OKLAHOMA MEDICARE CARRIER - 04312
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**414.58*393.85*452.93
#**G0186**357.98*340.08*391.09
**G0339**2423.13*2301.97*2647.27
**G0340**1822.37*1731.25*1990.94
**G0398**121.94*115.84*133.22
**G0398*TC*85.14*80.88*93.01
**G0398*26*36.80*34.96*40.20
**G0399**85.76*81.47*93.69
**G0399*TC*45.17*42.91*49.35
**G0399*26*40.88*38.84*44.67
**G0400**88.10*83.70*96.26
**G0400*TC*50.13*47.62*54.76
**G0400*26*37.97*36.07*41.48
**G0460**704.95*669.70*770.16
#**G0460**112.41*106.79*122.81
**G0465**704.95*669.70*770.16
#**G0465**112.41*106.79*122.81
**G0498**129.52*123.04*141.50
**G6017**70.91*67.36*77.46
**0042T**205.94*195.64*224.99
**0054T**212.12*201.51*231.74
**0055T**212.12*201.51*231.74
**0071T**530.31*503.79*579.36
**0072T**530.31*503.79*579.36
**0075T**898.90*853.96*982.05
**0075T*TC*898.90*853.96*982.05
**0075T*26*898.90*853.96*982.05
**0076T**965.90*917.61*1055.25
**0076T*TC*772.72*734.08*844.19
**0076T*26*193.19*183.53*211.06
**0095T**573.33*544.66*626.36
**0098T**642.03*609.93*701.42
**0100T**1750.51*1662.98*1912.43
**0101T**286.08*271.78*312.55
#**0101T**208.77*198.33*228.08
**0102T**286.08*271.78*312.55
#**0102T**208.77*198.33*228.08
**0106T**29.59*28.11*32.33
**0107T**29.59*28.11*32.33
**0108T**29.59*28.11*32.33
**0109T**29.59*28.11*32.33
**0110T**29.59*28.11*32.33
**0164T**626.48*595.16*684.43
**0165T**641.92*609.82*701.29
**0174T**9.38*8.91*10.25
**0184T**759.89*721.90*830.19
**0198T**76.52*72.69*83.59
#**0198T**29.84*28.35*32.60
**0200T**1579.63*1500.65*1725.75
#**0200T**375.86*357.07*410.63
**0201T**2369.44*2250.97*2588.62
#**0201T**563.80*535.61*615.95
**0207T**121.70*115.62*132.96
**0208T**33.23*31.57*36.31
**0209T**40.24*38.23*43.96
**0210T**25.36*24.09*27.70
**0211T**39.36*37.39*43.00
**0212T**33.89*32.20*37.03
#**0212T**29.51*28.03*32.23
**0213T**174.96*166.21*191.14
#**0213T**97.65*92.77*106.69
**0214T**89.02*84.57*97.26
#**0214T**55.18*52.42*60.28
**0215T**89.32*84.85*97.58
#**0215T**56.06*53.26*61.25
**0216T**160.55*152.52*175.40
#**0216T**83.81*79.62*91.56
**0217T**82.96*78.81*90.63
#**0217T**47.37*45.00*51.75
**0218T**82.96*78.81*90.63
#**0218T**48.24*45.83*52.70
**0219T**1204.72*1144.48*1316.15
**0220T**1184.79*1125.55*1294.38
**0221T**1461.04*1387.99*1596.19
**0222T**358.99*341.04*392.20
**0232T**704.95*669.70*770.16
#**0232T**112.41*106.79*122.81
**0234T**7524.99*7148.74*8221.05
#**0234T**543.39*516.22*593.65
**0235T**7524.99*7148.74*8221.05
#**0235T**543.39*516.22*593.65
**0236T**7662.66*7279.53*8371.46
#**0236T**630.01*598.51*688.29
**0237T**7662.66*7279.53*8371.46
#**0237T**630.01*598.51*688.29
**0238T**7662.66*7279.53*8371.46
#**0238T**630.01*598.51*688.29
**0253T**766.20*727.89*837.07
**0266T**827.92*786.52*904.50
**0267T**146.98*139.63*160.57
**0268T**307.51*292.13*335.95
**0269T**783.18*744.02*855.62
**0270T**146.98*139.63*160.57
**0271T**307.51*292.13*335.95
**0272T**50.50*47.98*55.18
**0273T**65.30*62.04*71.35
**0274T**1015.17*964.41*1109.07
**0278T**13.41*12.74*14.65
**0308T**1283.68*1219.50*1402.43
**0329T**76.52*72.69*83.59
#**0329T**29.84*28.35*32.60
**0330T**38.21*36.30*41.75
**0331T**163.14*154.98*178.23
**0332T**278.62*264.69*304.39
**0347T**131.37*124.80*143.52
**0348T**29.55*28.07*32.28
**0349T**31.23*29.67*34.12
**0350T**31.81*30.22*34.75
**0351T**151.25*143.69*165.24
**0352T**40.12*38.11*43.83
**0353T**151.25*143.69*165.24
**0354T**40.12*38.11*43.83
**0358T**23.61*22.43*25.79
**0362T**84.03*79.83*91.80
#**0362T**61.57*58.49*67.26
**0378T**23.23*22.07*25.38
**0394T**222.33*211.21*242.89
**0395T**542.98*515.83*593.20
**0397T**43.97*41.77*48.04
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**470.40*446.88*513.91
**0409T**324.70*308.47*354.74
**0410T**337.16*320.30*368.35
**0411T**337.16*320.30*368.35
**0412T**211.26*200.70*230.81
**0413T**439.54*417.56*480.19
**0414T**338.51*321.58*369.82
**0415T**282.21*268.10*308.32
**0416T**311.45*295.88*340.26
**0417T**75.87*72.08*82.89
**0418T**50.50*47.98*55.18
**0419T**409.31*388.84*447.17
#**0419T**331.13*314.57*361.76
**0420T**583.39*554.22*637.35
#**0420T**486.82*462.48*531.85
**0421T**1446.09*1373.79*1579.86
#**0421T**644.07*611.87*703.65
**0437T**197.06*187.21*215.29
**0439T**64.58*61.35*70.55
**0440T**224.18*212.97*244.92
#**0440T**110.39*104.87*120.60
**0441T**224.18*212.97*244.92
#**0441T**110.39*104.87*120.60
**0442T**224.18*212.97*244.92
#**0442T**110.39*104.87*120.60
**0449T**697.39*662.52*761.90
**0464T**60.13*57.12*65.69
**0472T**60.89*57.85*66.53
**0473T**50.50*47.98*55.18
**0479T**58.83*55.89*64.27
**0480T**70.11*66.60*76.59
#**0480T**29.41*27.94*32.13
**0483T**1100.20*1045.19*1201.97
**0484T**1427.16*1355.80*1559.17
**0485T**21.51*20.43*23.49
**0485T*TC*7.71*7.32*8.42
**0485T*26*14.07*13.37*15.38
**0486T**43.01*40.86*46.99
**0486T*TC*15.15*14.39*16.55
**0486T*26*27.87*26.48*30.45
**0488T**58.24*55.33*63.63
#**0488T**46.86*44.52*51.20
**0505T**9806.39*9316.07*10713.48
#**0505T**541.66*514.58*591.77
**0507T**20.55*19.52*22.45
**0507T*TC*17.77*16.88*19.41
**0507T*26*2.78*2.64*3.04
**0510T**546.93*519.58*597.52
#**0510T**389.38*369.91*425.40
**0512T**286.08*271.78*312.55
#**0512T**208.77*198.33*228.08
**0513T**85.83*81.54*93.77
#**0513T**62.63*59.50*68.43
**0515T**470.40*446.88*513.91
**0516T**434.10*412.40*474.26
**0517T**307.51*292.13*335.95
**0518T**211.26*200.70*230.81
**0519T**308.27*292.86*336.79
**0520T**434.10*412.40*474.26
**0521T**50.50*47.98*55.18
**0521T*TC*31.48*29.91*34.40
**0521T*26*19.01*18.06*20.77
**0522T**60.89*57.85*66.53
**0522T*TC*32.07*30.47*35.04
**0522T*26*28.82*27.38*31.49
**0523T**137.51*130.63*150.22
**0524T**1448.11*1375.70*1582.06
#**0524T**164.11*155.90*179.29
**0525T**434.40*412.68*474.58
**0526T**337.16*320.30*368.35
**0527T**293.57*278.89*320.72
**0528T**60.89*57.85*66.53
**0528T*TC*32.07*30.47*35.04
**0528T*26*28.82*27.38*31.49
**0529T**50.50*47.98*55.18
**0529T*TC*31.48*29.91*34.40
**0529T*26*19.01*18.06*20.77
**0530T**577.18*548.32*630.57
**0531T**439.54*417.56*480.19
**0532T**308.27*292.86*336.79
**0540T**164.53*156.30*179.75
**0543T**1427.16*1355.80*1559.17
**0544T**1637.76*1555.87*1789.25
**0545T**1637.76*1555.87*1789.25
**0546T**65.35*62.08*71.39
**0552T**6.02*5.72*6.58
**0553T**2172.50*2063.88*2373.46
#**0553T**363.35*345.18*396.96
**0565T**558.52*530.59*610.18
#**0565T**471.29*447.73*514.89
**0566T**90.78*86.24*99.18
#**0566T**54.89*52.15*59.97
**0569T**1637.76*1555.87*1789.25
**0570T**384.87*365.63*420.47
**0571T**508.61*483.18*555.66
**0572T**414.20*393.49*452.51
**0573T**315.51*299.73*344.69
**0574T**366.23*347.92*400.11
**0575T**60.89*57.85*66.53
**0576T**50.50*47.98*55.18
**0577T**176.60*167.77*192.94
**0578T**27.42*26.05*29.96
**0579T**18.65*17.72*20.38
**0580T**194.91*185.16*212.93
**0581T**1994.94*1895.19*2179.47
#**0581T**193.67*183.99*211.59
**0582T**1469.01*1395.56*1604.89
#**0582T**354.23*336.52*387.00
**0583T**1496.16*1421.35*1634.55
#**0583T**121.32*115.25*132.54
**0587T**403.49*383.32*440.82
#**0587T**273.95*260.25*299.29
**0588T**331.27*314.71*361.92
#**0588T**213.11*202.45*232.82
**0589T**44.62*42.39*48.75
#**0589T**36.16*34.35*39.50
**0590T**52.25*49.64*57.09
#**0590T**37.37*35.50*40.83
**0596T**2235.23*2123.47*2441.99
#**0596T**124.32*118.10*135.82
**0597T**672.69*639.06*734.92
#**0597T**124.32*118.10*135.82
**0598T**133.33*126.66*145.66
**0599T**88.98*84.53*97.21
**0600T**3178.42*3019.50*3472.43
#**0600T**676.95*643.10*739.57
**0601T**1338.10*1271.20*1461.88
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**176.58*167.75*192.91
**0611T**35.54*33.76*38.82
**0614T**338.00*321.10*369.27
**0615T**43.45*41.28*47.47
**0616T**609.55*579.07*665.93
**0617T**679.63*645.65*742.50
**0618T**822.32*781.20*898.38
**0619T**595.66*565.88*650.76
#**0619T**440.01*418.01*480.71
**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**232.36*220.74*253.85
#**0627T**92.32*87.70*100.86
**0628T**69.71*66.22*76.15
#**0628T**27.70*26.32*30.27
**0629T**232.36*220.74*253.85
#**0629T**92.32*87.70*100.86
**0630T**69.71*66.22*76.15
#**0630T**27.70*26.32*30.27
**0631T**72.83*69.19*79.57
**0632T**526.60*500.27*575.31
**0633T**180.47*171.45*197.17
*C*0633T*TC*93.33*88.66*101.96
**0633T*26*55.36*52.59*60.48
**0634T**180.47*171.45*197.17
**0634T*TC*125.11*118.85*136.68
**0634T*26*55.36*52.59*60.48
**0635T**180.47*171.45*197.17
**0635T*TC*125.11*118.85*136.68
**0635T*26*55.36*52.59*60.48
**0636T**180.47*171.45*197.17
**0636T*TC*125.11*118.85*136.68
**0636T*26*55.36*52.59*60.48
**0637T**180.47*171.45*197.17
**0637T*TC*125.11*118.85*136.68
**0637T*26*55.36*52.59*60.48
**0638T**180.47*171.45*197.17
**0638T*TC*125.11*118.85*136.68
**0638T*26*55.36*52.59*60.48
**0639T**72.83*69.19*79.57
**0640T**20.55*19.52*22.45
**0640T*TC*17.77*16.88*19.41
**0640T*26*2.78*2.64*3.04
**0644T**1031.15*979.59*1126.53
#**0644T**222.12*211.01*242.66
**0646T**1637.76*1555.87*1789.25
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**54.00*51.30*59.00
**0652T**258.58*245.65*282.50
#**0652T**112.70*107.07*123.13
**0653T**336.86*320.02*368.02
#**0653T**127.38*121.01*139.16
**0654T**130.87*124.33*142.98
**0655T**1446.09*1373.79*1579.86
#**0655T**644.07*611.87*703.65
**0658T**83.12*78.96*90.80
**0659T**2380.49*2261.47*2600.69
#**0659T**400.96*380.91*438.05
**0671T**937.77*890.88*1024.51
**0673T**3024.70*2873.47*3304.49
#**0673T**337.97*321.07*369.23
**0699T**103.18*98.02*112.72
#**0699T**83.92*79.72*91.68
**0707T**334.63*317.90*365.59
#**0707T**253.81*241.12*277.29
**0714T**1248.26*1185.85*1363.73
#**0714T**330.42*313.90*360.99
**0730T**245.97*233.67*268.72
#**0730T**221.88*210.79*242.41
**0738T**65.99*62.69*72.09
**0739T**1446.09*1373.79*1579.86
#**0739T**644.07*611.87*703.65
**0740T**17.45*16.58*19.07
**0741T**41.40*39.33*45.23
**0742T**83.59*79.41*91.32
**0742T*TC*65.61*62.33*71.68
**0742T*26*17.98*17.08*19.64
**0743T**47.67*45.29*52.08
**0744T**817.62*776.74*893.25
**0745T**225.05*213.80*245.87
**0746T**210.32*199.80*229.77
**0747T**870.24*826.73*950.74
**0748T**169.26*160.80*184.92
**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**389.94*370.44*426.01
**0756T**99.61*94.63*108.82
**0757T**71.99*68.39*78.65
**0758T**80.33*76.31*87.76
**0759T**119.68*113.70*130.76
**0760T**89.39*84.92*97.66
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**105.68*100.40*115.46
**0764T**3.93*3.73*4.29
**0765T**7.58*7.20*8.28
**0771T**24.62*23.39*26.90
**0772T**24.62*23.39*26.90
**0773T**21.04*19.99*22.99
**0774T**21.04*19.99*22.99
**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**384.56*365.33*420.13
**0779T*TC*360.29*342.28*393.62
**0779T*26*24.27*23.06*26.52
**0780T**21.04*19.99*22.99
**0783T**12.52*11.89*13.67
**0784T**1876.26*1782.45*2049.82
#**0784T**301.39*286.32*329.27
**0785T**219.16*208.20*239.43
#**0785T**133.09*126.44*145.41
**0786T**659.38*626.41*720.37
#**0786T**281.85*267.76*307.92
**0787T**219.16*208.20*239.43
#**0787T**133.09*126.44*145.41
**0788T**17.51*16.63*19.12
#**0788T**16.93*16.08*18.49
**0789T**24.08*22.88*26.31
#**0789T**21.16*20.10*23.12
**0790T**1791.35*1701.78*1957.05
**0791T**8.36*7.94*9.13
**0793T**526.60*500.27*575.31
**0794T**130.35*123.83*142.40
**0795T**651.16*618.60*711.39
**0796T**434.10*412.40*474.26
**0797T**434.10*412.40*474.26
**0798T**689.55*655.07*753.33
**0799T**459.70*436.72*502.23
**0800T**459.70*436.72*502.23
**0801T**893.81*849.12*976.49
**0802T**446.90*424.56*488.24
**0803T**446.90*424.56*488.24
**0804T**71.23*67.67*77.82
**0804T*TC*37.03*35.18*40.46
**0804T*26*34.21*32.50*37.38
**0805T**2612.21*2481.60*2853.84
#**0805T**302.42*287.30*330.40
**0806T**3482.95*3308.80*3805.12
#**0806T**403.23*383.07*440.53
**0807T**38.31*36.39*41.85
**0807T*TC*24.48*23.26*26.75
**0807T*26*13.83*13.14*15.11
**0808T**38.31*36.39*41.85
**0808T*TC*24.48*23.26*26.75
**0808T*26*13.83*13.14*15.11
**0810T**1041.42*989.35*1137.75
**0811T**17.45*16.58*19.07
**0813T**2284.99*2170.74*2496.35
#**0813T**166.30*157.99*181.69
**0814T**418.28*397.37*456.98
#**0814T**317.26*301.40*346.61
**0818T**331.27*314.71*361.92
#**0818T**213.11*202.45*232.82
**0820T**139.82*132.83*152.75
#**0820T**124.36*118.14*135.86
**0821T**139.82*132.83*152.75
#**0821T**124.36*118.14*135.86
**0822T**118.85*112.91*129.85
#**0822T**105.71*100.42*115.48
**0823T**651.16*618.60*711.39
**0824T**689.55*655.07*753.33
**0825T**893.81*849.12*976.49
**0826T**60.89*57.85*66.53
**0826T*TC*32.07*30.47*35.04
**0826T*26*28.82*27.38*31.49
**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**20.55*19.52*22.45
**0859T*TC*17.77*16.88*19.41
**0859T*26*2.78*2.64*3.04
**0864T**286.08*271.78*312.55
#**0864T**208.77*198.33*228.08
**10011**380.65*361.62*415.86
#**10011**100.86*95.82*110.19
**10012**211.04*200.49*230.56
#**10012**67.50*64.13*73.75
**15847**323.73*307.54*353.67
**21742**1068.46*1015.04*1167.30
**21743**1225.55*1164.27*1338.91
**32855**318.72*302.78*348.20
**32856**417.79*396.90*456.44
**33928**3069.86*2916.37*3353.83
**33929**1150.05*1092.55*1256.43
**33933**488.17*463.76*533.32
**33944**488.17*463.76*533.32
**34841**1933.03*1836.38*2111.84
**34842**2158.80*2050.86*2358.49
**34843**2384.58*2265.35*2605.15
**34844**2610.35*2479.83*2851.80
**34845**1933.03*1836.38*2111.84
**34846**2158.80*2050.86*2358.49
**34847**2384.58*2265.35*2605.15
**34848**2610.35*2479.83*2851.80
**43496**1882.70*1788.57*2056.86
**43647**442.49*420.37*483.43
**43648**477.31*453.44*521.46
#**43648**217.91*207.01*238.06
**43881**595.57*565.79*650.66
#**43881**546.88*519.54*597.47
**43882**629.04*597.59*687.23
#**43882**576.61*547.78*629.95
**47143**385.36*366.09*421.00
**47144**457.61*434.73*499.94
**47145**433.53*411.85*473.63
**48551**241.38*229.31*263.71
**49906**1802.51*1712.38*1969.24
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**703.44*668.27*768.51
**53452**351.72*334.13*384.25
**53453**597.80*567.91*653.10
**53454**51.94*49.34*56.74
#**53454**32.98*31.33*36.03
**54440**676.85*643.01*739.46
**63043**523.18*497.02*571.57
**63044**459.74*436.75*502.26
**64596**1876.26*1782.45*2049.82
#**64596**301.39*286.32*329.27
**64597**562.88*534.74*614.95
#**64597**90.42*85.90*98.79
**64598**219.16*208.20*239.43
#**64598**133.09*126.44*145.41
**65757**109.92*104.42*120.08
**66983**609.55*579.07*665.93
**66987**710.45*674.93*776.17
**66988**588.66*559.23*643.11
*C*70170**221.56*210.48*242.05
*C*70170*TC*207.99*197.59*227.23
**70555**233.47*221.80*255.07
**70555*TC*122.60*116.47*133.94
*C*70557**609.54*579.06*665.92
*C*70557*TC*468.23*444.82*511.54
*C*70558**311.83*296.24*340.68
*C*70558*TC*156.06*148.26*170.50
*C*70559**302.77*287.63*330.77
*C*70559*TC*156.06*148.26*170.50
*C*74190**488.83*464.39*534.05
*C*74190*TC*468.23*444.82*511.54
**74235**132.11*125.50*144.33
**74235*TC*79.29*75.33*86.63
**74300**75.46*71.69*82.44
**74300*TC*63.17*60.01*69.01
**74301**23.20*22.04*25.35
**74301*TC*14.02*13.32*15.32
**74328**175.06*166.31*191.26
**74328*TC*153.59*145.91*167.80
**74329**126.86*120.52*138.60
**74329*TC*105.10*99.85*114.83
**74330**262.59*249.46*286.88
**74330*TC*237.33*225.46*259.28
**74340**86.58*82.25*94.59
**74340*TC*62.85*59.71*68.67
**74355**86.58*82.25*94.59
**74355*TC*52.75*50.11*57.63
**74360**86.58*82.25*94.59
**74360*TC*61.44*58.37*67.13
**74363**175.06*166.31*191.26
**74363*TC*136.45*129.63*149.07
*C*74445**143.40*136.23*156.66
*C*74445*TC*93.33*88.66*101.96
*C*74450**222.57*211.44*243.16
*C*74450*TC*207.99*197.59*227.23
*C*74470**491.38*466.81*536.83
*C*74470*TC*468.23*444.82*511.54
**74742**233.47*221.80*255.07
**74742*TC*206.28*195.97*225.37
*C*74775**235.51*223.73*257.29
*C*74775*TC*207.99*197.59*227.23
*C*75801**572.61*543.98*625.58
*C*75801*TC*533.29*506.63*582.62
*C*75803**1411.69*1341.11*1542.28
*C*75803*TC*1359.53*1291.55*1485.28
*C*75805**2742.01*2604.91*2995.65
*C*75805*TC*2705.96*2570.66*2956.26
*C*75807**2755.16*2617.40*3010.01
*C*75807*TC*2705.96*2570.66*2956.26
*C*75810**2751.21*2613.65*3005.70
*C*75810*TC*2705.96*2570.66*2956.26
**75894**797.42*757.55*871.18
**75894*TC*731.87*695.28*799.57
*C*75898**2789.41*2649.94*3047.43
*C*75898*TC*2705.96*2570.66*2956.26
**75970**389.94*370.44*426.01
**75970*TC*354.75*337.01*387.56
**76125**35.82*34.03*39.13
**76125*TC*23.53*22.35*25.70
**76390**184.61*175.38*201.69
**76390*TC*135.62*128.84*148.17
**76390*26*48.99*46.54*53.52
**76932**76.77*72.93*83.87
**76932*TC*43.68*41.50*47.73
**76940**144.77*137.53*158.16
**76940*TC*51.96*49.36*56.76
**76941**106.22*100.91*116.05
**76941*TC*46.37*44.05*50.66
**76945**75.92*72.12*82.94
**76945*TC*46.13*43.82*50.39
*C*76975**245.82*233.53*268.56
*C*76975*TC*207.99*197.59*227.23
**76998**175.06*166.31*191.26
**76998*TC*131.96*125.36*144.16
**77013**377.42*358.55*412.33
**77013*TC*207.15*196.79*226.31
**77022**426.54*405.21*465.99
**77022*TC*241.00*228.95*263.29
**77371**527.20*500.84*575.97
**77520**765.00*726.75*835.76
**77522**765.00*726.75*835.76
**77523**878.42*834.50*959.68
**77525**991.87*942.28*1083.62
*C*78282**364.53*346.30*398.25
*C*78282*TC*350.08*332.58*382.47
**78414**514.99*489.24*562.63
**78414*TC*495.32*470.55*541.13
*C*78429**1401.84*1331.75*1531.51
*C*78429*TC*1328.02*1261.62*1450.86
*C*78430**1398.33*1328.41*1527.67
*C*78430*TC*1328.02*1261.62*1450.86
*C*78431**2087.08*1982.73*2280.14
*C*78431*TC*2005.18*1904.92*2190.66
*C*78432**1736.39*1649.57*1897.01
*C*78432*TC*1648.66*1566.23*1801.16
*C*78433**1833.90*1742.21*2003.54
*C*78433*TC*1737.93*1651.03*1898.68
**78434**626.12*594.81*684.03
**78434*TC*599.12*569.16*654.53
*C*78459**1273.81*1210.12*1391.64
*C*78459*TC*1205.49*1145.22*1317.00
*C*78491**1395.02*1325.27*1524.06
*C*78491*TC*1328.02*1261.62*1450.86
*C*78492**1406.65*1336.32*1536.77
*C*78492*TC*1328.02*1261.62*1450.86
*C*78608**1392.45*1322.83*1521.25
*C*78608*TC*1328.02*1261.62*1450.86
*C*78811**1271.78*1208.19*1389.42
*C*78811*TC*1205.49*1145.22*1317.00
*C*78812**1411.70*1341.12*1542.29
*C*78812*TC*1328.02*1261.62*1450.86
*C*78813**1413.71*1343.02*1544.47
*C*78813*TC*1328.02*1261.62*1450.86
*C*78814**1422.85*1351.71*1554.47
*C*78814*TC*1328.02*1261.62*1450.86
*C*78815**1433.60*1361.92*1566.21
*C*78815*TC*1328.02*1261.62*1450.86
*C*78816**1434.72*1362.98*1567.43
*C*78816*TC*1328.02*1261.62*1450.86
**79300**237.04*225.19*258.97
**79300*TC*176.82*167.98*193.18
**79445**237.04*225.19*258.97
**79445*TC*135.18*128.42*147.68
**86485**17.28*16.42*18.88
**90867**268.95*255.50*293.83
#**90867**125.84*119.55*137.48
**90868**182.79*173.65*199.70
#**90868**98.95*94.00*108.10
**90869**252.93*240.28*276.32
#**90869**147.20*139.84*160.82
**90952**450.03*427.53*491.66
**90953**319.19*303.23*348.71
**92978**220.97*209.92*241.41
**92978*TC*134.89*128.15*147.37
**92979**135.36*128.59*147.88
**92979*TC*66.99*63.64*73.19
*C*93315**585.26*556.00*639.40
*C*93315*TC*468.23*444.82*511.54
**93317**193.65*183.97*211.57
**93317*TC*112.41*106.79*122.81
*C*93318**562.25*534.14*614.26
*C*93318*TC*468.23*444.82*511.54
**93571**220.10*209.10*240.47
**93571*TC*154.55*146.82*168.84
**93572**133.34*126.67*145.67
**93572*TC*85.62*81.34*93.54
**93600**3557.81*3379.92*3886.91
**93600*TC*3452.65*3280.02*3772.02
**93602**3557.81*3379.92*3886.91
**93602*TC*3454.35*3281.63*3773.87
**93603**3557.81*3379.92*3886.91
**93603*TC*3454.35*3281.63*3773.87
**93609**2134.69*2027.96*2332.15
**93609*TC*1887.92*1793.52*2062.55
**93610**3557.81*3379.92*3886.91
**93610*TC*3411.58*3241.00*3727.15
**93612**3557.81*3379.92*3886.91
**93612*TC*3413.54*3242.86*3729.29
**93615**45.03*42.78*49.20
**93615*TC*11.81*11.22*12.90
**93619**7115.62*6759.84*7773.82
**93619*TC*6767.06*6428.71*7393.02
**93620**7115.62*6759.84*7773.82
**93620*TC*6556.43*6228.61*7162.90
**93621**7115.62*6759.84*7773.82
**93621*TC*7041.28*6689.22*7692.60
**93622**7115.62*6759.84*7773.82
**93622*TC*6962.23*6614.12*7606.24
**93623**2134.69*2027.96*2332.15
**93623*TC*2073.91*1970.21*2265.74
**93624**3557.81*3379.92*3886.91
**93624*TC*3340.47*3173.45*3649.47
**93631**7115.62*6759.84*7773.82
**93631*TC*6757.24*6419.38*7382.29
**93640**1133.95*1077.25*1238.84
**93640*TC*974.20*925.49*1064.31
**93641**1133.95*1077.25*1238.84
**93641*TC*854.82*812.08*933.89
**93662**377.49*358.62*412.41
**93662*TC*312.64*297.01*341.56
**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**884.81*840.57*966.66
**95965*TC*505.04*479.79*551.76
**95966**528.68*502.25*577.59
**95966*TC*345.30*328.04*377.25
**95967**444.52*422.29*485.63
**95967*TC*285.34*271.07*311.73
**96020**376.79*357.95*411.64
**96020*TC*230.12*218.61*251.40
**96547**660.15*627.14*721.21
#**96547**124.20*117.99*135.69
**96548**330.07*313.57*360.61
#**96548**62.10*59.00*67.85
**97151**47.16*44.80*51.52
#**97151**42.20*40.09*46.10
**97152**40.09*38.09*43.80
#**97152**35.87*34.08*39.19
**97153**31.98*30.38*34.94
#**97153**28.34*26.92*30.96
**97154**4.32*4.10*4.72
#**97154**3.95*3.75*4.31
**97155**31.98*30.38*34.94
#**97155**28.34*26.92*30.96
**97156**33.77*32.08*36.89
#**97156**29.97*28.47*32.74
**97157**9.80*9.31*10.71
#**97157**8.93*8.48*9.75
**97158**5.04*4.79*5.51
#**97158**4.60*4.37*5.03
**98978**41.40*39.33*45.23
# - 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.