LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
NEW ORLEANS
******
**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**431.56*409.98*471.48
#**G0186**372.16*353.55*406.58
**G0339**2763.05*2624.90*3018.64
**G0340**2078.06*1974.16*2270.28
**G0398**127.08*120.73*138.84
**G0398*TC*89.54*85.06*97.82
**G0398*26*37.54*35.66*41.01
**G0399**88.98*84.53*97.21
**G0399*TC*47.60*45.22*52.00
**G0399*26*41.69*39.61*45.55
**G0400**91.57*86.99*100.04
**G0400*TC*52.80*50.16*57.68
**G0400*26*38.77*36.83*42.35
**G0460**739.80*702.81*808.23
#**G0460**117.99*112.09*128.90
**G0465**739.80*702.81*808.23
#**G0465**117.99*112.09*128.90
**G0498**136.28*129.47*148.89
**G6017**73.83*70.14*80.66
**0042T**213.70*203.02*233.47
**0054T**229.92*218.42*251.18
**0055T**229.92*218.42*251.18
**0071T**557.17*529.31*608.71
**0072T**557.17*529.31*608.71
**0075T**960.01*912.01*1048.81
**0075T*TC*960.01*912.01*1048.81
**0075T*26*960.01*912.01*1048.81
**0076T**1045.19*992.93*1141.87
**0076T*TC*836.14*794.33*913.48
**0076T*26*209.04*198.59*228.38
**0095T**623.82*592.63*681.52
**0098T**698.91*663.96*763.55
**0100T**1814.04*1723.34*1981.84
**0101T**297.61*282.73*325.14
#**0101T**216.48*205.66*236.51
**0102T**297.61*282.73*325.14
#**0102T**216.48*205.66*236.51
**0106T**31.17*29.61*34.05
**0107T**31.17*29.61*34.05
**0108T**31.17*29.61*34.05
**0109T**31.17*29.61*34.05
**0110T**31.17*29.61*34.05
**0164T**681.34*647.27*744.36
**0165T**698.25*663.34*762.84
**0174T**9.73*9.24*10.63
**0184T**799.12*759.16*873.03
**0198T**79.51*75.53*86.86
#**0198T**30.53*29.00*33.35
**0200T**1656.39*1573.57*1809.61
#**0200T**393.18*373.52*429.55
**0201T**2484.59*2360.36*2714.41
#**0201T**589.77*560.28*644.32
**0207T**121.70*115.62*132.96
**0208T**34.97*33.22*38.20
**0209T**42.32*40.20*46.23
**0210T**26.71*25.37*29.18
**0211T**41.40*39.33*45.23
**0212T**34.79*33.05*38.01
#**0212T**30.20*28.69*32.99
**0213T**182.44*173.32*199.32
#**0213T**101.31*96.24*110.68
**0214T**92.74*88.10*101.32
#**0214T**57.22*54.36*62.51
**0215T**93.04*88.39*101.65
#**0215T**58.14*55.23*63.51
**0216T**167.50*159.13*183.00
#**0216T**86.98*82.63*95.02
**0217T**86.43*82.11*94.43
#**0217T**49.08*46.63*53.62
**0218T**86.43*82.11*94.43
#**0218T**50.00*47.50*54.63
**0219T**1296.77*1231.93*1416.72
**0220T**1272.48*1208.86*1390.19
**0221T**1561.98*1483.88*1706.46
**0222T**386.94*367.59*422.73
**0232T**739.80*702.81*808.23
#**0232T**117.99*112.09*128.90
**0234T**7902.78*7507.64*8633.79
#**0234T**576.41*547.59*629.73
**0235T**7902.78*7507.64*8633.79
#**0235T**576.41*547.59*629.73
**0236T**8046.42*7644.10*8790.72
#**0236T**666.47*633.15*728.12
**0237T**8046.42*7644.10*8790.72
#**0237T**666.47*633.15*728.12
**0238T**8046.42*7644.10*8790.72
#**0238T**666.47*633.15*728.12
**0253T**867.13*823.77*947.34
**0266T**878.39*834.47*959.64
**0267T**155.56*147.78*169.95
**0268T**326.15*309.84*356.32
**0269T**830.98*789.43*907.84
**0270T**155.56*147.78*169.95
**0271T**326.15*309.84*356.32
**0272T**52.49*49.87*57.35
**0273T**67.71*64.32*73.97
**0274T**1089.69*1035.21*1190.49
**0278T**13.77*13.08*15.04
**0308T**1330.52*1263.99*1453.59
**0329T**79.51*75.53*86.86
#**0329T**30.53*29.00*33.35
**0330T**38.21*36.30*41.75
**0331T**170.60*162.07*186.38
**0332T**291.14*276.58*318.07
**0347T**138.68*131.75*151.51
**0348T**30.88*29.34*33.74
**0349T**32.67*31.04*35.70
**0350T**33.29*31.63*36.37
**0351T**157.83*149.94*172.43
**0352T**41.11*39.05*44.91
**0353T**157.83*149.94*172.43
**0354T**41.11*39.05*44.91
**0358T**24.87*23.63*27.17
**0362T**87.07*82.72*95.13
#**0362T**63.50*60.33*69.38
**0378T**23.89*22.70*26.11
**0394T**232.50*220.88*254.01
**0395T**566.33*538.01*618.71
**0397T**45.16*42.90*49.34
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**498.99*474.04*545.15
**0409T**344.16*326.95*375.99
**0410T**357.31*339.44*390.36
**0411T**357.31*339.44*390.36
**0412T**223.75*212.56*244.44
**0413T**466.02*442.72*509.13
**0414T**358.96*341.01*392.16
**0415T**299.40*284.43*327.09
**0416T**330.10*313.60*360.64
**0417T**78.64*74.71*85.92
**0418T**52.49*49.87*57.35
**0419T**427.04*405.69*466.54
#**0419T**344.99*327.74*376.90
**0420T**610.30*579.79*666.76
#**0420T**508.96*483.51*556.04
**0421T**1512.63*1437.00*1652.55
#**0421T**671.00*637.45*733.07
**0437T**207.93*197.53*227.16
**0439T**67.91*64.51*74.19
**0440T**234.13*222.42*255.78
#**0440T**114.73*108.99*125.34
**0441T**234.13*222.42*255.78
#**0441T**114.73*108.99*125.34
**0442T**234.13*222.42*255.78
#**0442T**114.73*108.99*125.34
**0449T**723.76*687.57*790.71
**0464T**62.73*59.59*68.53
**0472T**63.14*59.98*68.98
**0473T**52.49*49.87*57.35
**0479T**60.37*57.35*65.95
**0480T**72.89*69.25*79.64
#**0480T**30.18*28.67*32.97
**0483T**1170.16*1111.65*1278.40
**0484T**1517.41*1441.54*1657.77
**0485T**22.23*21.12*24.29
**0485T*TC*8.19*7.78*8.95
**0485T*26*14.42*13.70*15.76
**0486T**44.46*42.24*48.58
**0486T*TC*15.99*15.19*17.47
**0486T*26*28.47*27.05*31.11
**0488T**60.19*57.18*65.76
#**0488T**48.25*45.84*52.72
**0505T**10619.39*10088.42*11601.68
#**0505T**574.78*546.04*627.95
**0507T**21.68*20.60*23.69
**0507T*TC*18.75*17.81*20.48
**0507T*26*2.93*2.78*3.20
**0510T**574.81*546.07*627.98
#**0510T**409.48*389.01*447.36
**0512T**297.61*282.73*325.14
#**0512T**216.48*205.66*236.51
**0513T**89.28*84.82*97.54
#**0513T**64.94*61.69*70.94
**0515T**498.99*474.04*545.15
**0516T**460.48*437.46*503.08
**0517T**326.15*309.84*356.32
**0518T**223.75*212.56*244.44
**0519T**327.01*310.66*357.26
**0520T**460.48*437.46*503.08
**0521T**52.49*49.87*57.35
**0521T*TC*33.14*31.48*36.20
**0521T*26*19.36*18.39*21.15
**0522T**63.14*59.98*68.98
**0522T*TC*33.75*32.06*36.87
**0522T*26*29.39*27.92*32.11
**0523T**144.55*137.32*157.92
**0524T**1521.10*1445.05*1661.81
#**0524T**173.70*165.02*189.77
**0525T**460.79*437.75*503.41
**0526T**357.31*339.44*390.36
**0527T**311.37*295.80*340.17
**0528T**63.14*59.98*68.98
**0528T*TC*33.75*32.06*36.87
**0528T*26*29.39*27.92*32.11
**0529T**52.49*49.87*57.35
**0529T*TC*33.14*31.48*36.20
**0529T*26*19.36*18.39*21.15
**0530T**612.08*581.48*668.70
**0531T**466.02*442.72*509.13
**0532T**327.01*310.66*357.26
**0540T**169.79*161.30*185.50
**0543T**1517.41*1441.54*1657.77
**0544T**1740.07*1653.07*1901.03
**0545T**1740.07*1653.07*1901.03
**0546T**67.57*64.19*73.82
**0552T**6.32*6.00*6.90
**0553T**2284.26*2170.05*2495.56
#**0553T**385.77*366.48*421.45
**0565T**587.62*558.24*641.98
#**0565T**496.08*471.28*541.97
**0566T**94.97*90.22*103.75
#**0566T**57.31*54.44*62.61
**0569T**1740.07*1653.07*1901.03
**0570T**409.00*388.55*446.83
**0571T**539.44*512.47*589.34
**0572T**439.58*417.60*480.24
**0573T**334.63*317.90*365.59
**0574T**388.78*369.34*424.74
**0575T**63.14*59.98*68.98
**0576T**52.49*49.87*57.35
**0577T**181.40*172.33*198.18
**0578T**28.20*26.79*30.81
**0579T**19.67*18.69*21.49
**0580T**206.56*196.23*225.66
**0581T**2096.91*1992.06*2290.87
#**0581T**206.69*196.36*225.81
**0582T**1539.20*1462.24*1681.58
#**0582T**369.37*350.90*403.54
**0583T**1496.16*1421.35*1634.55
#**0583T**127.10*120.75*138.86
**0587T**422.41*401.29*461.48
#**0587T**286.48*272.16*312.98
**0588T**347.06*329.71*379.17
#**0588T**223.06*211.91*243.70
**0589T**46.25*43.94*50.53
#**0589T**37.37*35.50*40.83
**0590T**54.33*51.61*59.35
#**0590T**38.71*36.77*42.29
**0596T**2235.23*2123.47*2441.99
#**0596T**127.26*120.90*139.04
**0597T**672.69*639.06*734.92
#**0597T**127.26*120.90*139.04
**0598T**139.69*132.71*152.62
**0599T**93.06*88.41*101.67
**0600T**3326.84*3160.50*3634.58
#**0600T**701.84*666.75*766.76
**0601T**1423.37*1352.20*1555.03
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**183.89*174.70*200.91
**0611T**37.50*35.63*40.97
**0614T**358.39*340.47*391.54
**0615T**44.81*42.57*48.96
**0616T**629.98*598.48*688.25
**0617T**704.45*669.23*769.61
**0618T**852.63*810.00*931.50
**0619T**621.94*590.84*679.47
#**0619T**458.67*435.74*501.10
**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**242.71*230.57*265.16
#**0627T**95.76*90.97*104.62
**0628T**72.81*69.17*79.55
#**0628T**28.73*27.29*31.38
**0629T**242.71*230.57*265.16
#**0629T**95.76*90.97*104.62
**0630T**72.81*69.17*79.55
#**0630T**28.73*27.29*31.38
**0631T**76.52*72.69*83.59
**0632T**559.05*531.10*610.77
**0633T**188.16*178.75*205.56
*C*0633T*TC*98.04*93.14*107.11
**0633T*26*56.67*53.84*61.92
**0634T**188.16*178.75*205.56
**0634T*TC*131.49*124.92*143.66
**0634T*26*56.67*53.84*61.92
**0635T**188.16*178.75*205.56
**0635T*TC*131.49*124.92*143.66
**0635T*26*56.67*53.84*61.92
**0636T**188.16*178.75*205.56
**0636T*TC*131.49*124.92*143.66
**0636T*26*56.67*53.84*61.92
**0637T**188.16*178.75*205.56
**0637T*TC*131.49*124.92*143.66
**0637T*26*56.67*53.84*61.92
**0638T**188.16*178.75*205.56
**0638T*TC*131.49*124.92*143.66
**0638T*26*56.67*53.84*61.92
**0639T**76.52*72.69*83.59
**0640T**21.68*20.60*23.69
**0640T*TC*18.75*17.81*20.48
**0640T*26*2.93*2.78*3.20
**0644T**1084.13*1029.92*1184.41
#**0644T**235.15*223.39*256.90
**0646T**1740.07*1653.07*1901.03
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**56.13*53.32*61.32
**0652T**270.54*257.01*295.56
#**0652T**117.47*111.60*128.34
**0653T**352.60*334.97*385.22
#**0653T**132.78*126.14*145.06
**0654T**136.58*129.75*149.21
**0655T**1512.63*1437.00*1652.55
#**0655T**671.00*637.45*733.07
**0658T**87.33*82.96*95.40
**0659T**2502.84*2377.70*2734.36
#**0659T**425.55*404.27*464.91
**0671T**973.15*924.49*1063.16
**0673T**3173.43*3014.76*3466.97
#**0673T**354.02*336.32*386.77
**0699T**107.04*101.69*116.94
#**0699T**86.83*82.49*94.86
**0707T**350.08*332.58*382.47
#**0707T**265.27*252.01*289.81
**0714T**1307.69*1242.31*1428.66
#**0714T**344.51*327.28*376.37
**0730T**258.95*246.00*282.90
#**0730T**233.60*221.92*255.21
**0738T**67.95*64.55*74.23
**0739T**1512.63*1437.00*1652.55
#**0739T**671.00*637.45*733.07
**0740T**18.51*17.58*20.22
**0741T**43.55*41.37*47.58
**0742T**87.34*82.97*95.42
**0742T*TC*68.99*65.54*75.37
**0742T*26*18.35*17.43*20.04
**0743T**49.84*47.35*54.45
**0744T**872.30*828.69*952.99
**0745T**236.86*225.02*258.77
**0746T**215.56*204.78*235.50
**0747T**915.69*869.91*1000.40
**0748T**177.71*168.82*194.14
**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**405.46*385.19*442.97
**0756T**103.86*98.67*113.47
**0757T**75.36*71.59*82.33
**0758T**83.77*79.58*91.52
**0759T**125.03*118.78*136.60
**0760T**92.87*88.23*101.46
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**109.72*104.23*119.86
**0764T**4.10*3.90*4.49
**0765T**7.78*7.39*8.50
**0771T**25.63*24.35*28.00
**0772T**25.63*24.35*28.00
**0773T**21.89*20.80*23.92
**0774T**21.89*20.80*23.92
**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**403.00*382.85*440.28
**0779T*TC*378.18*359.27*413.16
**0779T*26*24.83*23.59*27.13
**0780T**21.89*20.80*23.92
**0783T**13.24*12.58*14.47
**0784T**1965.75*1867.46*2147.58
#**0784T**313.11*297.45*342.07
**0785T**229.55*218.07*250.78
#**0785T**139.23*132.27*152.11
**0786T**690.48*655.96*754.35
#**0786T**294.31*279.59*321.53
**0787T**229.55*218.07*250.78
#**0787T**139.23*132.27*152.11
**0788T**18.11*17.20*19.78
#**0788T**17.49*16.62*19.11
**0789T**25.76*24.47*28.14
#**0789T**21.87*20.78*23.90
**0790T**1858.30*1765.39*2030.20
**0791T**8.66*8.23*9.46
**0793T**559.05*531.10*610.77
**0794T**130.35*123.83*142.40
**0795T**690.72*656.18*754.61
**0796T**460.48*437.46*503.08
**0797T**460.48*437.46*503.08
**0798T**732.37*695.75*800.11
**0799T**488.25*463.84*533.42
**0800T**488.25*463.84*533.42
**0801T**948.73*901.29*1036.48
**0802T**474.36*450.64*518.24
**0803T**474.36*450.64*518.24
**0804T**73.80*70.11*80.63
**0804T*TC*38.95*37.00*42.55
**0804T*26*34.85*33.11*38.08
**0805T**2739.76*2602.77*2993.19
#**0805T**315.91*300.11*345.13
**0806T**3653.02*3470.37*3990.93
#**0806T**421.21*400.15*460.17
**0807T**40.12*38.11*43.83
**0807T*TC*25.79*24.50*28.18
**0807T*26*14.33*13.61*15.65
**0808T**40.12*38.11*43.83
**0808T*TC*25.79*24.50*28.18
**0808T*26*14.33*13.61*15.65
**0810T**1079.14*1025.18*1178.96
**0811T**18.51*17.58*20.22
**0813T**2399.65*2279.67*2621.62
#**0813T**176.33*167.51*192.64
**0814T**437.60*415.72*478.08
#**0814T**331.59*315.01*362.26
**0818T**347.06*329.71*379.17
#**0818T**223.06*211.91*243.70
**0820T**142.41*135.29*155.58
#**0820T**126.19*119.88*137.86
**0821T**142.41*135.29*155.58
#**0821T**126.19*119.88*137.86
**0822T**121.05*115.00*132.25
#**0822T**107.26*101.90*117.19
**0823T**690.72*656.18*754.61
**0824T**732.37*695.75*800.11
**0825T**948.73*901.29*1036.48
**0826T**63.14*59.98*68.98
**0826T*TC*33.75*32.06*36.87
**0826T*26*29.39*27.92*32.11
**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**21.68*20.60*23.69
**0859T*TC*18.75*17.81*20.48
**0859T*26*2.93*2.78*3.20
**0864T**297.61*282.73*325.14
#**0864T**216.48*205.66*236.51
**10011**397.98*378.08*434.79
#**10011**104.37*99.15*114.02
**10012**220.87*209.83*241.30
#**10012**70.24*66.73*76.74
**15847**341.47*324.40*373.06
**21742**1131.59*1075.01*1236.26
**21743**1304.90*1239.66*1425.61
**32855**348.71*331.27*380.96
**32856**445.32*423.05*486.51
**33928**3267.64*3104.26*3569.90
**33929**1223.66*1162.48*1336.85
**33933**534.43*507.71*583.87
**33944**567.86*539.47*620.39
**34841**2132.10*2025.50*2329.33
**34842**2357.86*2239.97*2575.97
**34843**2583.65*2454.47*2822.64
**34844**2809.42*2668.95*3069.29
**34845**2132.10*2025.50*2329.33
**34846**2357.86*2239.97*2575.97
**34847**2583.65*2454.47*2822.64
**34848**2809.42*2668.95*3069.29
**43496**2083.27*1979.11*2275.98
**43647**693.16*658.50*757.28
**43648**527.22*500.86*575.99
#**43648**238.19*226.28*260.22
**43881**669.48*636.01*731.41
#**43881**613.95*583.25*670.74
**43882**709.55*674.07*775.18
#**43882**649.76*617.27*709.86
**47143**425.19*403.93*464.52
**47144**504.90*479.66*551.61
**47145**478.34*454.42*522.58
**48551**265.61*252.33*290.18
**49906**2004.56*1904.33*2189.98
**50323**160.15*152.14*174.96
**50325**265.30*252.04*289.85
**53451**732.93*696.28*800.72
**53452**366.46*348.14*400.36
**53453**622.88*591.74*680.50
**53454**53.97*51.27*58.96
#**53454**34.07*32.37*37.23
**54440**737.20*700.34*805.39
**63043**571.76*543.17*624.65
**63044**511.42*485.85*558.73
**64596**1965.75*1867.46*2147.58
#**64596**313.11*297.45*342.07
**64597**589.72*560.23*644.26
#**64597**93.93*89.23*102.61
**64598**229.55*218.07*250.78
#**64598**139.23*132.27*152.11
**65757**114.79*109.05*125.41
**66983**629.98*598.48*688.25
**66987**735.33*698.56*803.34
**66988**607.65*577.27*663.86
*C*70170**232.31*220.69*253.79
*C*70170*TC*218.36*207.44*238.56
**70555**233.47*221.80*255.07
**70555*TC*120.04*114.04*131.15
*C*70557**636.34*604.52*695.20
*C*70557*TC*491.46*466.89*536.92
*C*70558**323.55*307.37*353.48
*C*70558*TC*163.87*155.68*179.03
*C*70559**315.23*299.47*344.39
*C*70559*TC*163.87*155.68*179.03
*C*74190**512.60*486.97*560.02
*C*74190*TC*491.46*466.89*536.92
**74235**138.69*131.76*151.52
**74235*TC*84.59*80.36*92.41
**74300**78.97*75.02*86.27
**74300*TC*66.31*62.99*72.44
**74301**24.49*23.27*26.76
**74301*TC*15.09*14.34*16.49
**74328**175.06*166.31*191.26
**74328*TC*153.10*145.45*167.27
**74329**133.97*127.27*146.36
**74329*TC*111.70*106.12*122.04
**74330**262.59*249.46*286.88
**74330*TC*236.69*224.86*258.59
**74340**86.58*82.25*94.59
**74340*TC*62.25*59.14*68.01
**74355**86.58*82.25*94.59
**74355*TC*51.91*49.31*56.71
**74360**86.58*82.25*94.59
**74360*TC*60.58*57.55*66.18
**74363**175.06*166.31*191.26
**74363*TC*135.47*128.70*148.01
*C*74445**149.13*141.67*162.92
*C*74445*TC*98.04*93.14*107.11
*C*74450**233.22*221.56*254.79
*C*74450*TC*218.36*207.44*238.56
*C*74470**515.17*489.41*562.82
*C*74470*TC*491.46*466.89*536.92
**74742**233.47*221.80*255.07
**74742*TC*205.62*195.34*224.64
*C*74775**246.54*234.21*269.34
*C*74775*TC*218.36*207.44*238.56
*C*75801**600.97*570.92*656.56
*C*75801*TC*559.73*531.74*611.50
*C*75803**1480.21*1406.20*1617.13
*C*75803*TC*1426.77*1355.43*1558.74
*C*75805**2876.61*2732.78*3142.70
*C*75805*TC*2839.69*2697.71*3102.37
*C*75807**2890.21*2745.70*3157.56
*C*75807*TC*2839.69*2697.71*3102.37
*C*75810**2886.31*2741.99*3153.29
*C*75810*TC*2839.69*2697.71*3102.37
**75894**848.06*805.66*926.51
**75894*TC*778.72*739.78*850.75
*C*75898**2928.16*2781.75*3199.01
*C*75898*TC*2839.69*2697.71*3102.37
**75970**414.20*393.49*452.51
**75970*TC*378.02*359.12*412.99
**76125**37.75*35.86*41.24
**76125*TC*25.09*23.84*27.42
**76390**192.74*183.10*210.57
**76390*TC*142.51*135.38*155.69
**76390*26*50.23*47.72*54.88
**76932**80.67*76.64*88.14
**76932*TC*46.14*43.83*50.40
**76940**154.64*146.91*168.95
**76940*TC*57.81*54.92*63.16
**76941**110.79*105.25*121.04
**76941*TC*49.86*47.37*54.48
**76945**79.68*75.70*87.06
**76945*TC*129.72*123.23*141.71
*C*76975**257.04*244.19*280.82
*C*76975*TC*218.36*207.44*238.56
**76998**175.06*166.31*191.26
**76998*TC*129.72*123.23*141.71
**77013**394.43*374.71*430.92
**77013*TC*219.72*208.73*240.04
**77022**443.55*421.37*484.58
**77022*TC*253.52*240.84*276.97
**77371**601.27*571.21*656.89
**77520**872.41*828.79*953.11
**77522**872.41*828.79*953.11
**77523**1001.73*951.64*1094.39
**77525**1131.05*1074.50*1235.68
*C*78282**382.12*363.01*417.46
*C*78282*TC*367.46*349.09*401.45
**78414**514.99*489.24*562.63
**78414*TC*494.98*470.23*540.76
*C*78429**1468.91*1395.46*1604.78
*C*78429*TC*1393.70*1324.02*1522.62
*C*78430**1465.28*1392.02*1600.82
*C*78430*TC*1393.70*1324.02*1522.62
*C*78431**2187.77*2078.38*2390.14
*C*78431*TC*2104.30*1999.09*2298.95
*C*78432**1819.58*1728.60*1987.89
*C*78432*TC*1730.17*1643.66*1890.21
*C*78433**1921.71*1825.62*2099.46
*C*78433*TC*1823.86*1732.67*1992.57
**78434**656.33*623.51*717.04
**78434*TC*628.82*597.38*686.99
*C*78459**1334.80*1268.06*1458.27
*C*78459*TC*1265.12*1201.86*1382.14
*C*78491**1461.99*1388.89*1597.22
*C*78491*TC*1393.70*1324.02*1522.62
*C*78492**1473.90*1400.21*1610.24
*C*78492*TC*1393.70*1324.02*1522.62
*C*78608**1459.48*1386.51*1594.49
*C*78608*TC*1393.70*1324.02*1522.62
*C*78811**1332.89*1266.25*1456.19
*C*78811*TC*1265.12*1201.86*1382.14
*C*78812**1479.29*1405.33*1616.13
*C*78812*TC*1393.70*1324.02*1522.62
*C*78813**1481.28*1407.22*1618.30
*C*78813*TC*1393.70*1324.02*1522.62
*C*78814**1490.65*1416.12*1628.54
*C*78814*TC*1393.70*1324.02*1522.62
*C*78815**1501.64*1426.56*1640.54
*C*78815*TC*1393.70*1324.02*1522.62
*C*78816**1502.62*1427.49*1641.61
*C*78816*TC*1393.70*1324.02*1522.62
**79300**237.04*225.19*258.97
**79300*TC*176.24*167.43*192.54
**79445**237.04*225.19*258.97
**79445*TC*132.64*126.01*144.91
**86485**15.20*14.44*16.61
**90867**282.19*268.08*308.29
#**90867**132.02*125.42*144.23
**90868**190.99*181.44*208.66
#**90868**100.94*95.89*110.27
**90869**262.88*249.74*287.20
#**90869**153.63*145.95*167.84
**90952**483.64*459.46*528.38
**90953**344.53*327.30*376.40
**92978**231.95*220.35*253.40
**92978*TC*141.16*134.10*154.22
**92979**141.60*134.52*154.70
**92979*TC*69.61*66.13*76.05
*C*93315**610.81*580.27*667.31
*C*93315*TC*491.46*466.89*536.92
**93317**203.23*193.07*222.03
**93317*TC*119.76*113.77*130.84
*C*93318**587.83*558.44*642.21
*C*93318*TC*491.46*466.89*536.92
**93571**231.03*219.48*252.40
**93571*TC*161.99*153.89*176.97
**93572**139.38*132.41*152.27
**93572*TC*89.03*84.58*97.27
**93600**3557.81*3379.92*3886.91
**93600*TC*3446.92*3274.57*3765.76
**93602**3557.81*3379.92*3886.91
**93602*TC*3448.90*3276.46*3767.93
**93603**3557.81*3379.92*3886.91
**93603*TC*3448.90*3276.46*3767.93
**93609**2134.69*2027.96*2332.15
**93609*TC*1874.48*1780.76*2047.87
**93610**3557.81*3379.92*3886.91
**93610*TC*3403.89*3233.70*3718.76
**93612**3557.81*3379.92*3886.91
**93612*TC*3406.25*3235.94*3721.33
**93615**47.57*45.19*51.97
**93615*TC*13.70*13.02*14.97
**93619**7115.62*6759.84*7773.82
**93619*TC*6748.07*6410.67*7372.27
**93620**7115.62*6759.84*7773.82
**93620*TC*6525.80*6199.51*7129.44
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.16*6685.30*7688.10
**93622**7115.62*6759.84*7773.82
**93622*TC*6953.82*6606.13*7597.05
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.61*1967.08*2262.14
**93624**3557.81*3379.92*3886.91
**93624*TC*3328.37*3161.95*3636.24
**93631**7115.62*6759.84*7773.82
**93631*TC*6736.55*6399.72*7359.68
**93640**1133.95*1077.25*1238.84
**93640*TC*965.54*917.26*1054.85
**93641**1133.95*1077.25*1238.84
**93641*TC*839.30*797.34*916.94
**93662**400.34*380.32*437.37
**93662*TC*334.22*317.51*365.14
**93745**83.68*79.50*91.43
**93745*TC*58.58*55.65*64.00
**93745*26*25.10*23.85*27.43
**94642**36.81*34.97*40.22
**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**918.45*872.53*1003.41
**95965*TC*529.38*502.91*578.35
**96020**370.86*352.32*405.17
**96020*TC*221.10*210.05*241.56
**96547**690.71*656.17*754.60
#**96547**128.29*121.88*140.16
**96548**345.35*328.08*377.29
#**96548**64.15*60.94*70.08
**97151**48.06*45.66*52.51
#**97151**42.85*40.71*46.82
**97152**40.85*38.81*44.63
#**97152**36.43*34.61*39.80
**97153**32.53*30.90*35.54
#**97153**28.70*27.27*31.36
**97154**4.48*4.26*4.90
#**97154**4.09*3.89*4.47
**97155**32.53*30.90*35.54
#**97155**28.70*27.27*31.36
**97156**34.32*32.60*37.49
#**97156**30.34*28.82*33.14
**97157**10.03*9.53*10.96
#**97157**9.11*8.65*9.95
**97158**5.21*4.95*5.69
#**97158**4.75*4.51*5.19
**98978**43.55*41.37*47.58
# - 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.