TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BRAZORIA
******
**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**450.71*428.17*492.40
#**G0186**386.81*367.47*422.59
**G0339**2794.17*2654.46*3052.63
**G0340**2101.45*1996.38*2295.84
**G0398**134.28*127.57*146.71
**G0398*TC*96.05*91.25*104.94
**G0398*26*38.23*36.32*41.77
**G0399**93.12*88.46*101.73
**G0399*TC*50.92*48.37*55.63
**G0399*26*42.53*40.40*46.46
**G0400**96.06*91.26*104.95
**G0400*TC*56.52*53.69*61.74
**G0400*26*39.54*37.56*43.19
**G0460**785.97*746.67*858.67
#**G0460**116.95*111.10*127.77
**G0465**785.97*746.67*858.67
#**G0465**116.95*111.10*127.77
**G0498**145.17*137.91*158.60
**G6017**76.80*72.96*83.90
**0042T**225.00*213.75*245.81
**0054T**219.93*208.93*240.27
**0055T**219.93*208.93*240.27
**0071T**559.07*531.12*610.79
**0072T**559.07*531.12*610.79
**0075T**934.83*888.09*1021.30
**0075T*TC*934.83*888.09*1021.30
**0075T*26*929.60*883.12*1015.59
**0076T**1055.04*1002.29*1152.63
**0076T*TC*844.03*801.83*922.10
**0076T*26*211.03*200.48*230.55
**0095T**599.30*569.34*654.74
**0098T**670.41*636.89*732.42
**0100T**1864.44*1771.22*2036.90
**0101T**308.80*293.36*337.36
#**0101T**221.51*210.43*241.99
**0102T**308.80*293.36*337.36
#**0102T**221.51*210.43*241.99
**0106T**33.14*31.48*36.20
**0107T**33.14*31.48*36.20
**0108T**33.14*31.48*36.20
**0109T**33.14*31.48*36.20
**0110T**33.14*31.48*36.20
**0164T**655.48*622.71*716.12
**0165T**671.47*637.90*733.59
**0174T**9.82*9.33*10.73
**0184T**803.60*763.42*877.93
**0198T**84.02*79.82*91.79
#**0198T**31.32*29.75*34.21
**0200T**1751.58*1664.00*1913.60
#**0200T**392.45*372.83*428.75
**0201T**2627.37*2496.00*2870.40
#**0201T**588.68*559.25*643.14
**0207T**121.70*115.62*132.96
**0208T**37.48*35.61*40.95
**0209T**45.39*43.12*49.59
**0210T**28.59*27.16*31.23
**0211T**44.40*42.18*48.51
**0212T**35.92*34.12*39.24
#**0212T**30.98*29.43*33.84
**0213T**189.96*180.46*207.53
#**0213T**102.67*97.54*112.17
**0214T**95.66*90.88*104.51
#**0214T**57.45*54.58*62.77
**0215T**95.99*91.19*104.87
#**0215T**58.44*55.52*63.85
**0216T**174.94*166.19*191.12
#**0216T**88.30*83.89*96.47
**0217T**89.50*85.03*97.78
#**0217T**49.31*46.84*53.87
**0218T**89.50*85.03*97.78
#**0218T**50.30*47.79*54.96
**0219T**1270.02*1206.52*1387.50
**0220T**1249.42*1186.95*1364.99
**0221T**1533.83*1457.14*1675.71
**0222T**372.72*354.08*407.19
**0232T**785.97*746.67*858.67
#**0232T**116.95*111.10*127.77
**0234T**8441.73*8019.64*9222.59
#**0234T**559.03*531.08*610.74
**0235T**8441.73*8019.64*9222.59
#**0235T**559.03*531.08*610.74
**0236T**8588.44*8159.02*9382.87
#**0236T**648.09*615.69*708.04
**0237T**8588.44*8159.02*9382.87
#**0237T**648.09*615.69*708.04
**0238T**8588.44*8159.02*9382.87
#**0238T**648.09*615.69*708.04
**0253T**876.66*832.83*957.75
**0266T**864.87*821.63*944.87
**0267T**151.93*144.33*165.98
**0268T**322.43*306.31*352.26
**0269T**819.78*778.79*895.61
**0270T**151.93*144.33*165.98
**0271T**322.43*306.31*352.26
**0272T**55.31*52.54*60.42
**0273T**70.74*67.20*77.28
**0274T**1070.34*1016.82*1169.34
**0278T**14.16*13.45*15.47
**0308T**1368.75*1300.31*1495.36
**0329T**84.02*79.82*91.79
#**0329T**31.32*29.75*34.21
**0330T**38.21*36.30*41.75
**0331T**180.90*171.86*197.64
**0332T**308.98*293.53*337.56
**0347T**136.94*130.09*149.60
**0348T**32.53*30.90*35.54
**0349T**34.50*32.78*37.70
**0350T**35.16*33.40*38.41
**0351T**167.60*159.22*183.10
**0352T**42.17*40.06*46.07
**0353T**167.60*159.22*183.10
**0354T**42.17*40.06*46.07
**0358T**26.61*25.28*29.07
**0362T**89.58*85.10*97.87
#**0362T**64.21*61.00*70.15
**0378T**24.29*23.08*26.54
**0394T**246.71*234.37*269.53
**0395T**597.66*567.78*652.95
**0397T**46.01*43.71*50.27
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**491.24*466.68*536.68
**0409T**340.67*323.64*372.19
**0410T**354.39*336.67*387.17
**0411T**354.39*336.67*387.17
**0412T**223.80*212.61*244.50
**0413T**460.45*437.43*503.04
**0414T**355.07*337.32*387.92
**0415T**295.55*280.77*322.89
**0416T**328.87*312.43*359.29
**0417T**82.30*78.19*89.92
**0418T**55.31*52.54*60.42
**0419T**441.96*419.86*482.84
#**0419T**353.68*336.00*386.40
**0420T**626.32*595.00*684.25
#**0420T**517.28*491.42*565.13
**0421T**1580.96*1501.91*1727.20
#**0421T**675.42*641.65*737.90
**0437T**205.88*195.59*224.93
**0439T**70.53*67.00*77.05
**0440T**244.81*232.57*267.46
#**0440T**116.34*110.52*127.10
**0441T**244.81*232.57*267.46
#**0441T**116.34*110.52*127.10
**0442T**244.81*232.57*267.46
#**0442T**116.34*110.52*127.10
**0449T**747.51*710.13*816.65
**0464T**66.49*63.17*72.65
**0472T**66.17*62.86*72.29
**0473T**55.31*52.54*60.42
**0479T**61.88*58.79*67.61
**0480T**76.89*73.05*84.01
#**0480T**30.94*29.39*33.80
**0483T**1136.44*1079.62*1241.56
**0484T**1473.48*1399.81*1609.78
**0485T**23.22*22.06*25.37
**0485T*TC*8.66*8.23*9.46
**0485T*26*14.82*14.08*16.19
**0486T**46.45*44.13*50.75
**0486T*TC*17.06*16.21*18.64
**0486T*26*29.39*27.92*32.11
**0488T**61.71*58.62*67.41
#**0488T**48.86*46.42*53.38
**0505T**10917.98*10372.08*11927.89
#**0505T**551.05*523.50*602.03
**0507T**22.93*21.78*25.05
**0507T*TC*20.02*19.02*21.87
**0507T*26*2.91*2.76*3.17
**0510T**590.79*561.25*645.44
#**0510T**412.91*392.26*451.10
**0512T**308.80*293.36*337.36
#**0512T**221.51*210.43*241.99
**0513T**92.64*88.01*101.21
#**0513T**66.45*63.13*72.60
**0515T**491.24*466.68*536.68
**0516T**453.62*430.94*495.58
**0517T**322.43*306.31*352.26
**0518T**223.80*212.61*244.50
**0519T**323.41*307.24*353.33
**0520T**453.62*430.94*495.58
**0521T**55.31*52.54*60.42
**0521T*TC*35.51*33.73*38.79
**0521T*26*19.81*18.82*21.64
**0522T**66.17*62.86*72.29
**0522T*TC*36.17*34.36*39.51
**0522T*26*30.01*28.51*32.79
**0523T**148.79*141.35*162.55
**0524T**1618.93*1537.98*1768.68
#**0524T**169.21*160.75*184.86
**0525T**453.95*431.25*495.94
**0526T**354.39*336.67*387.17
**0527T**307.95*292.55*336.43
**0528T**66.17*62.86*72.29
**0528T*TC*36.17*34.36*39.51
**0528T*26*30.01*28.51*32.79
**0529T**55.31*52.54*60.42
**0529T*TC*35.51*33.73*38.79
**0529T*26*19.81*18.82*21.64
**0530T**605.28*575.02*661.27
**0531T**460.45*437.43*503.04
**0532T**323.41*307.24*353.33
**0540T**173.66*164.98*189.73
**0543T**1473.48*1399.81*1609.78
**0544T**1697.77*1612.88*1854.81
**0545T**1697.77*1612.88*1854.81
**0546T**70.88*67.34*77.44
**0552T**6.53*6.20*7.13
**0553T**2416.13*2295.32*2639.62
#**0553T**373.48*354.81*408.03
**0565T**600.22*570.21*655.74
#**0565T**501.73*476.64*548.14
**0566T**97.74*92.85*106.78
#**0566T**57.23*54.37*62.53
**0569T**1697.77*1612.88*1854.81
**0570T**397.38*377.51*434.14
**0571T**531.67*505.09*580.85
**0572T**432.47*410.85*472.48
**0573T**330.82*314.28*361.42
**0574T**382.93*363.78*418.35
**0575T**66.17*62.86*72.29
**0576T**55.31*52.54*60.42
**0577T**187.54*178.16*204.88
**0578T**28.54*27.11*31.18
**0579T**21.01*19.96*22.95
**0580T**205.79*195.50*224.83
**0581T**2234.70*2122.97*2441.42
#**0581T**200.94*190.89*219.52
**0582T**1633.33*1551.66*1784.41
#**0582T**374.67*355.94*409.33
**0583T**1496.16*1421.35*1634.55
#**0583T**130.25*123.74*142.30
**0587T**433.42*411.75*473.51
#**0587T**287.16*272.80*313.72
**0588T**357.49*339.62*390.56
#**0588T**224.08*212.88*244.81
**0589T**47.16*44.80*51.52
#**0589T**37.60*35.72*41.08
**0590T**55.66*52.88*60.81
#**0590T**38.86*36.92*42.46
**0596T**2235.23*2123.47*2441.99
#**0596T**128.03*121.63*139.87
**0597T**672.69*639.06*734.92
#**0597T**128.03*121.63*139.87
**0598T**149.48*142.01*163.31
**0599T**99.48*94.51*108.69
**0600T**3525.89*3349.60*3852.04
#**0600T**701.56*666.48*766.45
**0601T**1394.36*1324.64*1523.34
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**193.39*183.72*211.28
**0611T**40.05*38.05*43.76
**0614T**354.42*336.70*387.21
**0615T**46.41*44.09*50.70
**0616T**649.68*617.20*709.78
**0617T**725.55*689.27*792.66
**0618T**878.40*834.48*959.65
**0619T**640.28*608.27*699.51
#**0619T**464.69*441.46*507.68
**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**254.85*242.11*278.43
#**0627T**96.73*91.89*105.67
**0628T**76.45*72.63*83.52
#**0628T**29.02*27.57*31.71
**0629T**254.85*242.11*278.43
#**0629T**96.73*91.89*105.67
**0630T**76.45*72.63*83.52
#**0630T**29.02*27.57*31.71
**0631T**81.08*77.03*88.58
**0632T**546.64*519.31*597.21
**0633T**198.74*188.80*217.12
*C*0633T*TC*105.34*100.07*115.08
**0633T*26*57.56*54.68*62.88
**0634T**198.74*188.80*217.12
**0634T*TC*141.18*134.12*154.24
**0634T*26*57.56*54.68*62.88
**0635T**198.74*188.80*217.12
**0635T*TC*141.18*134.12*154.24
**0635T*26*57.56*54.68*62.88
**0636T**198.74*188.80*217.12
**0636T*TC*141.18*134.12*154.24
**0636T*26*57.56*54.68*62.88
**0637T**198.74*188.80*217.12
**0637T*TC*141.18*134.12*154.24
**0637T*26*57.56*54.68*62.88
**0638T**198.74*188.80*217.12
**0638T*TC*141.18*134.12*154.24
**0638T*26*57.56*54.68*62.88
**0639T**81.08*77.03*88.58
**0640T**22.93*21.78*25.05
**0640T*TC*20.02*19.02*21.87
**0640T*26*2.91*2.76*3.17
**0644T**1141.63*1084.55*1247.23
#**0644T**228.19*216.78*249.30
**0646T**1697.77*1612.88*1854.81
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**58.89*55.95*64.34
**0652T**283.03*268.88*309.21
#**0652T**118.33*112.41*129.27
**0653T**370.12*351.61*404.35
#**0653T**133.61*126.93*145.97
**0654T**137.05*130.20*149.73
**0655T**1580.96*1501.91*1727.20
#**0655T**675.42*641.65*737.90
**0658T**93.81*89.12*102.49
**0659T**2647.08*2514.73*2891.94
#**0659T**412.05*391.45*450.17
**0671T**1004.85*954.61*1097.80
**0673T**3384.30*3215.09*3697.35
#**0673T**350.80*333.26*383.25
**0699T**110.63*105.10*120.87
#**0699T**88.89*84.45*97.12
**0707T**365.55*347.27*399.36
#**0707T**274.31*260.59*299.68
**0714T**1386.30*1316.99*1514.54
#**0714T**349.98*332.48*382.35
**0730T**267.76*254.37*292.53
#**0730T**239.79*227.80*261.97
**0738T**69.29*65.83*75.70
**0739T**1580.96*1501.91*1727.20
#**0739T**675.42*641.65*737.90
**0740T**19.63*18.65*21.45
**0741T**46.71*44.37*51.03
**0742T**92.70*88.07*101.28
**0742T*TC*74.01*70.31*80.86
**0742T*26*18.68*17.75*20.41
**0743T**52.58*49.95*57.44
**0744T**842.79*800.65*920.75
**0745T**253.82*241.13*277.30
**0746T**220.58*209.55*240.98
**0747T**981.55*932.47*1072.34
**0748T**178.28*169.37*194.78
**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**429.40*407.93*469.12
**0756T**110.35*104.83*120.55
**0757T**80.30*76.29*87.73
**0758T**88.92*84.47*97.14
**0759T**133.01*126.36*145.31
**0760T**98.21*93.30*107.30
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**116.04*110.24*126.78
**0764T**4.22*4.01*4.61
**0765T**7.88*7.49*8.61
**0771T**25.55*24.27*27.91
**0772T**25.55*24.27*27.91
**0773T**23.04*21.89*25.17
**0774T**23.04*21.89*25.17
**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**432.11*410.50*472.08
**0779T*TC*406.75*386.41*444.37
**0779T*26*25.36*24.09*27.70
**0780T**23.04*21.89*25.17
**0783T**14.10*13.40*15.41
**0784T**2094.23*1989.52*2287.95
#**0784T**316.09*300.29*345.33
**0785T**238.29*226.38*260.34
#**0785T**141.11*134.05*154.16
**0786T**721.01*684.96*787.70
#**0786T**294.75*280.01*322.01
**0787T**238.29*226.38*260.34
#**0787T**141.11*134.05*154.16
**0788T**18.33*17.41*20.02
#**0788T**17.67*16.79*19.31
**0789T**25.06*23.81*27.38
#**0789T**22.09*20.99*24.14
**0790T**1872.03*1778.43*2045.19
**0791T**8.89*8.45*9.72
**0793T**546.64*519.31*597.21
**0794T**130.35*123.83*142.40
**0795T**680.43*646.41*743.37
**0796T**453.62*430.94*495.58
**0797T**453.62*430.94*495.58
**0798T**717.99*682.09*784.40
**0799T**478.66*454.73*522.94
**0800T**478.66*454.73*522.94
**0801T**932.28*885.67*1018.52
**0802T**466.14*442.83*509.25
**0803T**466.14*442.83*509.25
**0804T**77.40*73.53*84.56
**0804T*TC*41.77*39.68*45.63
**0804T*26*35.64*33.86*38.94
**0805T**2920.35*2774.33*3190.48
#**0805T**312.44*296.82*341.34
**0806T**3893.81*3699.12*4253.99
#**0806T**416.59*395.76*455.12
**0807T**41.97*39.87*45.85
**0807T*TC*27.60*26.22*30.15
**0807T*26*14.37*13.65*15.70
**0808T**41.97*39.87*45.85
**0808T*TC*27.60*26.22*30.15
**0808T*26*14.37*13.65*15.70
**0810T**1109.16*1053.70*1211.76
**0811T**19.63*18.65*21.45
**0813T**2565.42*2437.15*2802.72
#**0813T**173.27*164.61*189.30
**0814T**456.94*434.09*499.20
#**0814T**342.88*325.74*374.60
**0818T**357.49*339.62*390.56
#**0818T**224.08*212.88*244.81
**0820T**145.11*137.85*158.53
#**0820T**127.65*121.27*139.46
**0821T**145.11*137.85*158.53
#**0821T**127.65*121.27*139.46
**0822T**123.34*117.17*134.75
#**0822T**108.50*103.08*118.54
**0823T**680.43*646.41*743.37
**0824T**717.99*682.09*784.40
**0825T**932.28*885.67*1018.52
**0826T**66.17*62.86*72.29
**0826T*TC*36.17*34.36*39.51
**0826T*26*30.01*28.51*32.79
**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**22.93*21.78*25.05
**0859T*TC*20.02*19.02*21.87
**0859T*26*2.91*2.76*3.17
**0864T**308.80*293.36*337.36
#**0864T**221.51*210.43*241.99
**10011**420.38*399.36*459.26
#**10011**104.48*99.26*114.15
**10012**231.21*219.65*252.60
#**10012**69.14*65.68*75.53
**15847**342.09*324.99*373.74
**21742**1112.75*1057.11*1215.68
**21743**1274.02*1210.32*1391.87
**32855**351.74*334.15*384.27
**32856**431.54*409.96*471.45
**33928**3158.30*3000.39*3450.45
**33929**1183.27*1124.11*1292.73
**33933**538.99*512.04*588.85
**33944**538.99*512.04*588.85
**34841**2112.81*2007.17*2308.25
**34842**2338.58*2221.65*2554.90
**34843**2564.36*2436.14*2801.56
**34844**2790.13*2650.62*3048.21
**34845**2112.81*2007.17*2308.25
**34846**2338.58*2221.65*2554.90
**34847**2564.36*2436.14*2801.56
**34848**2790.13*2650.62*3048.21
**43496**2102.68*1997.55*2297.18
**43647**442.49*420.37*483.43
**43648**532.30*505.69*581.54
#**43648**240.44*228.42*262.68
**43881**675.69*641.91*738.20
#**43881**619.52*588.54*676.82
**43882**716.29*680.48*782.55
#**43882**655.82*623.03*716.48
**47143**422.20*401.09*461.25
**47144**501.36*476.29*547.73
**47145**474.95*451.20*518.88
**48551**268.04*254.64*292.84
**49906**2023.80*1922.61*2211.00
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**738.86*701.92*807.21
**53452**369.43*350.96*403.60
**53453**628.00*596.60*686.09
**53454**55.77*52.98*60.93
#**53454**34.36*32.64*37.54
**54440**743.74*706.55*812.53
**63043**549.00*521.55*599.78
**63044**515.91*490.11*563.63
**64596**2094.23*1989.52*2287.95
#**64596**316.09*300.29*345.33
**64597**628.27*596.86*686.39
#**64597**94.83*90.09*103.60
**64598**238.29*226.38*260.34
#**64598**141.11*134.05*154.16
**65757**116.85*111.01*127.66
**66983**649.68*617.20*709.78
**66987**748.52*711.09*817.75
**66988**623.78*592.59*681.48
*C*70170**248.90*236.46*271.93
*C*70170*TC*234.80*223.06*256.52
**70555**233.47*221.80*255.07
**70555*TC*118.34*112.42*129.28
*C*70557**676.72*642.88*739.31
*C*70557*TC*528.63*502.20*577.53
*C*70558**339.42*322.45*370.82
*C*70558*TC*176.16*167.35*192.45
*C*70559**328.71*312.27*359.11
*C*70559*TC*176.16*167.35*192.45
*C*74190**549.96*522.46*600.83
*C*74190*TC*528.63*502.20*577.53
**74235**144.22*137.01*157.56
**74235*TC*89.31*84.84*97.57
**74300**83.97*79.77*91.74
**74300*TC*71.19*67.63*77.77
**74301**25.74*24.45*28.12
**74301*TC*16.20*15.39*17.70
**74328**175.06*166.31*191.26
**74328*TC*152.68*145.05*166.81
**74329**139.99*132.99*152.94
**74329*TC*117.28*111.42*128.13
**74330**262.59*249.46*286.88
**74330*TC*236.30*224.49*258.16
**74340**86.58*82.25*94.59
**74340*TC*61.94*58.84*67.67
**74355**86.58*82.25*94.59
**74355*TC*51.41*48.84*56.17
**74360**86.58*82.25*94.59
**74360*TC*60.43*57.41*66.02
**74363**175.06*166.31*191.26
**74363*TC*134.99*128.24*147.48
*C*74445**157.41*149.54*171.97
*C*74445*TC*105.34*100.07*115.08
*C*74450**249.97*237.47*273.09
*C*74450*TC*234.80*223.06*256.52
*C*74470**552.61*524.98*603.73
*C*74470*TC*528.63*502.20*577.53
**74742**233.47*221.80*255.07
**74742*TC*205.19*194.93*224.17
*C*74775**263.41*250.24*287.78
*C*74775*TC*234.80*223.06*256.52
*C*75801**642.91*610.76*702.37
*C*75801*TC*602.09*571.99*657.79
*C*75803**1589.21*1509.75*1736.21
*C*75803*TC*1534.97*1458.22*1676.95
*C*75805**3092.67*2938.04*3378.75
*C*75805*TC*3055.18*2902.42*3337.78
*C*75807**3105.99*2950.69*3393.29
*C*75807*TC*3055.18*2902.42*3337.78
*C*75810**3101.56*2946.48*3388.45
*C*75810*TC*3055.18*2902.42*3337.78
**75894**890.35*845.83*972.70
**75894*TC*822.37*781.25*898.44
*C*75898**3141.73*2984.64*3432.34
*C*75898*TC*3055.18*2902.42*3337.78
**75970**434.81*413.07*475.03
**75970*TC*398.44*378.52*435.30
**76125**39.26*37.30*42.90
**76125*TC*26.48*25.16*28.93
**76390**204.29*194.08*223.19
**76390*TC*153.03*145.38*167.19
**76390*26*51.26*48.70*56.01
**76932**83.87*79.68*91.63
**76932*TC*49.40*46.93*53.97
**76940**154.09*146.39*168.35
**76940*TC*57.93*55.03*63.28
**76941**114.67*108.94*125.28
**76941*TC*52.27*49.66*57.11
**76945**82.95*78.80*90.62
**76945*TC*51.88*49.29*56.68
*C*76975**274.33*260.61*299.70
*C*76975*TC*234.80*223.06*256.52
**76998**175.06*166.31*191.26
**76998*TC*130.47*123.95*142.54
**77013**420.61*399.58*459.52
**77013*TC*244.40*232.18*267.01
**77022**470.85*447.31*514.41
**77022*TC*278.23*264.32*303.97
**77371**608.02*577.62*664.26
**77520**882.21*838.10*963.82
**77522**882.21*838.10*963.82
**77523**1013.00*962.35*1106.70
**77525**1143.78*1086.59*1249.58
*C*78282**410.07*389.57*448.01
*C*78282*TC*395.22*375.46*431.78
**78414**514.99*489.24*562.63
**78414*TC*494.52*469.79*540.26
*C*78429**1575.86*1497.07*1721.63
*C*78429*TC*1499.39*1424.42*1638.08
*C*78430**1572.28*1493.67*1717.72
*C*78430*TC*1499.39*1424.42*1638.08
*C*78431**2349.01*2231.56*2566.29
*C*78431*TC*2263.94*2150.74*2473.35
*C*78432**1952.38*1854.76*2132.97
*C*78432*TC*1861.41*1768.34*2033.59
*C*78433**2061.73*1958.64*2252.44
*C*78433*TC*1962.21*1864.10*2143.72
**78434**704.70*669.47*769.89
**78434*TC*676.67*642.84*739.27
*C*78459**1431.87*1360.28*1564.32
*C*78459*TC*1361.04*1292.99*1486.94
*C*78491**1568.96*1490.51*1714.09
*C*78491*TC*1499.39*1424.42*1638.08
*C*78492**1581.14*1502.08*1727.39
*C*78492*TC*1499.39*1424.42*1638.08
*C*78608**1566.24*1487.93*1711.12
*C*78608*TC*1499.39*1424.42*1638.08
*C*78811**1429.80*1358.31*1562.06
*C*78811*TC*1361.04*1292.99*1486.94
*C*78812**1586.24*1506.93*1732.97
*C*78812*TC*1499.39*1424.42*1638.08
*C*78813**1588.23*1508.82*1735.14
*C*78813*TC*1499.39*1424.42*1638.08
*C*78814**1597.77*1517.88*1745.56
*C*78814*TC*1499.39*1424.42*1638.08
*C*78815**1608.96*1528.51*1757.79
*C*78815*TC*1499.39*1424.42*1638.08
*C*78816**1610.03*1529.53*1758.96
*C*78816*TC*1499.39*1424.42*1638.08
**79300**237.04*225.19*258.97
**79300*TC*175.16*166.40*191.36
**79445**237.04*225.19*258.97
**79445*TC*131.64*125.06*143.82
**86485**17.28*16.42*18.88
**90867**294.34*279.62*321.56
#**90867**132.77*126.13*145.05
**90868**197.39*187.52*215.65
#**90868**103.56*98.38*113.14
**90869**272.60*258.97*297.82
#**90869**157.20*149.34*171.74
**90952**487.98*463.58*533.12
**90953**347.77*330.38*379.94
**92978**242.03*229.93*264.42
**92978*TC*152.99*145.34*167.14
**92979**147.06*139.71*160.67
**92979*TC*76.34*72.52*83.40
*C*93315**650.26*617.75*710.41
*C*93315*TC*528.63*502.20*577.53
**93317**211.08*200.53*230.61
**93317*TC*126.77*120.43*138.49
*C*93318**626.20*594.89*684.12
*C*93318*TC*528.63*502.20*577.53
**93571**241.04*228.99*263.34
**93571*TC*173.23*164.57*189.26
**93572**144.83*137.59*158.23
**93572*TC*95.48*90.71*104.32
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.68*3276.25*3767.69
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.52*3277.99*3769.69
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.52*3277.99*3769.69
**93609**2134.69*2027.96*2332.15
**93609*TC*1878.66*1784.73*2052.44
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.26*3235.95*3721.34
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.36*3237.94*3723.63
**93615**49.35*46.88*53.91
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6754.02*6416.32*7378.77
**93620**7115.62*6759.84*7773.82
**93620*TC*6835.57*6493.79*7467.86
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.50*6686.58*7689.57
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.49*6608.67*7599.97
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.52*1966.99*2262.04
**93624**3557.81*3379.92*3886.91
**93624*TC*3333.10*3166.45*3641.42
**93631**7115.62*6759.84*7773.82
**93631*TC*6745.78*6408.49*7369.76
**93640**1133.95*1077.25*1238.84
**93640*TC*968.32*919.90*1057.89
**93641**1133.95*1077.25*1238.84
**93641*TC*844.59*802.36*922.71
**93662**418.65*397.72*457.38
**93662*TC*351.02*333.47*383.49
**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**931.44*884.87*1017.60
**95965*TC*534.17*507.46*583.58
**95966**536.26*509.45*585.87
**95966*TC*345.30*328.04*377.25
**95967**450.95*428.40*492.66
**95967*TC*285.34*271.07*311.73
**96020**373.48*354.81*408.03
**96020*TC*221.36*210.29*241.83
**96547**736.80*699.96*804.95
#**96547**131.68*125.10*143.87
**96548**368.40*349.98*402.48
#**96548**65.84*62.55*71.93
**97151**48.96*46.51*53.49
#**97151**43.36*41.19*47.37
**97152**41.62*39.54*45.47
#**97152**36.86*35.02*40.27
**97153**33.17*31.51*36.24
#**97153**29.05*27.60*31.74
**97154**4.48*4.26*4.90
#**97154**4.06*3.86*4.44
**97155**33.17*31.51*36.24
#**97155**29.05*27.60*31.74
**97156**34.99*33.24*38.23
#**97156**30.71*29.17*33.55
**97157**10.20*9.69*11.14
#**97157**9.21*8.75*10.06
**97158**5.23*4.97*5.72
#**97158**4.74*4.50*5.18
**98978**46.71*44.37*51.03
# - 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.