38
**0410T**320.74*304.70*350.41
**0411T**320.74*304.70*350.41
**0412T**201.20*191.14*219.81
**0413T**417.87*396.98*456.53
**0414T**321.80*305.71*351.57
**0415T**268.13*254.72*292.93
**0416T**296.36*281.54*323.77
**0417T**73.85*70.16*80.68
**0418T**49.06*46.61*53.60
**0419T**395.90*376.11*432.53
#**0419T**320.43*304.41*350.07
**0420T**562.63*534.50*614.68
#**0420T**469.42*445.95*512.84
**0421T**1396.61*1326.78*1525.80
#**0421T**622.49*591.37*680.08
**0437T**188.16*178.75*205.56
**0439T**62.06*58.96*67.80
**0440T**216.80*205.96*236.85
#**0440T**106.97*101.62*116.86
**0441T**216.80*205.96*236.85
#**0441T**106.97*101.62*116.86
**0442T**216.80*205.96*236.85
#**0442T**106.97*101.62*116.86
**0449T**677.46*643.59*740.13
**0464T**58.26*55.35*63.65
**0472T**59.25*56.29*64.73
**0473T**49.06*46.61*53.60
**0479T**57.65*54.77*62.99
**0480T**68.11*64.70*74.41
#**0480T**28.83*27.39*31.50
**0483T**1041.75*989.66*1138.11
**0484T**1351.73*1284.14*1476.76
**0485T**20.98*19.93*22.92
**0485T*TC*7.35*6.98*8.03
**0485T*26*13.80*13.11*15.08
**0486T**41.96*39.86*45.84
**0486T*TC*14.53*13.80*15.87
**0486T*26*27.43*26.06*29.97
**0488T**56.74*53.90*61.99
#**0488T**45.76*43.47*49.99
**0505T**9576.86*9098.02*10462.72
#**0505T**509.69*484.21*556.84
**0507T**19.72*18.73*21.54
**0507T*TC*17.07*16.22*18.65
**0507T*26*2.65*2.52*2.90
**0510T**525.43*499.16*574.03
#**0510T**373.37*354.70*407.91
**0512T**277.44*263.57*303.11
#**0512T**202.82*192.68*221.58
**0513T**83.23*79.07*90.93
#**0513T**60.85*57.81*66.48
**0515T**446.88*424.54*488.22
**0516T**412.43*391.81*450.58
**0517T**292.25*277.64*319.29
**0518T**201.20*191.14*219.81
**0519T**292.96*278.31*320.06
**0520T**412.43*391.81*450.58
**0521T**49.06*46.61*53.60
**0521T*TC*30.30*28.79*33.11
**0521T*26*18.76*17.82*20.49
**0522T**59.25*56.29*64.73
**0522T*TC*30.86*29.32*33.72
**0522T*26*28.38*26.96*31.00
**0523T**132.10*125.50*144.33
**0524T**1395.43*1325.66*1524.51
#**0524T**156.10*148.30*170.55
**0525T**412.71*392.07*450.88
**0526T**320.74*304.70*350.41
**0527T**279.02*265.07*304.83
**0528T**59.25*56.29*64.73
**0528T*TC*30.86*29.32*33.72
**0528T*26*28.38*26.96*31.00
**0529T**49.06*46.61*53.60
**0529T*TC*30.30*28.79*33.11
**0529T*26*18.76*17.82*20.49
**0530T**548.64*521.21*599.39
**0531T**417.87*396.98*456.53
**0532T**292.96*278.31*320.06
**0540T**160.48*152.46*175.33
**0543T**1351.73*1284.14*1476.76
**0544T**1552.72*1475.08*1696.34
**0545T**1552.72*1475.08*1696.34
**0546T**63.76*60.57*69.66
**0552T**5.80*5.51*6.34
**0553T**2090.71*1986.17*2284.10
#**0553T**344.51*327.28*376.37
**0565T**535.84*509.05*585.41
#**0565T**451.64*429.06*493.42
**0566T**87.56*83.18*95.66
#**0566T**52.92*50.27*57.81
**0569T**1552.72*1475.08*1696.34
**0570T**364.70*346.47*398.44
**0571T**483.29*459.13*528.00
**0572T**393.31*373.64*429.69
**0573T**299.88*284.89*327.62
**0574T**347.71*330.32*379.87
**0575T**59.25*56.29*64.73
**0576T**49.06*46.61*53.60
**0577T**173.05*164.40*189.06
**0578T**26.80*25.46*29.28
**0579T**17.91*17.01*19.56
**0580T**185.48*176.21*202.64
**0581T**1921.44*1825.37*2099.18
#**0581T**182.84*173.70*199.76
**0582T**1418.28*1347.37*1549.48
#**0582T**342.29*325.18*373.96
**0583T**1496.16*1421.35*1634.55
#**0583T**116.84*111.00*127.65
**0587T**388.89*369.45*424.87
#**0587T**263.86*250.67*288.27
**0588T**319.17*303.21*348.69
#**0588T**205.13*194.87*224.10
**0589T**43.34*41.17*47.35
#**0589T**35.18*33.42*38.43
**0590T**50.64*48.11*55.33
#**0590T**36.28*34.47*39.64
**0596T**2235.23*2123.47*2441.99
#**0596T**121.93*115.83*133.20
**0597T**672.69*639.06*734.92
#**0597T**121.93*115.83*133.20
**0598T**128.81*122.37*140.73
**0599T**86.08*81.78*94.05
**0600T**3071.09*2917.54*3355.17
#**0600T**656.65*623.82*717.39
**0601T**1267.65*1204.27*1384.91
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**171.25*162.69*187.09
**0611T**34.13*32.42*37.28
**0614T**321.33*305.26*351.05
**0615T**42.44*40.32*46.37
**0616T**594.12*564.41*649.07
**0617T**660.76*627.72*721.88
**0618T**799.30*759.34*873.24
**0619T**575.54*546.76*628.77
#**0619T**425.26*404.00*464.60
**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**224.76*213.52*245.55
#**0627T**89.59*85.11*97.88
**0628T**67.43*64.06*73.67
#**0628T**26.88*25.54*29.37
**0629T**224.76*213.52*245.55
#**0629T**89.59*85.11*97.88
**0630T**67.43*64.06*73.67
#**0630T**26.88*25.54*29.37
**0631T**70.14*66.63*76.62
**0632T**499.68*474.70*545.91
**0633T**174.92*166.17*191.10
*C*0633T*TC*90.00*85.50*98.33
**0633T*26*54.34*51.62*59.36
**0634T**174.92*166.17*191.10
**0634T*TC*120.58*114.55*131.73
**0634T*26*54.34*51.62*59.36
**0635T**174.92*166.17*191.10
**0635T*TC*120.58*114.55*131.73
**0635T*26*54.34*51.62*59.36
**0636T**174.92*166.17*191.10
**0636T*TC*120.58*114.55*131.73
**0636T*26*54.34*51.62*59.36
**0637T**174.92*166.17*191.10
**0637T*TC*120.58*114.55*131.73
**0637T*26*54.34*51.62*59.36
**0638T**174.92*166.17*191.10
**0638T*TC*120.58*114.55*131.73
**0638T*26*54.34*51.62*59.36
**0639T**70.14*66.63*76.62
**0640T**19.72*18.73*21.54
**0640T*TC*17.07*16.22*18.65
**0640T*26*2.65*2.52*2.90
**0644T**992.06*942.46*1083.83
#**0644T**211.18*200.62*230.71
**0646T**1552.72*1475.08*1696.34
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**52.45*49.83*57.30
**0652T**249.69*237.21*272.79
#**0652T**108.89*103.45*118.97
**0653T**325.24*308.98*355.33
#**0653T**123.05*116.90*134.44
**0654T**126.27*119.96*137.95
**0655T**1396.61*1326.78*1525.80
#**0655T**622.49*591.37*680.08
**0658T**80.14*76.13*87.55
**0659T**2290.95*2176.40*2502.86
#**0659T**380.30*361.29*415.48
**0671T**911.01*865.46*995.28
**0673T**2918.03*2772.13*3187.95
#**0673T**324.78*308.54*354.82
**0699T**100.27*95.26*109.55
#**0699T**81.68*77.60*89.24
**0707T**323.11*306.95*352.99
#**0707T**245.11*232.85*267.78
**0714T**1205.24*1144.98*1316.73
#**0714T**319.33*303.36*348.86
**0730T**238.40*226.48*260.45
#**0730T**215.24*204.48*235.15
**0738T**64.48*61.26*70.45
**0739T**1396.61*1326.78*1525.80
#**0739T**622.49*591.37*680.08
**0740T**16.67*15.84*18.22
**0741T**39.88*37.89*43.57
**0742T**80.89*76.85*88.38
**0742T*TC*63.19*60.03*69.03
**0742T*26*17.70*16.82*19.34
**0743T**46.10*43.80*50.37
**0744T**771.77*733.18*843.16
**0745T**216.61*205.78*236.65
**0746T**206.32*196.00*225.40
**0747T**837.78*795.89*915.27
**0748T**162.47*154.35*177.50
**0751T**9.43*8.96*10.30
**0752T**12.24*11.63*13.37
**0753T**20.66*19.63*22.57
**0754T**83.17*79.01*90.86
**0755T**378.86*359.92*413.91
**0756T**96.59*91.76*105.52
**0757T**69.59*66.11*76.03
**0758T**77.87*73.98*85.08
**0759T**115.86*110.07*126.58
**0760T**86.90*82.56*94.94
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**102.80*97.66*112.31
**0764T**3.80*3.61*4.15
**0765T**7.43*7.06*8.12
**0771T**23.80*22.61*26.00
**0772T**23.80*22.61*26.00
**0773T**20.43*19.41*22.32
**0774T**20.43*19.41*22.32
**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*45.75*43.46*49.98
#**0777T*26*3.75*3.56*4.09
**0779T**371.51*352.93*405.87
**0779T*TC*347.66*330.28*379.82
**0779T*26*23.84*22.65*26.05
**0780T**20.43*19.41*22.32
**0783T**12.00*11.40*13.11
**0784T**1812.13*1721.52*1979.75
#**0784T**292.05*277.45*319.07
**0785T**211.32*200.75*230.86
#**0785T**128.25*121.84*140.12
**0786T**636.17*604.36*695.01
#**0786T**271.78*258.19*296.92
**0787T**211.32*200.75*230.86
#**0787T**128.25*121.84*140.12
**0788T**17.04*16.19*18.62
#**0788T**16.47*15.65*18.00
**0789T**22.70*21.57*24.81
#**0789T**20.59*19.56*22.49
**0790T**1737.73*1650.84*1898.47
**0791T**8.14*7.73*8.89
**0793T**499.68*474.70*545.91
**0794T**130.35*123.83*142.40
**0795T**618.64*587.71*675.87
**0796T**412.43*391.81*450.58
**0797T**412.43*391.81*450.58
**0798T**654.17*621.46*714.68
**0799T**436.11*414.30*476.45
**0800T**436.11*414.30*476.45
**0801T**848.54*806.11*927.03
**0802T**424.27*403.06*463.52
**0803T**424.27*403.06*463.52
**0804T**69.37*65.90*75.79
**0804T*TC*35.65*33.87*38.95
**0804T*26*33.72*32.03*36.83
**0805T**2520.69*2394.66*2753.86
#**0805T**291.27*276.71*318.22
**0806T**3360.93*3192.88*3671.81
#**0806T**388.36*368.94*424.28
**0807T**36.97*35.12*40.39
**0807T*TC*23.54*22.36*25.71
**0807T*26*13.43*12.76*14.67
**0808T**36.97*35.12*40.39
**0808T*TC*23.54*22.36*25.71
**0808T*26*13.43*12.76*14.67
**0810T**1012.62*961.99*1106.29
**0811T**16.67*15.84*18.22
**0813T**2203.01*2092.86*2406.79
#**0813T**158.03*150.13*172.65
**0814T**403.89*383.70*441.26
#**0814T**306.38*291.06*334.72
**0818T**319.17*303.21*348.69
#**0818T**205.13*194.87*224.10
**0820T**137.82*130.93*150.57
#**0820T**122.90*116.76*134.27
**0821T**137.82*130.93*150.57
#**0821T**122.90*116.76*134.27
**0822T**117.15*111.29*127.98
#**0822T**104.46*99.24*114.13
**0823T**618.64*587.71*675.87
**0824T**654.17*621.46*714.68
**0825T**848.54*806.11*927.03
**0826T**59.25*56.29*64.73
**0826T*TC*30.86*29.32*33.72
**0826T*26*28.38*26.96*31.00
**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**19.72*18.73*21.54
**0859T*TC*17.07*16.22*18.65
**0859T*26*2.65*2.52*2.90
**0864T**277.44*263.57*303.11
#**0864T**202.82*192.68*221.58
**10011**368.06*349.66*402.11
#**10011**98.01*93.11*107.08
**10012**203.74*193.55*222.58
#**10012**65.19*61.93*71.22
**15847**309.46*293.99*338.09
**21742**1016.41*965.59*1110.43
**21743**1159.76*1101.77*1267.04
**32855**315.04*299.29*344.18
**32856**394.78*375.04*431.30
**33928**2903.77*2758.58*3172.37
**33929**1088.26*1033.85*1188.93
**33933**481.02*456.97*525.52
**33944**453.77*431.08*495.74
**34841**1863.16*1770.00*2035.50
**34842**2088.94*1984.49*2282.16
**34843**2314.72*2198.98*2528.83
**34844**2540.49*2413.47*2775.49
**34845**1863.16*1770.00*2035.50
**34846**2088.94*1984.49*2282.16
**34847**2314.72*2198.98*2528.83
**34848**2540.49*2413.47*2775.49
**43496**1869.17*1775.71*2042.07
**43647**553.90*526.21*605.14
**43648**478.68*454.75*522.96
#**43648**219.95*208.95*240.29
**43881**579.14*550.18*632.71
#**43881**529.92*503.42*578.93
**43882**612.89*582.25*669.59
#**43882**559.91*531.91*611.70
**47143**372.81*354.17*407.30
**47144**442.71*420.57*483.66
**47145**419.40*398.43*458.19
**48551**240.49*228.47*262.74
**49906**1792.51*1702.88*1958.31
**50323**145.43*138.16*158.88
**50325**212.01*201.41*231.62
**53451**679.89*645.90*742.79
**53452**339.95*322.95*371.39
**53453**577.76*548.87*631.20
**53454**50.41*47.89*55.07
#**53454**32.11*30.50*35.08
**54440**676.31*642.49*738.86
**63043**482.86*458.72*527.53
**63044**446.68*424.35*488.00
**64596**1812.13*1721.52*1979.75
#**64596**292.05*277.45*319.07
**64597**543.64*516.46*593.93
#**64597**87.62*83.24*95.73
**64598**211.32*200.75*230.86
#**64598**128.25*121.84*140.12
**65757**106.10*100.80*115.92
**66983**594.12*564.41*649.07
**66987**691.01*656.46*754.93
**66988**574.17*545.46*627.28
*C*70170**213.93*203.23*233.71
*C*70170*TC*200.67*190.64*219.24
**70555**233.47*221.80*255.07
**70555*TC*124.61*118.38*136.14
*C*70557**590.41*560.89*645.02
*C*70557*TC*451.86*429.27*493.66
*C*70558**303.32*288.15*331.37
*C*70558*TC*150.54*143.01*164.46
*C*70559**293.53*278.85*320.68
*C*70559*TC*150.54*143.01*164.46
*C*74190**472.02*448.42*515.68
*C*74190*TC*451.86*429.27*493.66
**74235**127.12*120.76*138.87
**74235*TC*75.31*71.54*82.27
**74300**72.94*69.29*79.68
**74300*TC*60.94*57.89*66.57
**74301**22.24*21.13*24.30
**74301*TC*13.22*12.56*14.44
**74328**175.06*166.31*191.26
**74328*TC*153.98*146.28*168.22
**74329**121.49*115.42*132.73
**74329*TC*100.13*95.12*109.39
**74330**262.59*249.46*286.88
**74330*TC*237.83*225.94*259.83
**74340**86.58*82.25*94.59
**74340*TC*63.32*60.15*69.17
**74355**86.58*82.25*94.59
**74355*TC*53.41*50.74*58.35
**74360**86.58*82.25*94.59
**74360*TC*62.14*59.03*67.88
**74363**175.06*166.31*191.26
**74363*TC*137.23*130.37*149.93
*C*74445**139.27*132.31*152.16
*C*74445*TC*90.00*85.50*98.33
*C*74450**215.02*204.27*234.91
*C*74450*TC*200.67*190.64*219.24
*C*74470**474.55*450.82*518.44
*C*74470*TC*451.86*429.27*493.66
**74742**233.47*221.80*255.07
**74742*TC*206.79*196.45*225.92
*C*74775**227.67*216.29*248.73
*C*74775*TC*200.67*190.64*219.24
*C*75801**552.39*524.77*603.49
*C*75801*TC*514.65*488.92*562.26
*C*75803**1363.30*1295.14*1489.41
*C*75803*TC*1312.14*1246.53*1433.51
*C*75805**2647.10*2514.75*2891.96
*C*75805*TC*2611.73*2481.14*2853.31
*C*75807**2659.84*2526.85*2905.88
*C*75807*TC*2611.73*2481.14*2853.31
*C*75810**2655.82*2523.03*2901.48
*C*75810*TC*2611.73*2481.14*2853.31
**75894**759.37*721.40*829.61
**75894*TC*696.97*662.12*761.44
*C*75898**2691.01*2556.46*2939.93
*C*75898*TC*2611.73*2481.14*2853.31
**75970**371.73*353.14*406.11
**75970*TC*337.34*320.47*368.54
**76125**34.36*32.64*37.54
**76125*TC*22.36*21.24*24.43
**76390**178.74*169.80*195.27
**76390*TC*130.72*124.18*142.81
**76390*26*48.02*45.62*52.46
**76932**73.82*70.13*80.65
**76932*TC*41.91*39.81*45.78
**76940**136.77*129.93*149.42
**76940*TC*47.27*44.91*51.65
**76941**102.74*97.60*112.24
**76941*TC*43.71*41.52*47.75
**76945**73.08*69.43*79.84
**76945*TC*43.65*41.47*47.69
*C*76975**237.84*225.95*259.84
*C*76975*TC*200.67*190.64*219.24
**76998**175.06*166.31*191.26
**76998*TC*133.82*127.13*146.20
**77013**365.30*347.04*399.10
**77013*TC*198.59*188.66*216.96
**77022**414.42*393.70*452.76
**77022*TC*232.43*220.81*253.93
**77371**532.23*505.62*581.46
**77520**772.52*733.89*843.97
**77522**772.52*733.89*843.97
**77523**887.13*842.77*969.19
**77525**1001.75*951.66*1094.41
*C*78282**352.11*334.50*384.68
*C*78282*TC*337.81*320.92*369.06
**78414**514.99*489.24*562.63
**78414*TC*495.58*470.80*541.42
*C*78429**1354.46*1286.74*1479.75
*C*78429*TC*1281.73*1217.64*1400.29
*C*78430**1351.06*1283.51*1476.04
*C*78430*TC*1281.73*1217.64*1400.29
*C*78431**2016.02*1915.22*2202.50
*C*78431*TC*1935.33*1838.56*2114.34
*C*78432**1677.64*1593.76*1832.82
*C*78432*TC*1591.21*1511.65*1738.40
*C*78433**1771.89*1683.30*1935.80
*C*78433*TC*1677.38*1593.51*1832.54
**78434**604.81*574.57*660.76
**78434*TC*578.21*549.30*631.70
*C*78459**1230.71*1169.17*1344.55
*C*78459*TC*1163.46*1105.29*1271.08
*C*78491**1347.74*1280.35*1472.40
*C*78491*TC*1281.73*1217.64*1400.29
*C*78492**1359.15*1291.19*1484.87
*C*78492*TC*1281.73*1217.64*1400.29
*C*78608**1345.10*1277.85*1469.53
*C*78608*TC*1281.73*1217.64*1400.29
*C*78811**1228.59*1167.16*1342.23
*C*78811*TC*1163.46*1105.29*1271.08
*C*78812**1363.91*1295.71*1490.07
*C*78812*TC*1281.73*1217.64*1400.29
*C*78813**1365.92*1297.62*1492.26
*C*78813*TC*1281.73*1217.64*1400.29
*C*78814**1374.90*1306.16*1502.08
*C*78814*TC*1281.73*1217.64*1400.29
*C*78815**1385.46*1316.19*1513.62
*C*78815*TC*1281.73*1217.64*1400.29
*C*78816**1386.69*1317.36*1514.96
*C*78816*TC*1281.73*1217.64*1400.29
**79300**237.04*225.19*258.97
**79300*TC*177.27*168.41*193.67
**79445**237.04*225.19*258.97
**79445*TC*137.21*130.35*149.90
**90867**259.02*246.07*282.98
#**90867**120.90*114.86*132.09
**90868**176.57*167.74*192.90
#**90868**97.46*92.59*106.48
**90869**245.47*233.20*268.18
#**90869**142.21*135.10*155.37
**90952**461.05*438.00*503.70
**90953**327.32*310.95*357.59
**92978**212.74*202.10*232.42
**92978*TC*130.57*124.04*142.65
**92979**130.63*124.10*142.72
**92979*TC*65.27*62.01*71.31
*C*93315**567.09*538.74*619.55
*C*93315*TC*451.86*429.27*493.66
**93317**186.38*177.06*203.62
**93317*TC*106.92*101.57*116.81
*C*93318**544.00*516.80*594.32
*C*93318*TC*451.86*429.27*493.66
**93571**211.87*201.28*231.47
**93571*TC*149.21*141.75*163.01
**93572**128.77*122.33*140.68
**93572*TC*83.23*79.07*90.93
**93600**3557.81*3379.92*3886.91
**93600*TC*3457.39*3284.52*3777.20
**93602**3557.81*3379.92*3886.91
**93602*TC*3458.86*3285.92*3778.81
**93603**3557.81*3379.92*3886.91
**93603*TC*3458.86*3285.92*3778.81
**93609**2134.69*2027.96*2332.15
**93609*TC*1899.03*1804.08*2074.69
**93610**3557.81*3379.92*3886.91
**93610*TC*3417.94*3247.04*3734.10
**93612**3557.81*3379.92*3886.91
**93612*TC*3419.58*3248.60*3735.89
**93615**44.25*42.04*48.35
**93615*TC*11.51*10.93*12.57
**93619**7115.62*6759.84*7773.82
**93619*TC*6782.76*6443.62*7410.16
**93620**7115.62*6759.84*7773.82
**93620*TC*6581.77*6252.68*7190.58
**93621**7115.62*6759.84*7773.82
**93621*TC*7044.69*6692.46*7696.33
**93622**7115.62*6759.84*7773.82
**93622*TC*6969.19*6620.73*7613.84
**93623**2134.69*2027.96*2332.15
**93623*TC*2076.57*1972.74*2268.65
**93624**3557.81*3379.92*3886.91
**93624*TC*3350.53*3183.00*3660.45
**93631**7115.62*6759.84*7773.82
**93631*TC*6774.51*6435.78*7401.15
**93640**1133.95*1077.25*1238.84
**93640*TC*981.38*932.31*1072.16
**93641**1133.95*1077.25*1238.84
**93641*TC*867.68*824.30*947.95
**93662**362.16*344.05*395.66
**93662*TC*298.28*283.37*325.88
**93745**78.23*74.32*85.47
**93745*TC*56.13*53.32*61.32
**93745*26*22.10*21.00*24.15
**94642**29.42*27.95*32.14
**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
**95965**901.98*856.88*985.41
**95965*TC*529.38*502.91*578.35
**96020**377.70*358.82*412.64
**96020*TC*233.44*221.77*255.04
**96547**638.37*606.45*697.42
#**96547**121.07*115.02*132.27
**96548**319.19*303.23*348.71
#**96548**60.54*57.51*66.14
**97151**46.47*44.15*50.77
#**97151**41.68*39.60*45.54
**97152**39.50*37.53*43.16
#**97152**35.43*33.66*38.71
**97153**31.56*29.98*34.48
#**97153**28.04*26.64*30.64
**97154**4.19*3.98*4.58
#**97154**3.83*3.64*4.19
**97155**31.56*29.98*34.48
#**97155**28.04*26.64*30.64
**97156**33.34*31.67*36.42
#**97156**29.68*28.20*32.43
**97157**9.63*9.15*10.52
#**97157**8.78*8.34*9.59
**97158**4.90*4.66*5.36
#**97158**4.48*4.26*4.90
**98978**39.88*37.89*43.57
# - 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.