TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
DALLAS
******
**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**451.50*428.93*493.27
#**G0186**387.54*368.16*423.38
**G0339**2878.81*2734.87*3145.10
**G0340**2165.02*2056.77*2365.29
**G0398**134.43*127.71*146.87
**G0398*TC*96.20*91.39*105.10
**G0398*26*38.23*36.32*41.77
**G0399**93.22*88.56*101.84
**G0399*TC*51.02*48.47*55.74
**G0399*26*42.53*40.40*46.46
**G0400**96.18*91.37*105.08
**G0400*TC*56.63*53.80*61.87
**G0400*26*39.55*37.57*43.21
**G0460**787.44*748.07*860.28
#**G0460**117.75*111.86*128.64
**G0465**787.44*748.07*860.28
#**G0465**117.75*111.86*128.64
**G0498**145.47*138.20*158.93
**G6017**76.96*73.11*84.08
**0042T**225.16*213.90*245.99
**0054T**223.25*212.09*243.90
**0055T**223.25*212.09*243.90
**0071T**562.50*534.38*614.54
**0072T**562.50*534.38*614.54
**0075T**943.86*896.67*1031.17
**0075T*TC*943.86*896.67*1031.17
**0075T*26*940.38*893.36*1027.36
**0076T**1060.79*1007.75*1158.91
**0076T*TC*848.62*806.19*927.12
**0076T*26*212.17*201.56*231.79
**0095T**608.51*578.08*664.79
**0098T**680.85*646.81*743.83
**0100T**1868.44*1775.02*2041.27
**0101T**309.45*293.98*338.08
#**0101T**222.08*210.98*242.63
**0102T**309.45*293.98*338.08
#**0102T**222.08*210.98*242.63
**0106T**33.22*31.56*36.29
**0107T**33.22*31.56*36.29
**0108T**33.22*31.56*36.29
**0109T**33.22*31.56*36.29
**0110T**33.22*31.56*36.29
**0164T**665.43*632.16*726.98
**0165T**681.70*647.62*744.76
**0174T**9.77*9.28*10.67
**0184T**808.53*768.10*883.32
**0198T**84.08*79.88*91.86
#**0198T**31.32*29.75*34.21
**0200T**1755.21*1667.45*1917.57
#**0200T**394.72*374.98*431.23
**0201T**2632.81*2501.17*2876.35
#**0201T**592.09*562.49*646.86
**0207T**121.70*115.62*132.96
**0208T**37.55*35.67*41.02
**0209T**45.46*43.19*49.67
**0210T**28.64*27.21*31.29
**0211T**44.47*42.25*48.59
**0212T**35.93*34.13*39.25
#**0212T**30.99*29.44*33.86
**0213T**190.39*180.87*208.00
#**0213T**103.01*97.86*112.54
**0214T**95.92*91.12*104.79
#**0214T**57.67*54.79*63.01
**0215T**96.25*91.44*105.16
#**0215T**58.66*55.73*64.09
**0216T**175.31*166.54*191.52
#**0216T**88.59*84.16*96.78
**0217T**89.72*85.23*98.01
#**0217T**49.50*47.03*54.08
**0218T**89.72*85.23*98.01
#**0218T**50.48*47.96*55.15
**0219T**1285.27*1221.01*1404.16
**0220T**1263.71*1200.52*1380.60
**0221T**1550.19*1472.68*1693.58
**0222T**377.78*358.89*412.72
**0232T**787.44*748.07*860.28
#**0232T**117.75*111.86*128.64
**0234T**8455.33*8032.56*9237.44
#**0234T**564.79*536.55*617.03
**0235T**8455.33*8032.56*9237.44
#**0235T**564.79*536.55*617.03
**0236T**8602.59*8172.46*9398.33
#**0236T**654.35*621.63*714.87
**0237T**8602.59*8172.46*9398.33
#**0237T**654.35*621.63*714.87
**0238T**8602.59*8172.46*9398.33
#**0238T**654.35*621.63*714.87
**0253T**899.87*854.88*983.11
**0266T**872.82*829.18*953.56
**0267T**153.35*145.68*167.53
**0268T**325.27*309.01*355.36
**0269T**827.19*785.83*903.70
**0270T**153.35*145.68*167.53
**0271T**325.27*309.01*355.36
**0272T**55.37*52.60*60.49
**0273T**70.82*67.28*77.37
**0274T**1082.45*1028.33*1182.58
**0278T**14.17*13.46*15.48
**0308T**1371.64*1303.06*1498.52
**0329T**84.08*79.88*91.86
#**0329T**31.32*29.75*34.21
**0330T**38.21*36.30*41.75
**0331T**181.16*172.10*197.92
**0332T**309.38*293.91*338.00
**0347T**138.05*131.15*150.82
**0348T**32.58*30.95*35.59
**0349T**34.56*32.83*37.75
**0350T**35.22*33.46*38.48
**0351T**167.77*159.38*183.29
**0352T**42.18*40.07*46.08
**0353T**167.77*159.38*183.29
**0354T**42.18*40.07*46.08
**0358T**26.67*25.34*29.14
**0362T**89.76*85.27*98.06
#**0362T**64.37*61.15*70.32
**0378T**24.34*23.12*26.59
**0394T**247.05*234.70*269.91
**0395T**598.48*568.56*653.84
**0397T**46.07*43.77*50.34
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**495.74*470.95*541.59
**0409T**343.61*326.43*375.39
**0410T**357.38*339.51*390.44
**0411T**357.38*339.51*390.44
**0412T**225.52*214.24*246.38
**0413T**464.50*441.28*507.47
**0414T**358.18*340.27*391.31
**0415T**298.20*283.29*325.78
**0416T**331.54*314.96*362.20
**0417T**82.37*78.25*89.99
**0418T**55.37*52.60*60.49
**0419T**443.18*421.02*484.17
#**0419T**354.81*337.07*387.63
**0420T**628.70*597.27*686.86
#**0420T**519.55*493.57*567.61
**0421T**1584.90*1505.66*1731.51
#**0421T**678.46*644.54*741.22
**0437T**207.50*197.13*226.70
**0439T**70.80*67.26*77.35
**0440T**245.35*233.08*268.04
#**0440T**116.75*110.91*127.55
**0441T**245.35*233.08*268.04
#**0441T**116.75*110.91*127.55
**0442T**245.35*233.08*268.04
#**0442T**116.75*110.91*127.55
**0449T**749.04*711.59*818.33
**0464T**66.57*63.24*72.73
**0472T**66.23*62.92*72.36
**0473T**55.37*52.60*60.49
**0479T**61.93*58.83*67.65
**0480T**76.96*73.11*84.08
#**0480T**30.96*29.41*33.82
**0483T**1148.56*1091.13*1254.80
**0484T**1489.12*1414.66*1626.86
**0485T**23.24*22.08*25.39
**0485T*TC*8.70*8.27*9.51
**0485T*26*14.83*14.09*16.20
**0486T**46.48*44.16*50.78
**0486T*TC*17.10*16.25*18.69
**0486T*26*29.37*27.90*32.09
**0488T**61.82*58.73*67.54
#**0488T**48.96*46.51*53.49
**0505T**11087.91*10533.51*12113.54
#**0505T**544.21*517.00*594.55
**0507T**23.00*21.85*25.13
**0507T*TC*20.07*19.07*21.93
**0507T*26*2.93*2.78*3.20
**0510T**593.42*563.75*648.31
#**0510T**415.36*394.59*453.78
**0512T**309.45*293.98*338.08
#**0512T**222.08*210.98*242.63
**0513T**92.84*88.20*101.43
#**0513T**66.62*63.29*72.78
**0515T**495.74*470.95*541.59
**0516T**457.75*434.86*500.09
**0517T**325.27*309.01*355.36
**0518T**225.52*214.24*246.38
**0519T**326.26*309.95*356.44
**0520T**457.75*434.86*500.09
**0521T**55.37*52.60*60.49
**0521T*TC*35.57*33.79*38.86
**0521T*26*19.80*18.81*21.63
**0522T**66.23*62.92*72.36
**0522T*TC*36.23*34.42*39.58
**0522T*26*30.01*28.51*32.79
**0523T**149.44*141.97*163.27
**0524T**1621.99*1540.89*1772.02
#**0524T**170.83*162.29*186.63
**0525T**458.08*435.18*500.46
**0526T**357.38*339.51*390.44
**0527T**310.66*295.13*339.40
**0528T**66.23*62.92*72.36
**0528T*TC*36.23*34.42*39.58
**0528T*26*30.01*28.51*32.79
**0529T**55.37*52.60*60.49
**0529T*TC*35.57*33.79*38.86
**0529T*26*19.80*18.81*21.63
**0530T**610.59*580.06*667.07
**0531T**464.50*441.28*507.47
**0532T**326.26*309.95*356.44
**0540T**173.97*165.27*190.06
**0543T**1489.12*1414.66*1626.86
**0544T**1714.95*1629.20*1873.58
**0545T**1714.95*1629.20*1873.58
**0546T**70.91*67.36*77.46
**0552T**6.56*6.23*7.16
**0553T**2422.12*2301.01*2646.16
#**0553T**377.44*358.57*412.36
**0565T**603.26*573.10*659.07
#**0565T**504.67*479.44*551.36
**0566T**98.10*93.20*107.18
#**0566T**57.54*54.66*62.86
**0569T**1714.95*1629.20*1873.58
**0570T**401.54*381.46*438.68
**0571T**536.48*509.66*586.11
**0572T**436.49*414.67*476.87
**0573T**333.74*317.05*364.61
**0574T**386.48*367.16*422.23
**0575T**66.23*62.92*72.36
**0576T**55.37*52.60*60.49
**0577T**187.59*178.21*204.94
**0578T**28.60*27.17*31.25
**0579T**21.06*20.01*23.01
**0580T**207.46*197.09*226.65
**0581T**2238.96*2127.01*2446.06
#**0581T**203.18*193.02*221.97
**0582T**1636.12*1554.31*1787.46
#**0582T**376.20*357.39*411.00
**0583T**1496.16*1421.35*1634.55
#**0583T**130.79*124.25*142.89
**0587T**435.12*413.36*475.36
#**0587T**288.72*274.28*315.42
**0588T**358.84*340.90*392.04
#**0588T**225.30*214.04*246.15
**0589T**47.29*44.93*51.67
#**0589T**37.72*35.83*41.20
**0590T**55.82*53.03*60.98
#**0590T**39.00*37.05*42.61
**0596T**2235.23*2123.47*2441.99
#**0596T**128.23*121.82*140.09
**0597T**672.69*639.06*734.92
#**0597T**128.23*121.82*140.09
**0598T**149.65*142.17*163.50
**0599T**99.57*94.59*108.78
**0600T**3531.63*3355.05*3858.31
#**0600T**704.49*669.27*769.66
**0601T**1408.32*1337.90*1538.59
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**193.65*183.97*211.57
**0611T**40.14*38.13*43.85
**0614T**357.52*339.64*390.59
**0615T**46.45*44.13*50.75
**0616T**650.63*618.10*710.82
**0617T**727.02*690.67*794.27
**0618T**880.22*836.21*961.64
**0619T**642.37*610.25*701.79
#**0619T**466.61*443.28*509.77
**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**255.34*242.57*278.96
#**0627T**97.07*92.22*106.05
**0628T**76.60*72.77*83.69
#**0628T**29.12*27.66*31.81
**0629T**255.34*242.57*278.96
#**0629T**97.07*92.22*106.05
**0630T**76.60*72.77*83.69
#**0630T**29.12*27.66*31.81
**0631T**81.26*77.20*88.78
**0632T**552.01*524.41*603.07
**0633T**198.98*189.03*217.38
*C*0633T*TC*105.47*100.20*115.23
**0633T*26*57.61*54.73*62.94
**0634T**198.98*189.03*217.38
**0634T*TC*141.37*134.30*154.45
**0634T*26*57.61*54.73*62.94
**0635T**198.98*189.03*217.38
**0635T*TC*141.37*134.30*154.45
**0635T*26*57.61*54.73*62.94
**0636T**198.98*189.03*217.38
**0636T*TC*141.37*134.30*154.45
**0636T*26*57.61*54.73*62.94
**0637T**198.98*189.03*217.38
**0637T*TC*141.37*134.30*154.45
**0637T*26*57.61*54.73*62.94
**0638T**198.98*189.03*217.38
**0638T*TC*141.37*134.30*154.45
**0638T*26*57.61*54.73*62.94
**0639T**81.26*77.20*88.78
**0640T**23.00*21.85*25.13
**0640T*TC*20.07*19.07*21.93
**0640T*26*2.93*2.78*3.20
**0644T**1144.81*1087.57*1250.71
#**0644T**230.46*218.94*251.78
**0646T**1714.95*1629.20*1873.58
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**58.96*56.01*64.41
**0652T**283.73*269.54*309.97
#**0652T**118.86*112.92*129.86
**0653T**370.98*352.43*405.29
#**0653T**134.23*127.52*146.65
**0654T**137.74*130.85*150.48
**0655T**1584.90*1505.66*1731.51
#**0655T**678.46*644.54*741.22
**0658T**93.93*89.23*102.61
**0659T**2653.64*2520.96*2899.10
#**0659T**416.39*395.57*454.91
**0671T**1006.91*956.56*1100.04
**0673T**3389.62*3220.14*3703.16
#**0673T**353.09*335.44*385.76
**0699T**110.84*105.30*121.10
#**0699T**89.08*84.63*97.32
**0707T**366.50*348.18*400.41
#**0707T**275.16*261.40*300.61
**0714T**1388.72*1319.28*1517.17
#**0714T**351.38*333.81*383.88
**0730T**267.13*253.77*291.84
#**0730T**239.08*227.13*261.20
**0738T**69.40*65.93*75.82
**0739T**1584.90*1505.66*1731.51
#**0739T**678.46*644.54*741.22
**0740T**19.70*18.72*21.53
**0741T**46.78*44.44*51.11
**0742T**92.81*88.17*101.40
**0742T*TC*74.13*70.42*80.98
**0742T*26*18.69*17.76*20.42
**0743T**52.67*50.04*57.55
**0744T**852.56*809.93*931.42
**0745T**254.26*241.55*277.78
**0746T**220.72*209.68*241.13
**0747T**983.19*934.03*1074.13
**0748T**179.36*170.39*195.95
**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**429.67*408.19*469.42
**0756T**110.45*104.93*120.67
**0757T**80.40*76.38*87.84
**0758T**89.00*84.55*97.23
**0759T**133.15*126.49*145.46
**0760T**98.27*93.36*107.36
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**116.09*110.29*126.83
**0764T**4.23*4.02*4.62
**0765T**7.89*7.50*8.63
**0771T**25.68*24.40*28.06
**0772T**25.68*24.40*28.06
**0773T**23.06*21.91*25.20
**0774T**23.06*21.91*25.20
**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**432.55*410.92*472.56
**0779T*TC*407.18*386.82*444.84
**0779T*26*25.37*24.10*27.72
**0780T**23.06*21.91*25.20
**0783T**14.14*13.43*15.44
**0784T**2097.20*1992.34*2291.19
#**0784T**317.30*301.44*346.66
**0785T**239.05*227.10*261.17
#**0785T**141.77*134.68*154.88
**0786T**722.98*686.83*789.85
#**0786T**296.30*281.49*323.71
**0787T**239.05*227.10*261.17
#**0787T**141.77*134.68*154.88
**0788T**18.38*17.46*20.08
#**0788T**17.72*16.83*19.35
**0789T**25.35*24.08*27.69
#**0789T**22.15*21.04*24.20
**0790T**1879.00*1785.05*2052.81
**0791T**8.91*8.46*9.73
**0793T**552.01*524.41*603.07
**0794T**130.35*123.83*142.40
**0795T**686.63*652.30*750.15
**0796T**457.75*434.86*500.09
**0797T**457.75*434.86*500.09
**0798T**724.95*688.70*792.01
**0799T**483.30*459.14*528.01
**0800T**483.30*459.14*528.01
**0801T**941.05*894.00*1028.10
**0802T**470.53*447.00*514.05
**0803T**470.53*447.00*514.05
**0804T**77.46*73.59*84.63
**0804T*TC*41.83*39.74*45.70
**0804T*26*35.63*33.85*38.93
**0805T**2924.89*2778.65*3195.45
#**0805T**314.39*298.67*343.47
**0806T**3899.86*3704.87*4260.60
#**0806T**419.18*398.22*457.95
**0807T**42.07*39.97*45.97
**0807T*TC*27.66*26.28*30.22
**0807T*26*14.42*13.70*15.76
**0808T**42.07*39.97*45.97
**0808T*TC*27.66*26.28*30.22
**0808T*26*14.42*13.70*15.76
**0810T**1111.52*1055.94*1214.33
**0811T**19.70*18.72*21.53
**0813T**2569.40*2440.93*2807.07
#**0813T**174.87*166.13*191.05
**0814T**458.12*435.21*500.49
#**0814T**343.95*326.75*375.76
**0818T**358.84*340.90*392.04
#**0818T**225.30*214.04*246.15
**0820T**145.09*137.84*158.52
#**0820T**127.61*121.23*139.41
**0821T**145.09*137.84*158.52
#**0821T**127.61*121.23*139.41
**0822T**123.32*117.15*134.72
#**0822T**108.47*103.05*118.51
**0823T**686.63*652.30*750.15
**0824T**724.95*688.70*792.01
**0825T**941.05*894.00*1028.10
**0826T**66.23*62.92*72.36
**0826T*TC*36.23*34.42*39.58
**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**23.00*21.85*25.13
**0859T*TC*20.07*19.07*21.93
**0859T*26*2.93*2.78*3.20
**0864T**309.45*293.98*338.08
#**0864T**222.08*210.98*242.63
**10011**421.09*400.04*460.05
#**10011**104.87*99.63*114.57
**10012**231.78*220.19*253.22
#**10012**69.56*66.08*75.99
**15847**344.46*327.24*376.33
**21742**1122.74*1066.60*1226.59
**21743**1287.31*1222.94*1406.38
**32855**349.86*332.37*382.23
**32856**436.37*414.55*476.73
**33928**3193.57*3033.89*3488.97
**33929**1196.37*1136.55*1307.03
**33933**535.43*508.66*584.96
**33944**535.43*508.66*584.96
**34841**2086.01*1981.71*2278.97
**34842**2311.78*2196.19*2525.62
**34843**2537.57*2410.69*2772.29
**34844**2763.34*2625.17*3018.95
**34845**2086.01*1981.71*2278.97
**34846**2311.78*2196.19*2525.62
**34847**2537.57*2410.69*2772.29
**34848**2763.34*2625.17*3018.95
**43496**2110.70*2005.17*2305.95
**43647**442.49*420.37*483.43
**43648**536.48*509.66*586.11
#**43648**241.61*229.53*263.96
**43881**677.72*643.83*740.40
#**43881**619.85*588.86*677.19
**43882**720.61*684.58*787.27
#**43882**658.32*625.40*719.21
**47143**418.01*397.11*456.68
**47144**496.38*471.56*542.29
**47145**470.26*446.75*513.76
**48551**268.65*255.22*293.50
**49906**2039.33*1937.36*2227.96
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**742.11*705.00*810.75
**53452**371.06*352.51*405.39
**53453**630.76*599.22*689.10
**53454**55.89*53.10*61.07
#**53454**34.46*32.74*37.65
**54440**741.84*704.75*810.46
**63043**557.86*529.97*609.47
**63044**513.97*488.27*561.51
**64596**2097.20*1992.34*2291.19
#**64596**317.30*301.44*346.66
**64597**629.16*597.70*687.36
#**64597**95.19*90.43*103.99
**64598**239.05*227.10*261.17
#**64598**141.77*134.68*154.88
**65757**117.33*111.46*128.18
**66983**650.63*618.10*710.82
**66987**750.47*712.95*819.89
**66988**624.77*593.53*682.56
*C*70170**249.19*236.73*272.24
*C*70170*TC*235.06*223.31*256.81
**70555**233.47*221.80*255.07
**70555*TC*118.24*112.33*129.18
*C*70557**677.39*643.52*740.05
*C*70557*TC*529.18*502.72*578.13
*C*70558**339.74*322.75*371.16
*C*70558*TC*176.37*167.55*192.68
*C*70559**329.33*312.86*359.79
*C*70559*TC*176.37*167.55*192.68
*C*74190**550.55*523.02*601.47
*C*74190*TC*529.18*502.72*578.13
**74235**144.62*137.39*158.00
**74235*TC*89.65*85.17*97.95
**74300**84.06*79.86*91.84
**74300*TC*71.25*67.69*77.84
**74301**25.82*24.53*28.21
**74301*TC*16.27*15.46*17.78
**74328**175.06*166.31*191.26
**74328*TC*152.66*145.03*166.78
**74329**140.50*133.48*153.50
**74329*TC*117.77*111.88*128.66
**74330**262.59*249.46*286.88
**74330*TC*236.27*224.46*258.13
**74340**86.58*82.25*94.59
**74340*TC*61.91*58.81*67.63
**74355**86.58*82.25*94.59
**74355*TC*51.37*48.80*56.12
**74360**86.58*82.25*94.59
**74360*TC*60.34*57.32*65.92
**74363**175.06*166.31*191.26
**74363*TC*134.93*128.18*147.41
*C*74445**157.55*149.67*172.12
*C*74445*TC*105.47*100.20*115.23
*C*74450**250.23*237.72*273.38
*C*74450*TC*235.06*223.31*256.81
*C*74470**553.19*525.53*604.36
*C*74470*TC*529.18*502.72*578.13
**74742**233.47*221.80*255.07
**74742*TC*205.16*194.90*224.14
*C*74775**263.70*250.52*288.10
*C*74775*TC*235.06*223.31*256.81
*C*75801**643.81*611.62*703.36
*C*75801*TC*602.71*572.57*658.46
*C*75803**1590.82*1511.28*1737.97
*C*75803*TC*1536.52*1459.69*1678.64
*C*75805**3095.77*2940.98*3382.13
*C*75805*TC*3058.24*2905.33*3341.13
*C*75807**3109.16*2953.70*3396.76
*C*75807*TC*3058.24*2905.33*3341.13
*C*75810**3104.79*2949.55*3391.98
*C*75810*TC*3058.24*2905.33*3341.13
**75894**894.53*849.80*977.27
**75894*TC*825.93*784.63*902.32
*C*75898**3145.62*2988.34*3436.59
*C*75898*TC*3058.24*2905.33*3341.13
**75970**436.75*414.91*477.15
**75970*TC*400.30*380.29*437.33
**76125**39.40*37.43*43.04
**76125*TC*26.59*25.26*29.05
**76390**204.45*194.23*223.36
**76390*TC*153.24*145.58*167.42
**76390*26*51.21*48.65*55.95
**76932**84.12*79.91*91.90
**76932*TC*49.46*46.99*54.04
**76940**155.38*147.61*169.75
**76940*TC*58.67*55.74*64.10
**76941**114.88*109.14*125.51
**76941*TC*52.51*49.88*57.36
**76945**83.17*79.01*90.86
**76945*TC*52.13*49.52*56.95
*C*76975**274.60*260.87*300.00
*C*76975*TC*235.06*223.31*256.81
**76998**175.06*166.31*191.26
**76998*TC*130.12*123.61*142.15
**77013**420.89*399.85*459.83
**77013*TC*244.36*232.14*266.96
**77022**470.84*447.30*514.40
**77022*TC*278.00*264.10*303.72
**77371**626.29*594.98*684.23
**77520**908.83*863.39*992.90
**77522**908.83*863.39*992.90
**77523**1043.59*991.41*1140.12
**77525**1178.33*1119.41*1287.32
*C*78282**410.48*389.96*448.45
*C*78282*TC*395.64*375.86*432.24
**78414**514.99*489.24*562.63
**78414*TC*494.53*469.80*540.27
*C*78429**1577.38*1498.51*1723.29
*C*78429*TC*1500.91*1425.86*1639.74
*C*78430**1573.78*1495.09*1719.35
*C*78430*TC*1500.91*1425.86*1639.74
*C*78431**2351.28*2233.72*2568.78
*C*78431*TC*2266.22*2152.91*2475.85
*C*78432**1954.26*1856.55*2135.03
*C*78432*TC*1863.28*1770.12*2035.64
*C*78433**2063.72*1960.53*2254.61
*C*78433*TC*1964.18*1865.97*2145.87
**78434**705.38*670.11*770.63
**78434*TC*677.36*643.49*740.01
*C*78459**1433.27*1361.61*1565.85
*C*78459*TC*1362.42*1294.30*1488.45
*C*78491**1570.47*1491.95*1715.74
*C*78491*TC*1500.91*1425.86*1639.74
*C*78492**1582.66*1503.53*1729.06
*C*78492*TC*1500.91*1425.86*1639.74
*C*78608**1567.78*1489.39*1712.80
*C*78608*TC*1500.91*1425.86*1639.74
*C*78811**1431.24*1359.68*1563.63
*C*78811*TC*1362.42*1294.30*1488.45
*C*78812**1587.83*1508.44*1734.71
*C*78812*TC*1500.91*1425.86*1639.74
*C*78813**1589.81*1510.32*1736.87
*C*78813*TC*1500.91*1425.86*1639.74
*C*78814**1599.36*1519.39*1747.30
*C*78814*TC*1500.91*1425.86*1639.74
*C*78815**1610.56*1530.03*1759.53
*C*78815*TC*1500.91*1425.86*1639.74
*C*78816**1611.60*1531.02*1760.67
*C*78816*TC*1500.91*1425.86*1639.74
**79300**237.04*225.19*258.97
**79300*TC*175.26*166.50*191.48
**79445**237.04*225.19*258.97
**79445*TC*131.48*124.91*143.65
**86485**17.28*16.42*18.88
**90867**295.26*280.50*322.58
#**90867**133.53*126.85*145.88
**90868**198.00*188.10*216.32
#**90868**103.53*98.35*113.10
**90869**273.15*259.49*298.41
#**90869**157.77*149.88*172.36
**90952**490.40*465.88*535.76
**90953**349.74*332.25*382.09
**92978**242.66*230.53*265.11
**92978*TC*152.86*145.22*167.00
**92979**147.38*140.01*161.01
**92979*TC*76.09*72.29*83.13
*C*93315**650.82*618.28*711.02
*C*93315*TC*529.18*502.72*578.13
**93317**211.67*201.09*231.25
**93317*TC*127.20*120.84*138.97
*C*93318**626.88*595.54*684.87
*C*93318*TC*529.18*502.72*578.13
**93571**241.67*229.59*264.03
**93571*TC*173.31*164.64*189.34
**93572**145.12*137.86*158.54
**93572*TC*95.35*90.58*104.17
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.78*3275.39*3766.70
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.68*3277.20*3768.78
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.68*3277.20*3768.78
**93609**2134.69*2027.96*2332.15
**93609*TC*1876.56*1782.73*2050.14
**93610**3557.81*3379.92*3886.91
**93610*TC*3405.07*3234.82*3720.04
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.25*3236.89*3722.42
**93615**49.34*46.87*53.90
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6751.05*6413.50*7375.53
**93620**7115.62*6759.84*7773.82
**93620*TC*6530.76*6204.22*7134.85
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.85*6685.96*7688.85
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.17*6607.41*7598.52
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.08*1966.58*2261.57
**93624**3557.81*3379.92*3886.91
**93624*TC*3331.14*3164.58*3639.27
**93631**7115.62*6759.84*7773.82
**93631*TC*6742.32*6405.20*7365.98
**93640**1133.95*1077.25*1238.84
**93640*TC*966.97*918.62*1056.41
**93641**1133.95*1077.25*1238.84
**93641*TC*842.12*800.01*920.01
**93662**419.72*398.73*458.54
**93662*TC*352.11*334.50*384.68
**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**931.72*885.13*1017.90
**95965*TC*534.17*507.46*583.58
**95966**536.62*509.79*586.26
**95966*TC*345.30*328.04*377.25
**95967**451.29*428.73*493.04
**95967*TC*285.34*271.07*311.73
**96020**374.11*355.40*408.71
**96020*TC*221.92*210.82*242.44
**96547**737.63*700.75*805.86
#**96547**131.91*125.31*144.11
**96548**368.81*350.37*402.93
#**96548**65.95*62.65*72.05
**97151**48.96*46.51*53.49
#**97151**43.36*41.19*47.37
**97152**41.62*39.54*45.47
#**97152**36.85*35.01*40.26
**97153**33.15*31.49*36.21
#**97153**29.03*27.58*31.72
**97154**4.50*4.28*4.92
#**97154**4.08*3.88*4.46
**97155**33.15*31.49*36.21
#**97155**29.03*27.58*31.72
**97156**34.97*33.22*38.20
#**97156**30.69*29.16*33.53
**97157**10.21*9.70*11.16
#**97157**9.22*8.76*10.07
**97158**5.25*4.99*5.74
#**97158**4.75*4.51*5.19
**98978**46.78*44.44*51.11
# - 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.