LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**413.47*392.80*451.72
#**G0186**357.51*339.63*390.57
**G0339**2482.57*2358.44*2712.21
**G0340**1867.06*1773.71*2039.77
**G0398**121.18*115.12*132.39
**G0398*TC*84.30*80.09*92.10
**G0398*26*36.87*35.03*40.28
**G0399**85.43*81.16*93.33
**G0399*TC*44.78*42.54*48.92
**G0399*26*40.94*38.89*44.72
**G0400**87.71*83.32*95.82
**G0400*TC*49.68*47.20*54.28
**G0400*26*38.03*36.13*41.55
**G0460**700.03*665.03*764.78
#**G0460**114.13*108.42*124.68
**G0465**700.03*665.03*764.78
#**G0465**114.13*108.42*124.68
**G0498**128.56*122.13*140.45
**G6017**70.81*67.27*77.36
**0042T**204.74*194.50*223.68
**0054T**218.99*208.04*239.25
**0055T**218.99*208.04*239.25
**0071T**536.50*509.68*586.13
**0072T**536.50*509.68*586.13
**0075T**922.05*875.95*1007.34
**0075T*TC*922.05*875.95*1007.34
**0075T*26*922.05*875.95*1007.34
**0076T**1004.67*954.44*1097.61
**0076T*TC*803.74*763.55*878.08
**0076T*26*200.93*190.88*219.51
**0095T**591.57*561.99*646.29
**0098T**662.83*629.69*724.14
**0100T**1753.54*1665.86*1915.74
**0101T**285.89*271.60*312.34
#**0101T**209.45*198.98*228.83
**0102T**285.89*271.60*312.34
#**0102T**209.45*198.98*228.83
**0106T**29.40*27.93*32.12
**0107T**29.40*27.93*32.12
**0108T**29.40*27.93*32.12
**0109T**29.40*27.93*32.12
**0110T**29.40*27.93*32.12
**0164T**646.08*613.78*705.85
**0165T**662.11*629.00*723.35
**0174T**9.50*9.03*10.38
**0184T**768.35*729.93*839.42
**0198T**76.00*72.20*83.03
#**0198T**29.85*28.36*32.61
**0200T**1570.83*1492.29*1716.13
#**0200T**380.58*361.55*415.78
**0201T**2356.25*2238.44*2574.21
#**0201T**570.87*542.33*623.68
**0207T**121.70*115.62*132.96
**0208T**32.92*31.27*35.96
**0209T**39.84*37.85*43.53
**0210T**25.13*23.87*27.45
**0211T**38.98*37.03*42.58
**0212T**33.85*32.16*36.98
#**0212T**29.52*28.04*32.25
**0213T**174.71*165.97*190.87
#**0213T**98.27*93.36*107.36
**0214T**89.15*84.69*97.39
#**0214T**55.69*52.91*60.85
**0215T**89.44*84.97*97.72
#**0215T**56.55*53.72*61.78
**0216T**160.18*152.17*175.00
#**0216T**84.31*80.09*92.10
**0217T**82.98*78.83*90.65
#**0217T**47.79*45.40*52.21
**0218T**82.98*78.83*90.65
#**0218T**48.65*46.22*53.15
**0219T**1233.29*1171.63*1347.37
**0220T**1211.44*1150.87*1323.50
**0221T**1492.61*1417.98*1630.68
**0222T**369.45*350.98*403.63
**0232T**700.03*665.03*764.78
#**0232T**114.13*108.42*124.68
**0234T**7459.66*7086.68*8149.68
#**0234T**556.42*528.60*607.89
**0235T**7459.66*7086.68*8149.68
#**0235T**556.42*528.60*607.89
**0236T**7598.00*7218.10*8300.82
#**0236T**644.28*612.07*703.88
**0237T**7598.00*7218.10*8300.82
#**0237T**644.28*612.07*703.88
**0238T**7598.00*7218.10*8300.82
#**0238T**644.28*612.07*703.88
**0253T**786.78*747.44*859.56
**0266T**843.94*801.74*922.00
**0267T**150.13*142.62*164.01
**0268T**313.05*297.40*342.01
**0269T**797.87*757.98*871.68
**0270T**150.13*142.62*164.01
**0271T**313.05*297.40*342.01
**0272T**50.21*47.70*54.86
**0273T**65.08*61.83*71.10
**0274T**1037.78*985.89*1133.77
**0278T**13.41*12.74*14.65
**0308T**1285.57*1221.29*1404.48
**0329T**76.00*72.20*83.03
#**0329T**29.85*28.36*32.61
**0330T**38.21*36.30*41.75
**0331T**162.01*153.91*177.00
**0332T**276.59*262.76*302.17
**0347T**133.68*127.00*146.05
**0348T**29.40*27.93*32.12
**0349T**31.06*29.51*33.94
**0350T**31.63*30.05*34.56
**0351T**150.08*142.58*163.97
**0352T**40.14*38.13*43.85
**0353T**150.08*142.58*163.97
**0354T**40.14*38.13*43.85
**0358T**23.40*22.23*25.56
**0362T**84.15*79.94*91.93
#**0362T**61.94*58.84*67.67
**0378T**23.32*22.15*25.47
**0394T**220.75*209.71*241.17
**0395T**539.86*512.87*589.80
**0397T**44.10*41.90*48.19
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**479.51*455.53*523.86
**0409T**330.39*313.87*360.95
**0410T**342.85*325.71*374.57
**0411T**342.85*325.71*374.57
**0412T**214.24*203.53*234.06
**0413T**447.51*425.13*488.90
**0414T**344.54*327.31*376.41
**0415T**287.44*273.07*314.03
**0416T**316.27*300.46*345.53
**0417T**75.56*71.78*82.55
**0418T**50.21*47.70*54.86
**0419T**409.57*389.09*447.45
#**0419T**332.26*315.65*363.00
**0420T**585.60*556.32*639.77
#**0420T**490.12*465.61*535.45
**0421T**1443.02*1370.87*1576.50
#**0421T**649.99*617.49*710.11
**0437T**200.33*190.31*218.86
**0439T**64.63*61.40*70.61
**0440T**223.61*212.43*244.29
#**0440T**111.11*105.55*121.38
**0441T**223.61*212.43*244.29
#**0441T**111.11*105.55*121.38
**0442T**223.61*212.43*244.29
#**0442T**111.11*105.55*121.38
**0449T**697.68*662.80*762.22
**0464T**59.70*56.72*65.23
**0472T**60.62*57.59*66.23
**0473T**50.21*47.70*54.86
**0479T**58.88*55.94*64.33
**0480T**69.68*66.20*76.13
#**0480T**29.44*27.97*32.17
**0483T**1126.67*1070.34*1230.89
**0484T**1461.47*1388.40*1596.66
**0485T**21.42*20.35*23.40
**0485T*TC*7.68*7.30*8.40
**0485T*26*14.07*13.37*15.38
**0486T**42.85*40.71*46.82
**0486T*TC*15.03*14.28*16.42
**0486T*26*27.81*26.42*30.38
**0488T**58.36*55.44*63.76
#**0488T**47.11*44.75*51.46
**0505T**9783.83*9294.64*10688.84
#**0505T**560.69*532.66*612.56
**0507T**20.45*19.43*22.34
**0507T*TC*17.63*16.75*19.26
**0507T*26*2.82*2.68*3.08
**0510T**549.16*521.70*599.96
#**0510T**393.38*373.71*429.77
**0512T**285.89*271.60*312.34
#**0512T**209.45*198.98*228.83
**0513T**85.77*81.48*93.70
#**0513T**62.83*59.69*68.64
**0515T**479.51*455.53*523.86
**0516T**442.42*420.30*483.35
**0517T**313.05*297.40*342.01
**0518T**214.24*203.53*234.06
**0519T**313.80*298.11*342.83
**0520T**442.42*420.30*483.35
**0521T**50.21*47.70*54.86
**0521T*TC*31.19*29.63*34.07
**0521T*26*19.02*18.07*20.78
**0522T**60.62*57.59*66.23
**0522T*TC*31.77*30.18*34.71
**0522T*26*28.85*27.41*31.52
**0523T**138.02*131.12*150.79
**0524T**1437.34*1365.47*1570.29
#**0524T**167.76*159.37*183.28
**0525T**442.71*420.57*483.66
**0526T**342.85*325.71*374.57
**0527T**298.82*283.88*326.46
**0528T**60.62*57.59*66.23
**0528T*TC*31.77*30.18*34.71
**0528T*26*28.85*27.41*31.52
**0529T**50.21*47.70*54.86
**0529T*TC*31.19*29.63*34.07
**0529T*26*19.02*18.07*20.78
**0530T**587.52*558.14*641.86
**0531T**447.51*425.13*488.90
**0532T**313.80*298.11*342.83
**0540T**164.96*156.71*180.22
**0543T**1461.47*1388.40*1596.66
**0544T**1674.51*1590.78*1829.40
**0545T**1674.51*1590.78*1829.40
**0546T**65.01*61.76*71.02
**0552T**6.04*5.74*6.60
**0553T**2161.17*2053.11*2361.08
#**0553T**372.32*353.70*406.76
**0565T**562.02*533.92*614.01
#**0565T**475.77*451.98*519.78
**0566T**91.04*86.49*99.46
#**0566T**55.55*52.77*60.69
**0569T**1674.51*1590.78*1829.40
**0570T**394.02*374.32*430.47
**0571T**518.26*492.35*566.20
**0572T**422.34*401.22*461.40
**0573T**321.20*305.14*350.91
**0574T**373.32*354.65*407.85
**0575T**60.62*57.59*66.23
**0576T**50.21*47.70*54.86
**0577T**176.32*167.50*192.63
**0578T**27.57*26.19*30.12
**0579T**18.50*17.58*20.22
**0580T**197.92*188.02*216.22
**0581T**1979.45*1880.48*2162.55
#**0581T**198.39*188.47*216.74
**0582T**1458.96*1386.01*1593.91
#**0582T**356.69*338.86*389.69
**0583T**1496.16*1421.35*1634.55
#**0583T**121.86*115.77*133.14
**0587T**405.09*384.84*442.57
#**0587T**277.01*263.16*302.63
**0588T**332.21*315.60*362.94
#**0588T**215.38*204.61*235.30
**0589T**44.81*42.57*48.96
#**0589T**36.45*34.63*39.82
**0590T**52.42*49.80*57.27
#**0590T**37.71*35.82*41.19
**0596T**2235.23*2123.47*2441.99
#**0596T**125.10*118.85*136.68
**0597T**672.69*639.06*734.92
#**0597T**125.10*118.85*136.68
**0598T**132.05*125.45*144.27
**0599T**88.13*83.72*96.28
**0600T**3157.47*2999.60*3449.54
#**0600T**684.07*649.87*747.35
**0601T**1366.75*1298.41*1493.17
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**175.72*166.93*191.97
**0611T**35.26*33.50*38.53
**0614T**344.04*326.84*375.87
**0615T**43.39*41.22*47.40
**0616T**609.68*579.20*666.08
**0617T**680.37*646.35*743.30
**0618T**823.20*782.04*899.35
**0619T**597.13*567.27*652.36
#**0619T**443.21*421.05*484.21
**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**231.47*219.90*252.89
#**0627T**93.00*88.35*101.60
**0628T**69.44*65.97*75.87
#**0628T**27.90*26.51*30.49
**0629T**231.47*219.90*252.89
#**0629T**93.00*88.35*101.60
**0630T**69.44*65.97*75.87
#**0630T**27.90*26.51*30.49
**0631T**72.39*68.77*79.09
**0632T**537.98*511.08*587.74
**0633T**179.38*170.41*195.97
*C*0633T*TC*92.35*87.73*100.89
**0633T*26*55.55*52.77*60.69
**0634T**179.38*170.41*195.97
**0634T*TC*123.82*117.63*135.27
**0634T*26*55.55*52.77*60.69
**0635T**179.38*170.41*195.97
**0635T*TC*123.82*117.63*135.27
**0635T*26*55.55*52.77*60.69
**0636T**179.38*170.41*195.97
**0636T*TC*123.82*117.63*135.27
**0636T*26*55.55*52.77*60.69
**0637T**179.38*170.41*195.97
**0637T*TC*123.82*117.63*135.27
**0637T*26*55.55*52.77*60.69
**0638T**179.38*170.41*195.97
**0638T*TC*123.82*117.63*135.27
**0638T*26*55.55*52.77*60.69
**0639T**72.39*68.77*79.09
**0640T**20.45*19.43*22.34
**0640T*TC*17.63*16.75*19.26
**0640T*26*2.82*2.68*3.08
**0644T**1027.27*975.91*1122.30
#**0644T**227.33*215.96*248.35
**0646T**1674.51*1590.78*1829.40
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**53.76*51.07*58.73
**0652T**257.96*245.06*281.82
#**0652T**113.72*108.03*124.23
**0653T**335.71*318.92*366.76
#**0653T**128.58*122.15*140.47
**0654T**132.24*125.63*144.47
**0655T**1443.02*1370.87*1576.50
#**0655T**649.99*617.49*710.11
**0658T**82.25*78.14*89.86
**0659T**2368.13*2249.72*2587.18
#**0659T**410.82*390.28*448.82
**0671T**938.22*891.31*1025.01
**0673T**2999.64*2849.66*3277.11
#**0673T**343.06*325.91*374.80
**0699T**103.19*98.03*112.73
#**0699T**84.15*79.94*91.93
**0707T**334.02*317.32*364.92
#**0707T**254.12*241.41*277.62
**0714T**1240.10*1178.10*1354.82
#**0714T**332.55*315.92*363.31
**0730T**249.23*236.77*272.29
#**0730T**225.39*214.12*246.24
**0738T**66.20*62.89*72.32
**0739T**1443.02*1370.87*1576.50
#**0739T**649.99*617.49*710.11
**0740T**17.37*16.50*18.98
**0741T**41.00*38.95*44.79
**0742T**82.98*78.83*90.65
**0742T*TC*64.96*61.71*70.97
**0742T*26*18.02*17.12*19.69
**0743T**47.42*45.05*51.81
**0744T**839.07*797.12*916.69
**0745T**222.94*211.79*243.56
**0746T**210.59*200.06*230.07
**0747T**861.93*818.83*941.65
**0748T**171.22*162.66*187.06
**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**387.06*367.71*422.87
**0756T**98.81*93.87*107.95
**0757T**71.39*67.82*77.99
**0758T**79.71*75.72*87.08
**0759T**118.71*112.77*129.69
**0760T**88.76*84.32*96.97
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**104.92*99.67*114.62
**0764T**3.94*3.74*4.30
**0765T**7.62*7.24*8.33
**0771T**24.92*23.67*27.22
**0772T**24.92*23.67*27.22
**0773T**20.93*19.88*22.86
**0774T**20.93*19.88*22.86
**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**380.61*361.58*415.82
**0779T*TC*356.30*338.49*389.26
**0779T*26*24.31*23.09*26.55
**0780T**20.93*19.88*22.86
**0783T**12.44*11.82*13.59
**0784T**1860.94*1767.89*2033.07
#**0784T**303.74*288.55*331.83
**0785T**219.22*208.26*239.50
#**0785T**134.12*127.41*146.52
**0786T**658.29*625.38*719.19
#**0786T**285.00*270.75*311.36
**0787T**219.22*208.26*239.50
#**0787T**134.12*127.41*146.52
**0788T**17.62*16.74*19.25
#**0788T**17.04*16.19*18.62
**0789T**24.67*23.44*26.96
#**0789T**21.30*20.24*23.28
**0790T**1806.06*1715.76*1973.12
**0791T**8.38*7.96*9.15
**0793T**537.98*511.08*587.74
**0794T**130.35*123.83*142.40
**0795T**663.63*630.45*725.02
**0796T**442.42*420.30*483.35
**0797T**442.42*420.30*483.35
**0798T**703.96*668.76*769.07
**0799T**469.31*445.84*512.72
**0800T**469.31*445.84*512.72
**0801T**911.73*866.14*996.06
**0802T**455.86*433.07*498.03
**0803T**455.86*433.07*498.03
**0804T**70.89*67.35*77.45
**0804T*TC*36.67*34.84*40.07
**0804T*26*34.22*32.51*37.39
**0805T**2590.86*2461.32*2830.52
#**0805T**307.00*291.65*335.40
**0806T**3454.48*3281.76*3774.02
#**0806T**409.33*388.86*447.19
**0807T**38.23*36.32*41.77
**0807T*TC*24.27*23.06*26.52
**0807T*26*13.96*13.26*15.25
**0808T**38.23*36.32*41.77
**0808T*TC*24.27*23.06*26.52
**0808T*26*13.96*13.26*15.25
**0810T**1043.20*991.04*1139.70
**0811T**17.37*16.50*18.98
**0813T**2264.52*2151.29*2473.98
#**0813T**169.60*161.12*185.29
**0814T**417.53*396.65*456.15
#**0814T**317.65*301.77*347.04
**0818T**332.21*315.60*362.94
#**0818T**215.38*204.61*235.30
**0820T**140.04*133.04*153.00
#**0820T**124.75*118.51*136.29
**0821T**140.04*133.04*153.00
#**0821T**124.75*118.51*136.29
**0822T**119.03*113.08*130.04
#**0822T**106.04*100.74*115.85
**0823T**663.63*630.45*725.02
**0824T**703.96*668.76*769.07
**0825T**911.73*866.14*996.06
**0826T**60.62*57.59*66.23
**0826T*TC*31.77*30.18*34.71
**0826T*26*28.85*27.41*31.52
**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**20.45*19.43*22.34
**0859T*TC*17.63*16.75*19.26
**0859T*26*2.82*2.68*3.08
**0864T**285.89*271.60*312.34
#**0864T**209.45*198.98*228.83
**10011**378.50*359.58*413.52
#**10011**101.85*96.76*111.27
**10012**210.50*199.98*229.98
#**10012**68.57*65.14*74.91
**15847**327.90*311.51*358.24
**21742**1089.21*1034.75*1189.96
**21743**1253.29*1190.63*1369.22
**32855**331.01*314.46*361.63
**32856**428.30*406.89*467.92
**33928**3148.71*2991.27*3439.96
**33929**1179.34*1120.37*1288.43
**33933**507.00*481.65*553.90
**33944**513.77*488.08*561.29
**34841**2014.32*1913.60*2200.64
**34842**2240.11*2128.10*2447.32
**34843**2465.88*2342.59*2693.98
**34844**2691.67*2557.09*2940.65
**34845**2014.32*1913.60*2200.64
**34846**2240.11*2128.10*2447.32
**34847**2465.88*2342.59*2693.98
**34848**2691.67*2557.09*2940.65
**43496**1948.34*1850.92*2128.56
**43647**627.11*595.75*685.11
**43648**493.98*469.28*539.67
#**43648**226.14*214.83*247.05
**43881**614.08*583.38*670.89
#**43881**564.16*535.95*616.34
**43882**647.84*615.45*707.77
#**43882**594.12*564.41*649.07
**47143**400.79*380.75*437.86
**47144**475.96*452.16*519.98
**47145**450.90*428.36*492.61
**48551**250.17*237.66*273.31
**49906**1862.39*1769.27*2034.66
**50323**151.40*143.83*165.40
**50325**240.02*228.02*262.22
**53451**709.60*674.12*775.24
**53452**354.80*337.06*387.62
**53453**603.01*572.86*658.79
**53454**51.97*49.37*56.78
#**53454**33.22*31.56*36.29
**54440**703.51*668.33*768.58
**63043**540.36*513.34*590.34
**63044**475.51*451.73*519.49
**64596**1860.94*1767.89*2033.07
#**64596**303.74*288.55*331.83
**64597**558.28*530.37*609.93
#**64597**91.12*86.56*99.54
**64598**219.22*208.26*239.50
#**64598**134.12*127.41*146.52
**65757**110.59*105.06*120.82
**66983**609.68*579.20*666.08
**66987**713.70*678.02*779.72
**66988**589.52*560.04*644.05
*C*70170**219.36*208.39*239.65
*C*70170*TC*205.72*195.43*224.74
**70555**233.47*221.80*255.07
**70555*TC*122.21*116.10*133.52
*C*70557**604.58*574.35*660.50
*C*70557*TC*463.04*439.89*505.87
*C*70558**310.38*294.86*339.09
*C*70558*TC*154.37*146.65*168.65
*C*70559**302.13*287.02*330.07
*C*70559*TC*154.37*146.65*168.65
*C*74190**483.76*459.57*528.51
*C*74190*TC*463.04*439.89*505.87
**74235**132.23*125.62*144.46
**74235*TC*79.22*75.26*86.55
**74300**74.91*71.16*81.83
**74300*TC*62.54*59.41*68.32
**74301**23.15*21.99*25.29
**74301*TC*13.93*13.23*15.21
**74328**175.06*166.31*191.26
**74328*TC*153.55*145.87*167.75
**74329**126.86*120.52*138.60
**74329*TC*105.06*99.81*114.78
**74330**262.59*249.46*286.88
**74330*TC*237.23*225.37*259.18
**74340**86.58*82.25*94.59
**74340*TC*62.74*59.60*68.54
**74355**86.58*82.25*94.59
**74355*TC*52.62*49.99*57.49
**74360**86.58*82.25*94.59
**74360*TC*61.23*58.17*66.90
**74363**175.06*166.31*191.26
**74363*TC*136.27*129.46*148.88
*C*74445**142.50*135.38*155.69
*C*74445*TC*92.35*87.73*100.89
*C*74450**220.31*209.29*240.68
*C*74450*TC*205.72*195.43*224.74
*C*74470**486.30*461.99*531.29
*C*74470*TC*463.04*439.89*505.87
**74742**233.47*221.80*255.07
**74742*TC*206.18*195.87*225.25
*C*74775**233.33*221.66*254.91
*C*74775*TC*205.72*195.43*224.74
*C*75801**567.30*538.94*619.78
*C*75801*TC*527.37*501.00*576.15
*C*75803**1396.69*1326.86*1525.89
*C*75803*TC*1344.33*1277.11*1468.68
*C*75805**2711.83*2576.24*2962.68
*C*75805*TC*2675.65*2541.87*2923.15
*C*75807**2725.19*2588.93*2977.27
*C*75807*TC*2675.65*2541.87*2923.15
*C*75810**2721.39*2585.32*2973.12
*C*75810*TC*2675.65*2541.87*2923.15
**75894**796.82*756.98*870.53
**75894*TC*729.95*693.45*797.47
*C*75898**2760.87*2622.83*3016.25
*C*75898*TC*2675.65*2541.87*2923.15
**75970**389.60*370.12*425.64
**75970*TC*354.15*336.44*386.91
**76125**35.87*34.08*39.19
**76125*TC*23.50*22.33*25.68
**76390**183.41*174.24*200.38
**76390*TC*134.21*127.50*146.63
**76390*26*49.20*46.74*53.75
**76932**76.86*73.02*83.97
**76932*TC*43.37*41.20*47.38
**76940**147.38*140.01*161.01
**76940*TC*53.30*50.64*58.24
**76941**106.40*101.08*116.24
**76941*TC*46.56*44.23*50.86
**76945**75.96*72.16*82.98
**76945*TC*46.20*43.89*50.47
*C*76975**243.59*231.41*266.12
*C*76975*TC*205.72*195.43*224.74
**76998**175.06*166.31*191.26
**76998*TC*131.18*124.62*143.31
**77013**374.21*355.50*408.83
**77013*TC*202.92*192.77*221.69
**77022**423.32*402.15*462.47
**77022*TC*237.02*225.17*258.95
**77371**540.13*513.12*590.09
**77520**783.77*744.58*856.27
**77522**783.77*744.58*856.27
**77523**899.97*854.97*983.22
**77525**1016.17*965.36*1110.16
*C*78282**360.70*342.67*394.07
*C*78282*TC*346.20*328.89*378.22
**78414**514.99*489.24*562.63
**78414*TC*495.32*470.55*541.13
*C*78429**1387.16*1317.80*1515.47
*C*78429*TC*1313.18*1247.52*1434.65
*C*78430**1383.60*1314.42*1511.58
*C*78430*TC*1313.18*1247.52*1434.65
*C*78431**2064.76*1961.52*2255.75
*C*78431*TC*1982.73*1883.59*2166.13
*C*78432**1718.13*1632.22*1877.05
*C*78432*TC*1630.21*1548.70*1781.01
*C*78433**1814.68*1723.95*1982.54
*C*78433*TC*1718.49*1632.57*1877.46
**78434**619.38*588.41*676.67
**78434*TC*592.34*562.72*647.13
*C*78459**1260.51*1197.48*1377.10
*C*78459*TC*1192.02*1132.42*1302.28
*C*78491**1380.29*1311.28*1507.97
*C*78491*TC*1313.18*1247.52*1434.65
*C*78492**1391.93*1322.33*1520.68
*C*78492*TC*1313.18*1247.52*1434.65
*C*78608**1377.78*1308.89*1505.22
*C*78608*TC*1313.18*1247.52*1434.65
*C*78811**1258.54*1195.61*1374.95
*C*78811*TC*1192.02*1132.42*1302.28
*C*78812**1397.15*1327.29*1526.38
*C*78812*TC*1313.18*1247.52*1434.65
*C*78813**1399.16*1329.20*1528.58
*C*78813*TC*1313.18*1247.52*1434.65
*C*78814**1408.34*1337.92*1538.61
*C*78814*TC*1313.18*1247.52*1434.65
*C*78815**1419.11*1348.15*1550.37
*C*78815*TC*1313.18*1247.52*1434.65
*C*78816**1420.18*1349.17*1551.55
*C*78816*TC*1313.18*1247.52*1434.65
**79300**237.04*225.19*258.97
**79300*TC*176.79*167.95*193.14
**79445**237.04*225.19*258.97
**79445*TC*134.62*127.89*147.07
**86485**15.20*14.44*16.61
**90867**268.69*255.26*293.55
#**90867**127.19*120.83*138.95
**90868**183.03*173.88*199.96
#**90868**98.92*93.97*108.07
**90869**252.77*240.13*276.15
#**90869**147.84*140.45*161.52
**90952**467.64*444.26*510.90
**90953**332.18*315.57*362.91
**92978**220.90*209.86*241.34
**92978*TC*133.14*126.48*145.45
**92979**135.48*128.71*148.02
**92979*TC*65.83*62.54*71.92
*C*93315**580.26*551.25*633.94
*C*93315*TC*463.04*439.89*505.87
**93317**193.90*184.21*211.84
**93317*TC*112.20*106.59*122.58
*C*93318**557.49*529.62*609.06
*C*93318*TC*463.04*439.89*505.87
**93571**220.04*209.04*240.40
**93571*TC*153.26*145.60*167.44
**93572**133.42*126.75*145.76
**93572*TC*84.76*80.52*92.60
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.72*3278.18*3769.91
**93602**3557.81*3379.92*3886.91
**93602*TC*3452.52*3279.89*3771.87
**93603**3557.81*3379.92*3886.91
**93603*TC*3452.52*3279.89*3771.87
**93609**2134.69*2027.96*2332.15
**93609*TC*1883.38*1789.21*2057.59
**93610**3557.81*3379.92*3886.91
**93610*TC*3408.96*3238.51*3724.29
**93612**3557.81*3379.92*3886.91
**93612*TC*3411.08*3240.53*3726.61
**93615**45.50*43.23*49.71
**93615*TC*12.26*11.65*13.40
**93619**7115.62*6759.84*7773.82
**93619*TC*6760.62*6422.59*7385.98
**93620**7115.62*6759.84*7773.82
**93620*TC*6546.01*6218.71*7151.52
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.87*6687.88*7691.06
**93622**7115.62*6759.84*7773.82
**93622*TC*6959.37*6611.40*7603.11
**93623**2134.69*2027.96*2332.15
**93623*TC*2073.12*1969.46*2264.88
**93624**3557.81*3379.92*3886.91
**93624*TC*3336.10*3169.30*3644.70
**93631**7115.62*6759.84*7773.82
**93631*TC*6749.49*6412.02*7373.82
**93640**1133.95*1077.25*1238.84
**93640*TC*971.24*922.68*1061.08
**93641**1133.95*1077.25*1238.84
**93641*TC*849.46*806.99*928.04
**93662**379.58*360.60*414.69
**93662*TC*314.70*298.97*343.82
**93745**79.27*75.31*86.61
**93745*TC*56.75*53.91*62.00
**93745*26*22.54*21.41*24.62
**94642**33.33*31.66*36.41
**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**909.86*864.37*994.03
**95965*TC*529.38*502.91*578.35
**96020**374.35*355.63*408.97
**96020*TC*227.25*215.89*248.27
**96547**654.33*621.61*714.85
#**96547**124.40*118.18*135.91
**96548**327.17*310.81*357.43
#**96548**62.20*59.09*67.95
**97151**47.24*44.88*51.61
#**97151**42.34*40.22*46.25
**97152**40.15*38.14*43.86
#**97152**35.99*34.19*39.32
**97153**32.02*30.42*34.98
#**97153**28.41*26.99*31.04
**97154**4.36*4.14*4.76
#**97154**4.00*3.80*4.37
**97155**32.02*30.42*34.98
#**97155**28.41*26.99*31.04
**97156**33.80*32.11*36.93
#**97156**30.05*28.55*32.83
**97157**9.83*9.34*10.74
#**97157**8.97*8.52*9.80
**97158**5.08*4.83*5.55
#**97158**4.64*4.41*5.07
**98978**41.00*38.95*44.79
# - 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.