NEW MEXICO MEDICARE CARRIER - 04212
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**423.66*402.48*462.85
#**G0186**365.98*347.68*399.83
**G0339**2593.52*2463.84*2833.42
**G0340**1950.66*1853.13*2131.10
**G0398**124.30*118.09*135.80
**G0398*TC*86.99*82.64*95.04
**G0398*26*37.31*35.44*40.76
**G0399**87.37*83.00*95.45
**G0399*TC*46.26*43.95*50.54
**G0399*26*41.41*39.34*45.24
**G0400**89.81*85.32*98.12
**G0400*TC*51.31*48.74*56.05
**G0400*26*38.50*36.58*42.07
**G0460**721.16*685.10*787.87
#**G0460**117.31*111.44*128.16
**G0465**721.16*685.10*787.87
#**G0465**117.31*111.44*128.16
**G0498**132.65*126.02*144.92
**G6017**72.56*68.93*79.27
**0042T**209.46*198.99*228.84
**0054T**229.01*217.56*250.19
**0055T**229.01*217.56*250.19
**0071T**551.96*524.36*603.01
**0072T**551.96*524.36*603.01
**0075T**956.47*908.65*1044.95
**0075T*TC*956.47*908.65*1044.95
**0075T*26*956.47*908.65*1044.95
**0076T**1020.84*969.80*1115.27
**0076T*TC*816.66*775.83*892.20
**0076T*26*204.17*193.96*223.05
**0095T**620.09*589.09*677.45
**0098T**694.93*660.18*759.21
**0100T**1791.08*1701.53*1956.76
**0101T**292.76*278.12*319.84
#**0101T**213.97*203.27*233.76
**0102T**292.76*278.12*319.84
#**0102T**213.97*203.27*233.76
**0106T**30.35*28.83*33.15
**0107T**30.35*28.83*33.15
**0108T**30.35*28.83*33.15
**0109T**30.35*28.83*33.15
**0110T**30.35*28.83*33.15
**0164T**677.09*643.24*739.73
**0165T**693.94*659.24*758.13
**0174T**9.57*9.09*10.45
**0184T**790.99*751.44*864.16
**0198T**77.83*73.94*85.03
#**0198T**30.26*28.75*33.06
**0200T**1617.22*1536.36*1766.81
#**0200T**390.49*370.97*426.62
**0201T**2425.83*2304.54*2650.22
#**0201T**585.74*556.45*639.92
**0207T**121.70*115.62*132.96
**0208T**33.98*32.28*37.12
**0209T**41.12*39.06*44.92
**0210T**25.95*24.65*28.35
**0211T**40.22*38.21*43.94
**0212T**34.39*32.67*37.57
#**0212T**29.93*28.43*32.69
**0213T**179.19*170.23*195.76
#**0213T**100.40*95.38*109.69
**0214T**91.35*86.78*99.80
#**0214T**56.86*54.02*62.12
**0215T**91.65*87.07*100.13
#**0215T**57.75*54.86*63.09
**0216T**164.35*156.13*179.55
#**0216T**86.15*81.84*94.12
**0217T**85.04*80.79*92.91
#**0217T**48.77*46.33*53.28
**0218T**85.04*80.79*92.91
#**0218T**49.66*47.18*54.26
**0219T**1285.67*1221.39*1404.60
**0220T**1261.39*1198.32*1378.07
**0221T**1550.03*1472.53*1693.41
**0222T**385.21*365.95*420.84
**0232T**721.16*685.10*787.87
#**0232T**117.31*111.44*128.16
**0234T**7689.79*7305.30*8401.10
#**0234T**574.98*546.23*628.16
**0235T**7689.79*7305.30*8401.10
#**0235T**574.98*546.23*628.16
**0236T**7831.62*7440.04*8556.05
#**0236T**664.78*631.54*726.27
**0237T**7831.62*7440.04*8556.05
#**0237T**664.78*631.54*726.27
**0238T**7831.62*7440.04*8556.05
#**0238T**664.78*631.54*726.27
**0253T**818.91*777.96*894.65
**0266T**872.63*829.00*953.35
**0267T**154.97*147.22*169.30
**0268T**323.68*307.50*353.63
**0269T**825.08*783.83*901.40
**0270T**154.97*147.22*169.30
**0271T**323.68*307.50*353.63
**0272T**51.42*48.85*56.18
**0273T**66.53*63.20*72.68
**0274T**1080.23*1026.22*1180.15
**0278T**13.62*12.94*14.88
**0308T**1313.27*1247.61*1434.75
**0329T**77.83*73.94*85.03
#**0329T**30.26*28.75*33.06
**0330T**38.21*36.30*41.75
**0331T**166.54*158.21*181.94
**0332T**284.20*269.99*310.49
**0347T**137.83*130.94*150.58
**0348T**30.21*28.70*33.01
**0349T**31.93*30.33*34.88
**0350T**32.53*30.90*35.54
**0351T**154.09*146.39*168.35
**0352T**40.73*38.69*44.49
**0353T**154.09*146.39*168.35
**0354T**40.73*38.69*44.49
**0358T**24.17*22.96*26.40
**0362T**85.95*81.65*93.90
#**0362T**63.05*59.90*68.89
**0378T**23.71*22.52*25.90
**0394T**226.93*215.58*247.92
**0395T**554.01*526.31*605.26
**0397T**44.80*42.56*48.94
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**495.76*470.97*541.62
**0409T**341.49*324.42*373.08
**0410T**354.36*336.64*387.14
**0411T**354.36*336.64*387.14
**0412T**221.43*210.36*241.91
**0413T**462.60*439.47*505.39
**0414T**356.20*338.39*389.15
**0415T**297.23*282.37*324.73
**0416T**326.96*310.61*357.20
**0417T**77.24*73.38*84.39
**0418T**51.42*48.85*56.18
**0419T**420.09*399.09*458.95
#**0419T**340.41*323.39*371.90
**0420T**601.42*571.35*657.05
#**0420T**503.01*477.86*549.54
**0421T**1482.85*1408.71*1620.02
#**0421T**665.52*632.24*727.08
**0437T**206.52*196.19*225.62
**0439T**66.61*63.28*72.77
**0440T**229.58*218.10*250.82
#**0440T**113.62*107.94*124.13
**0441T**229.58*218.10*250.82
#**0441T**113.62*107.94*124.13
**0442T**229.58*218.10*250.82
#**0442T**113.62*107.94*124.13
**0449T**713.34*677.67*779.32
**0464T**61.29*58.23*66.96
**0472T**61.98*58.88*67.71
**0473T**51.42*48.85*56.18
**0479T**59.79*56.80*65.32
**0480T**71.37*67.80*77.97
#**0480T**29.90*28.41*32.67
**0483T**1166.09*1107.79*1273.96
**0484T**1512.31*1436.69*1652.19
**0485T**21.86*20.77*23.89
**0485T*TC*7.97*7.57*8.71
**0485T*26*14.28*13.57*15.61
**0486T**43.72*41.53*47.76
**0486T*TC*15.55*14.77*16.99
**0486T*26*28.17*26.76*30.77
**0488T**59.51*56.53*65.01
#**0488T**47.92*45.52*52.35
**0505T**10144.72*9637.48*11083.10
#**0505T**568.03*539.63*620.57
**0507T**21.14*20.08*23.09
**0507T*TC*18.22*17.31*19.91
**0507T*26*2.91*2.76*3.17
**0510T**565.56*537.28*617.87
#**0510T**405.01*384.76*442.47
**0512T**292.76*278.12*319.84
#**0512T**213.97*203.27*233.76
**0513T**87.83*83.44*95.96
#**0513T**64.19*60.98*70.13
**0515T**495.76*470.97*541.62
**0516T**457.42*434.55*499.73
**0517T**323.68*307.50*353.63
**0518T**221.43*210.36*241.91
**0519T**324.48*308.26*354.50
**0520T**457.42*434.55*499.73
**0521T**51.42*48.85*56.18
**0521T*TC*32.20*30.59*35.18
**0521T*26*19.22*18.26*21.00
**0522T**61.98*58.88*67.71
**0522T*TC*32.79*31.15*35.82
**0522T*26*29.19*27.73*31.89
**0523T**142.16*135.05*155.31
**0524T**1481.65*1407.57*1618.71
#**0524T**173.16*164.50*189.18
**0525T**457.72*434.83*500.05
**0526T**354.36*336.64*387.14
**0527T**308.97*293.52*337.55
**0528T**61.98*58.88*67.71
**0528T*TC*32.79*31.15*35.82
**0528T*26*29.19*27.73*31.89
**0529T**51.42*48.85*56.18
**0529T*TC*32.20*30.59*35.18
**0529T*26*19.22*18.26*21.00
**0530T**607.42*577.05*663.61
**0531T**462.60*439.47*505.39
**0532T**324.48*308.26*354.50
**0540T**168.05*159.65*183.60
**0543T**1512.31*1436.69*1652.19
**0544T**1732.32*1645.70*1892.56
**0545T**1732.32*1645.70*1892.56
**0546T**66.36*63.04*72.50
**0552T**6.21*5.90*6.79
**0553T**2228.58*2117.15*2434.72
#**0553T**384.92*365.67*420.52
**0565T**579.04*550.09*632.60
#**0565T**490.14*465.63*535.47
**0566T**93.51*88.83*102.15
#**0566T**56.94*54.09*62.20
**0569T**1732.32*1645.70*1892.56
**0570T**407.61*387.23*445.31
**0571T**535.79*509.00*585.35
**0572T**436.76*414.92*477.16
**0573T**332.09*315.49*362.81
**0574T**386.14*366.83*421.85
**0575T**61.98*58.88*67.71
**0576T**51.42*48.85*56.18
**0577T**179.20*170.24*195.78
**0578T**28.02*26.62*30.61
**0579T**19.11*18.15*20.87
**0580T**204.60*194.37*223.53
**0581T**2041.38*1939.31*2230.21
#**0581T**205.75*195.46*224.78
**0582T**1501.54*1426.46*1640.43
#**0582T**365.49*347.22*399.30
**0583T**1496.16*1421.35*1634.55
#**0583T**125.26*119.00*136.85
**0587T**416.21*395.40*454.71
#**0587T**284.21*270.00*310.50
**0588T**341.52*324.44*373.11
#**0588T**221.11*210.05*241.56
**0589T**45.77*43.48*50.00
#**0589T**37.15*35.29*40.58
**0590T**53.65*50.97*58.62
#**0590T**38.48*36.56*42.04
**0596T**2235.23*2123.47*2441.99
#**0596T**126.79*120.45*138.52
**0597T**672.69*639.06*734.92
#**0597T**126.79*120.45*138.52
**0598T**135.94*129.14*148.51
**0599T**90.63*86.10*99.02
**0600T**3247.48*3085.11*3547.88
#**0600T**698.28*663.37*762.88
**0601T**1415.10*1344.35*1546.00
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**180.15*171.14*196.81
**0611T**36.45*34.63*39.82
**0614T**355.66*337.88*388.56
**0615T**44.20*41.99*48.29
**0616T**621.82*590.73*679.34
**0617T**695.08*660.33*759.38
**0618T**841.15*799.09*918.95
**0619T**612.64*582.01*669.31
#**0619T**454.05*431.35*496.05
**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**237.70*225.82*259.69
#**0627T**94.98*90.23*103.76
**0628T**71.31*67.74*77.90
#**0628T**28.50*27.08*31.14
**0629T**237.70*225.82*259.69
#**0629T**94.98*90.23*103.76
**0630T**71.31*67.74*77.90
#**0630T**28.50*27.08*31.14
**0631T**74.62*70.89*81.52
**0632T**556.34*528.52*607.80
**0633T**184.04*174.84*201.07
*C*0633T*TC*95.23*90.47*104.04
**0633T*26*56.31*53.49*61.51
**0634T**184.04*174.84*201.07
**0634T*TC*127.72*121.33*139.53
**0634T*26*56.31*53.49*61.51
**0635T**184.04*174.84*201.07
**0635T*TC*127.72*121.33*139.53
**0635T*26*56.31*53.49*61.51
**0636T**184.04*174.84*201.07
**0636T*TC*127.72*121.33*139.53
**0636T*26*56.31*53.49*61.51
**0637T**184.04*174.84*201.07
**0637T*TC*127.72*121.33*139.53
**0637T*26*56.31*53.49*61.51
**0638T**184.04*174.84*201.07
**0638T*TC*127.72*121.33*139.53
**0638T*26*56.31*53.49*61.51
**0639T**74.62*70.89*81.52
**0640T**21.14*20.08*23.09
**0640T*TC*18.22*17.31*19.91
**0640T*26*2.91*2.76*3.17
**0644T**1059.11*1006.15*1157.07
#**0644T**234.65*222.92*256.36
**0646T**1732.32*1645.70*1892.56
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**55.05*52.30*60.15
**0652T**265.13*251.87*289.65
#**0652T**116.47*110.65*127.25
**0653T**345.17*327.91*377.10
#**0653T**131.69*125.11*143.88
**0654T**135.52*128.74*148.05
**0655T**1482.85*1408.71*1620.02
#**0655T**665.52*632.24*727.08
**0658T**84.82*80.58*92.67
**0659T**2441.92*2319.82*2667.79
#**0659T**424.63*403.40*463.91
**0671T**959.23*911.27*1047.96
**0673T**3090.18*2935.67*3376.02
#**0673T**352.18*334.57*384.76
**0699T**105.48*100.21*115.24
#**0699T**85.86*81.57*93.81
**0707T**343.27*326.11*375.03
#**0707T**260.91*247.86*285.04
**0714T**1276.12*1212.31*1394.16
#**0714T**340.76*323.72*372.28
**0730T**251.42*238.85*274.68
#**0730T**226.92*215.57*247.91
**0738T**67.34*63.97*73.57
**0739T**1482.85*1408.71*1620.02
#**0739T**665.52*632.24*727.08
**0740T**18.01*17.11*19.68
**0741T**42.31*40.19*46.22
**0742T**85.26*81.00*93.15
**0742T*TC*67.03*63.68*73.23
**0742T*26*18.23*17.32*19.92
**0743T**48.73*46.29*53.23
**0744T**869.82*826.33*950.28
**0745T**230.13*218.62*251.41
**0746T**213.68*203.00*233.45
**0747T**889.65*845.17*971.95
**0748T**176.08*167.28*192.37
**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**396.53*376.70*433.21
**0756T**101.40*96.33*110.78
**0757T**73.44*69.77*80.24
**0758T**81.80*77.71*89.37
**0759T**121.97*115.87*133.25
**0760T**90.88*86.34*99.29
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**107.39*102.02*117.32
**0764T**4.04*3.84*4.42
**0765T**7.73*7.34*8.44
**0771T**25.49*24.22*27.85
**0772T**25.49*24.22*27.85
**0773T**21.44*20.37*23.43
**0774T**21.44*20.37*23.43
**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**391.91*372.31*428.16
**0779T*TC*367.27*348.91*401.25
**0779T*26*24.63*23.40*26.91
**0780T**21.44*20.37*23.43
**0783T**12.87*12.23*14.06
**0784T**1915.43*1819.66*2092.61
#**0784T**310.51*294.98*339.23
**0785T**225.40*214.13*246.25
#**0785T**137.69*130.81*150.43
**0786T**676.88*643.04*739.50
#**0786T**292.15*277.54*319.17
**0787T**225.40*214.13*246.25
#**0787T**137.69*130.81*150.43
**0788T**17.96*17.06*19.62
#**0788T**17.37*16.50*18.98
**0789T**25.62*24.34*27.99
#**0789T**21.71*20.62*23.71
**0790T**1844.66*1752.43*2015.29
**0791T**8.55*8.12*9.34
**0793T**556.34*528.52*607.80
**0794T**130.35*123.83*142.40
**0795T**686.13*651.82*749.59
**0796T**457.42*434.55*499.73
**0797T**457.42*434.55*499.73
**0798T**728.23*691.82*795.59
**0799T**485.49*461.22*530.40
**0800T**485.49*461.22*530.40
**0801T**942.91*895.76*1030.12
**0802T**471.45*447.88*515.06
**0803T**471.45*447.88*515.06
**0804T**72.45*68.83*79.15
**0804T*TC*37.85*35.96*41.35
**0804T*26*34.60*32.87*37.80
**0805T**2668.50*2535.08*2915.34
#**0805T**314.64*298.91*343.75
**0806T**3558.00*3380.10*3887.12
#**0806T**419.52*398.54*458.32
**0807T**39.31*37.34*42.94
**0807T*TC*25.06*23.81*27.38
**0807T*26*14.25*13.54*15.57
**0808T**39.31*37.34*42.94
**0808T*TC*25.06*23.81*27.38
**0808T*26*14.25*13.54*15.57
**0810T**1065.49*1012.22*1164.05
**0811T**18.01*17.11*19.68
**0813T**2334.41*2217.69*2550.34
#**0813T**175.29*166.53*191.51
**0814T**429.08*407.63*468.77
#**0814T**326.14*309.83*356.30
**0818T**341.52*324.44*373.11
#**0818T**221.11*210.05*241.56
**0820T**141.56*134.48*154.65
#**0820T**125.81*119.52*137.45
**0821T**141.56*134.48*154.65
#**0821T**125.81*119.52*137.45
**0822T**120.33*114.31*131.46
#**0822T**106.94*101.59*116.83
**0823T**686.13*651.82*749.59
**0824T**728.23*691.82*795.59
**0825T**942.91*895.76*1030.12
**0826T**61.98*58.88*67.71
**0826T*TC*32.79*31.15*35.82
**0826T*26*29.19*27.73*31.89
**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**21.14*20.08*23.09
**0859T*TC*18.22*17.31*19.91
**0859T*26*2.91*2.76*3.17
**0864T**292.76*278.12*319.84
#**0864T**213.97*203.27*233.76
**10011**388.98*369.53*424.96
#**10011**103.85*98.66*113.46
**10012**216.39*205.57*236.41
#**10012**70.11*66.60*76.59
**15847**338.11*321.20*369.38
**21742**1125.04*1068.79*1229.11
**21743**1298.18*1233.27*1418.26
**32855**344.68*327.45*376.57
**32856**443.80*421.61*484.85
**33928**3259.81*3096.82*3561.34
**33929**1220.69*1159.66*1333.61
**33933**529.04*502.59*577.98
**33944**529.04*502.59*577.98
**34841**2081.49*1977.42*2274.03
**34842**2307.25*2191.89*2520.67
**34843**2533.03*2406.38*2767.34
**34844**2758.81*2620.87*3014.00
**34845**2081.49*1977.42*2274.03
**34846**2307.25*2191.89*2520.67
**34847**2533.03*2406.38*2767.34
**34848**2758.81*2620.87*3014.00
**43496**2032.41*1930.79*2220.41
**43647**442.49*420.37*483.43
**43648**511.84*486.25*559.19
#**43648**232.48*220.86*253.99
**43881**652.36*619.74*712.70
#**43881**600.24*570.23*655.76
**43882**688.41*653.99*752.09
#**43882**632.30*600.69*690.79
**47143**414.19*393.48*452.50
**47144**491.86*467.27*537.36
**47145**465.96*442.66*509.06
**48551**259.86*246.87*283.90
**49906**1944.65*1847.42*2124.53
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**726.63*690.30*793.85
**53452**363.31*345.14*396.91
**53453**617.50*586.63*674.62
**53454**53.17*50.51*58.09
#**53454**33.85*32.16*36.98
**54440**726.63*690.30*793.85
**63043**567.83*539.44*620.36
**63044**503.36*478.19*549.92
**64596**1915.43*1819.66*2092.61
#**64596**310.51*294.98*339.23
**64597**574.63*545.90*627.79
#**64597**93.15*88.49*101.76
**64598**225.40*214.13*246.25
#**64598**137.69*130.81*150.43
**65757**113.43*107.76*123.92
**66983**621.82*590.73*679.34
**66987**728.22*691.81*795.58
**66988**600.74*570.70*656.31
*C*70170**225.93*214.63*246.82
*C*70170*TC*212.07*201.47*231.69
**70555**233.47*221.80*255.07
**70555*TC*120.72*114.68*131.88
*C*70557**620.93*589.88*678.36
*C*70557*TC*477.28*453.42*521.43
*C*70558**317.47*301.60*346.84
*C*70558*TC*159.15*151.19*173.87
*C*70559**309.59*294.11*338.23
*C*70559*TC*159.15*151.19*173.87
*C*74190**498.31*473.39*544.40
*C*74190*TC*477.28*453.42*521.43
**74235**136.13*129.32*148.72
**74235*TC*82.37*78.25*89.99
**74300**77.04*73.19*84.17
**74300*TC*64.46*61.24*70.43
**74301**23.92*22.72*26.13
**74301*TC*14.58*13.85*15.93
**74328**175.06*166.31*191.26
**74328*TC*153.25*145.59*167.43
**74329**131.09*124.54*143.22
**74329*TC*108.99*103.54*119.07
**74330**262.59*249.46*286.88
**74330*TC*236.86*225.02*258.77
**74340**86.58*82.25*94.59
**74340*TC*62.40*59.28*68.17
**74355**86.58*82.25*94.59
**74355*TC*52.13*49.52*56.95
**74360**86.58*82.25*94.59
**74360*TC*60.74*57.70*66.36
**74363**175.06*166.31*191.26
**74363*TC*135.70*128.92*148.26
*C*74445**145.98*138.68*159.48
*C*74445*TC*95.23*90.47*104.04
*C*74450**226.83*215.49*247.81
*C*74450*TC*212.07*201.47*231.69
*C*74470**500.87*475.83*547.20
*C*74470*TC*477.28*453.42*521.43
**74742**233.47*221.80*255.07
**74742*TC*205.80*195.51*224.84
*C*74775**240.07*228.07*262.28
*C*74775*TC*212.07*201.47*231.69
*C*75801**584.61*555.38*638.69
*C*75801*TC*543.58*516.40*593.86
*C*75803**1438.69*1366.76*1571.77
*C*75803*TC*1385.59*1316.31*1513.76
*C*75805**2794.38*2654.66*3052.86
*C*75805*TC*2757.70*2619.82*3012.79
*C*75807**2808.01*2667.61*3067.75
*C*75807*TC*2757.70*2619.82*3012.79
*C*75810**2804.22*2664.01*3063.61
*C*75810*TC*2757.70*2619.82*3012.79
**75894**827.00*785.65*903.50
**75894*TC*757.99*720.09*828.10
*C*75898**2845.77*2703.48*3109.00
*C*75898*TC*2757.70*2619.82*3012.79
**75970**404.06*383.86*441.44
**75970*TC*368.04*349.64*402.09
**76125**37.01*35.16*40.43
**76125*TC*24.43*23.21*26.69
**76390**188.34*178.92*205.76
**76390*TC*138.42*131.50*151.23
**76390*26*49.92*47.42*54.53
**76932**79.17*75.21*86.49
**76932*TC*44.86*42.62*49.01
**76940**153.03*145.38*167.19
**76940*TC*56.67*53.84*61.92
**76941**109.10*103.65*119.20
**76941*TC*48.61*46.18*53.11
**76945**78.19*74.28*85.42
**76945*TC*48.14*45.73*52.59
*C*76975**250.45*237.93*273.62
*C*76975*TC*212.07*201.47*231.69
**76998**175.06*166.31*191.26
**76998*TC*129.91*123.41*141.92
**77013**384.59*365.36*420.16
**77013*TC*210.75*200.21*230.24
**77022**433.70*412.02*473.82
**77022*TC*244.80*232.56*267.44
**77371**564.54*536.31*616.76
**77520**818.99*778.04*894.75
**77522**818.99*778.04*894.75
**77523**940.38*893.36*1027.36
**77525**1061.74*1008.65*1159.95
*C*78282**371.48*352.91*405.85
*C*78282*TC*356.87*339.03*389.88
**78414**514.99*489.24*562.63
**78414*TC*495.11*470.35*540.90
*C*78429**1428.27*1356.86*1560.39
*C*78429*TC*1353.47*1285.80*1478.67
*C*78430**1424.65*1353.42*1556.43
*C*78430*TC*1353.47*1285.80*1478.67
*C*78431**2126.50*2020.18*2323.21
*C*78431*TC*2043.55*1941.37*2232.58
*C*78432**1769.13*1680.67*1932.77
*C*78432*TC*1680.23*1596.22*1835.65
*C*78433**1868.50*1775.08*2041.34
*C*78433*TC*1771.21*1682.65*1935.05
**78434**637.95*606.05*696.96
**78434*TC*610.61*580.08*667.09
*C*78459**1297.89*1233.00*1417.95
*C*78459*TC*1228.60*1167.17*1342.25
*C*78491**1421.34*1350.27*1552.81
*C*78491*TC*1353.47*1285.80*1478.67
*C*78492**1433.15*1361.49*1565.71
*C*78492*TC*1353.47*1285.80*1478.67
*C*78608**1418.87*1347.93*1550.12
*C*78608*TC*1353.47*1285.80*1478.67
*C*78811**1295.99*1231.19*1415.87
*C*78811*TC*1228.60*1167.17*1342.25
*C*78812**1438.56*1366.63*1571.62
*C*78812*TC*1353.47*1285.80*1478.67
*C*78813**1440.55*1368.52*1573.80
*C*78813*TC*1353.47*1285.80*1478.67
*C*78814**1449.86*1377.37*1583.98
*C*78814*TC*1353.47*1285.80*1478.67
*C*78815**1460.78*1387.74*1595.90
*C*78815*TC*1353.47*1285.80*1478.67
*C*78816**1461.77*1388.68*1596.98
*C*78816*TC*1353.47*1285.80*1478.67
**79300**237.04*225.19*258.97
**79300*TC*176.45*167.63*192.77
**79445**237.04*225.19*258.97
**79445*TC*133.16*126.50*145.48
**86485**17.28*16.42*18.88
**90867**276.58*262.75*302.16
#**90867**130.75*124.21*142.84
**90868**187.89*178.50*205.28
#**90868**100.10*95.10*109.37
**90869**258.70*245.77*282.64
#**90869**151.61*144.03*165.63
**90952**473.23*449.57*517.01
**90953**336.49*319.67*367.62
**92978**227.44*216.07*248.48
**92978*TC*137.02*130.17*149.70
**92979**139.18*132.22*152.05
**92979*TC*67.48*64.11*73.73
*C*93315**595.87*566.08*650.99
*C*93315*TC*477.28*453.42*521.43
**93317**199.58*189.60*218.04
**93317*TC*116.59*110.76*127.37
*C*93318**573.10*544.45*626.12
*C*93318*TC*477.28*453.42*521.43
**93571**226.54*215.21*247.49
**93571*TC*157.79*149.90*172.39
**93572**137.01*130.16*149.68
**93572*TC*86.87*82.53*94.91
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.47*3275.10*3766.37
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.43*3276.96*3768.50
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.43*3276.96*3768.50
**93609**2134.69*2027.96*2332.15
**93609*TC*1875.76*1781.97*2049.27
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.60*3234.37*3719.53
**93612**3557.81*3379.92*3886.91
**93612*TC*3406.94*3236.59*3722.08
**93615**46.29*43.98*50.58
**93615*TC*12.67*12.04*13.85
**93619**7115.62*6759.84*7773.82
**93619*TC*6749.86*6412.37*7374.23
**93620**7115.62*6759.84*7773.82
**93620*TC*6528.65*6202.22*7132.55
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.54*6685.66*7688.51
**93622**7115.62*6759.84*7773.82
**93622*TC*6954.60*6606.87*7597.90
**93623**2134.69*2027.96*2332.15
**93623*TC*2071.23*1967.67*2262.82
**93624**3557.81*3379.92*3886.91
**93624*TC*3329.27*3162.81*3637.23
**93631**7115.62*6759.84*7773.82
**93631*TC*6737.83*6400.94*7361.08
**93640**1133.95*1077.25*1238.84
**93640*TC*966.33*918.01*1055.71
**93641**1133.95*1077.25*1238.84
**93641*TC*840.67*798.64*918.44
**93662**388.34*368.92*424.26
**93662*TC*322.71*306.57*352.56
**93745**60.46*57.44*66.06
**93745*TC*42.32*40.20*46.23
**93745*26*18.15*17.24*19.83
**94642**19.40*18.43*21.19
**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**909.00*863.55*993.08
**95965*TC*523.04*496.89*571.42
**95966**532.61*505.98*581.88
**95966*TC*345.30*328.04*377.25
**95967**448.07*425.67*489.52
**95967*TC*285.34*271.07*311.73
**96020**373.48*354.81*408.03
**96020*TC*224.58*213.35*245.35
**96547**672.99*639.34*735.24
#**96547**126.82*120.48*138.55
**96548**336.50*319.68*367.63
#**96548**63.41*60.24*69.28
**97151**47.77*45.38*52.19
#**97151**42.71*40.57*46.66
**97152**40.60*38.57*44.36
#**97152**36.31*34.49*39.66
**97153**32.34*30.72*35.33
#**97153**28.63*27.20*31.28
**97154**4.46*4.24*4.88
#**97154**4.08*3.88*4.46
**97155**32.34*30.72*35.33
#**97155**28.63*27.20*31.28
**97156**34.13*32.42*37.28
#**97156**30.26*28.75*33.06
**97157**9.97*9.47*10.89
#**97157**9.07*8.62*9.91
**97158**5.17*4.91*5.65
#**97158**4.73*4.49*5.16
**98978**42.31*40.19*46.22
# - 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.