TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
GALVESTON
******
**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**449.58*427.10*491.17
#**G0186**386.06*366.76*421.77
**G0339**2819.77*2678.78*3080.60
**G0340**2120.74*2014.70*2316.91
**G0398**133.75*127.06*146.12
**G0398*TC*95.52*90.74*104.35
**G0398*26*38.23*36.32*41.77
**G0399**92.86*88.22*101.45
**G0399*TC*50.66*48.13*55.35
**G0399*26*42.52*40.39*46.45
**G0400**95.77*90.98*104.63
**G0400*TC*56.23*53.42*61.43
**G0400*26*39.54*37.56*43.19
**G0460**782.52*743.39*854.90
#**G0460**117.48*111.61*128.35
**G0465**782.52*743.39*854.90
#**G0465**117.48*111.61*128.35
**G0498**144.49*137.27*157.86
**G6017**76.65*72.82*83.74
**0042T**224.19*212.98*244.93
**0054T**222.23*211.12*242.79
**0055T**222.23*211.12*242.79
**0071T**560.72*532.68*612.58
**0072T**560.72*532.68*612.58
**0075T**942.51*895.38*1029.69
**0075T*TC*942.51*895.38*1029.69
**0075T*26*937.28*890.42*1023.98
**0076T**1060.82*1007.78*1158.95
**0076T*TC*848.64*806.21*927.14
**0076T*26*212.18*201.57*231.81
**0095T**605.26*575.00*661.25
**0098T**677.23*643.37*739.88
**0100T**1863.33*1770.16*2035.68
**0101T**308.28*292.87*336.80
#**0101T**221.51*210.43*241.99
**0102T**308.28*292.87*336.80
#**0102T**221.51*210.43*241.99
**0106T**33.00*31.35*36.05
**0107T**33.00*31.35*36.05
**0108T**33.00*31.35*36.05
**0109T**33.00*31.35*36.05
**0110T**33.00*31.35*36.05
**0164T**661.87*628.78*723.10
**0165T**678.05*644.15*740.77
**0174T**9.84*9.35*10.75
**0184T**805.77*765.48*880.30
**0198T**83.68*79.50*91.43
#**0198T**31.29*29.73*34.19
**0200T**1744.86*1657.62*1906.26
#**0200T**393.83*374.14*430.26
**0201T**2617.28*2486.42*2859.38
#**0201T**590.74*561.20*645.38
**0207T**121.70*115.62*132.96
**0208T**37.28*35.42*40.73
**0209T**45.14*42.88*49.31
**0210T**28.44*27.02*31.07
**0211T**44.16*41.95*48.24
**0212T**35.87*34.08*39.19
#**0212T**30.96*29.41*33.82
**0213T**189.57*180.09*207.10
#**0213T**102.80*97.66*112.31
**0214T**95.58*90.80*104.42
#**0214T**57.59*54.71*62.92
**0215T**95.90*91.11*104.78
#**0215T**58.57*55.64*63.99
**0216T**174.51*165.78*190.65
#**0216T**88.39*83.97*96.57
**0217T**89.38*84.91*97.65
#**0217T**49.43*46.96*54.00
**0218T**89.38*84.91*97.65
#**0218T**50.41*47.89*55.07
**0219T**1278.86*1214.92*1397.16
**0220T**1257.60*1194.72*1373.93
**0221T**1543.63*1466.45*1686.42
**0222T**376.18*357.37*410.98
**0232T**782.52*743.39*854.90
#**0232T**117.48*111.61*128.35
**0234T**8399.09*7979.14*9176.01
#**0234T**563.40*535.23*615.51
**0235T**8399.09*7979.14*9176.01
#**0235T**563.40*535.23*615.51
**0236T**8545.86*8118.57*9336.36
#**0236T**652.88*620.24*713.28
**0237T**8545.86*8118.57*9336.36
#**0237T**652.88*620.24*713.28
**0238T**8545.86*8118.57*9336.36
#**0238T**652.88*620.24*713.28
**0253T**884.32*840.10*966.12
**0266T**869.88*826.39*950.35
**0267T**152.96*145.31*167.11
**0268T**324.12*307.91*354.10
**0269T**824.31*783.09*900.55
**0270T**152.96*145.31*167.11
**0271T**324.12*307.91*354.10
**0272T**55.11*52.35*60.20
**0273T**70.55*67.02*77.07
**0274T**1077.27*1023.41*1176.92
**0278T**14.15*13.44*15.46
**0308T**1367.78*1299.39*1494.30
**0329T**83.68*79.50*91.43
#**0329T**31.29*29.73*34.19
**0330T**38.21*36.30*41.75
**0331T**180.13*171.12*196.79
**0332T**307.63*292.25*336.09
**0347T**137.65*130.77*150.39
**0348T**32.41*30.79*35.41
**0349T**34.37*32.65*37.55
**0350T**35.02*33.27*38.26
**0351T**166.84*158.50*182.28
**0352T**42.14*40.03*46.03
**0353T**166.84*158.50*182.28
**0354T**42.14*40.03*46.03
**0358T**26.48*25.16*28.93
**0362T**89.51*85.03*97.78
#**0362T**64.30*61.09*70.25
**0378T**24.31*23.09*26.55
**0394T**245.64*233.36*268.36
**0395T**595.42*565.65*650.50
**0397T**46.02*43.72*50.28
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**494.09*469.39*539.80
**0409T**342.39*325.27*374.06
**0410T**356.08*338.28*389.02
**0411T**356.08*338.28*389.02
**0412T**224.61*213.38*245.39
**0413T**462.88*439.74*505.70
**0414T**356.90*339.06*389.92
**0415T**297.15*282.29*324.63
**0416T**330.24*313.73*360.79
**0417T**82.06*77.96*89.65
**0418T**55.11*52.35*60.20
**0419T**441.40*419.33*482.23
#**0419T**353.64*335.96*386.35
**0420T**626.25*594.94*684.18
#**0420T**517.87*491.98*565.78
**0421T**1577.09*1498.24*1722.98
#**0421T**676.96*643.11*739.58
**0437T**206.88*196.54*226.02
**0439T**70.43*66.91*76.95
**0440T**244.18*231.97*266.77
#**0440T**116.48*110.66*127.26
**0441T**244.18*231.97*266.77
#**0441T**116.48*110.66*127.26
**0442T**244.18*231.97*266.77
#**0442T**116.48*110.66*127.26
**0449T**746.63*709.30*815.70
**0464T**66.21*62.90*72.34
**0472T**65.97*62.67*72.07
**0473T**55.11*52.35*60.20
**0479T**61.85*58.76*67.57
**0480T**76.60*72.77*83.69
#**0480T**30.92*29.37*33.78
**0483T**1145.22*1087.96*1251.15
**0484T**1484.88*1410.64*1622.24
**0485T**23.16*22.00*25.30
**0485T*TC*8.63*8.20*9.43
**0485T*26*14.81*14.07*16.18
**0486T**46.32*44.00*50.60
**0486T*TC*16.98*16.13*18.55
**0486T*26*29.34*27.87*32.05
**0488T**61.69*58.61*67.40
#**0488T**48.91*46.46*53.43
**0505T**11065.01*10511.76*12088.52
#**0505T**552.51*524.88*603.61
**0507T**22.85*21.71*24.97
**0507T*TC*19.93*18.93*21.77
**0507T*26*2.92*2.77*3.19
**0510T**590.70*561.17*645.35
#**0510T**413.88*393.19*452.17
**0512T**308.28*292.87*336.80
#**0512T**221.51*210.43*241.99
**0513T**92.48*87.86*101.04
#**0513T**66.45*63.13*72.60
**0515T**494.09*469.39*539.80
**0516T**456.21*433.40*498.41
**0517T**324.12*307.91*354.10
**0518T**224.61*213.38*245.39
**0519T**325.09*308.84*355.17
**0520T**456.21*433.40*498.41
**0521T**55.11*52.35*60.20
**0521T*TC*35.32*33.55*38.58
**0521T*26*19.80*18.81*21.63
**0522T**65.97*62.67*72.07
**0522T*TC*35.97*34.17*39.30
**0522T*26*30.00*28.50*32.78
**0523T**148.74*141.30*162.50
**0524T**1611.49*1530.92*1760.56
#**0524T**170.42*161.90*186.19
**0525T**456.54*433.71*498.77
**0526T**356.08*338.28*389.02
**0527T**309.54*294.06*338.17
**0528T**65.97*62.67*72.07
**0528T*TC*35.97*34.17*39.30
**0528T*26*30.00*28.50*32.78
**0529T**55.11*52.35*60.20
**0529T*TC*35.32*33.55*38.58
**0529T*26*19.80*18.81*21.63
**0530T**608.42*578.00*664.70
**0531T**462.88*439.74*505.70
**0532T**325.09*308.84*355.17
**0540T**173.64*164.96*189.70
**0543T**1484.88*1410.64*1622.24
**0544T**1709.76*1624.27*1867.91
**0545T**1709.76*1624.27*1867.91
**0546T**70.65*67.12*77.19
**0552T**6.53*6.20*7.13
**0553T**2406.97*2286.62*2629.61
#**0553T**376.50*357.68*411.33
**0565T**600.63*570.60*656.19
#**0565T**502.72*477.58*549.22
**0566T**97.70*92.82*106.74
#**0566T**57.42*54.55*62.73
**0569T**1709.76*1624.27*1867.91
**0570T**400.41*380.39*437.45
**0571T**534.67*507.94*584.13
**0572T**435.03*413.28*475.27
**0573T**332.55*315.92*363.31
**0574T**385.14*365.88*420.76
**0575T**65.97*62.67*72.07
**0576T**55.11*52.35*60.20
**0577T**187.23*177.87*204.55
**0578T**28.57*27.14*31.21
**0579T**20.91*19.86*22.84
**0580T**206.65*196.32*225.77
**0581T**2224.11*2112.90*2429.84
#**0581T**202.49*192.37*221.23
**0582T**1626.31*1544.99*1776.74
#**0582T**375.16*356.40*409.86
**0583T**1496.16*1421.35*1634.55
#**0583T**130.26*123.75*142.31
**0587T**433.39*411.72*473.48
#**0587T**288.00*273.60*314.64
**0588T**357.30*339.44*390.36
#**0588T**224.69*213.46*245.48
**0589T**47.18*44.82*51.54
#**0589T**37.68*35.80*41.17
**0590T**55.65*52.87*60.80
#**0590T**38.95*37.00*42.55
**0596T**2235.23*2123.47*2441.99
#**0596T**128.26*121.85*140.13
**0597T**672.69*639.06*734.92
#**0597T**128.26*121.85*140.13
**0598T**148.68*141.25*162.44
**0599T**98.95*94.00*108.10
**0600T**3511.18*3335.62*3835.96
#**0600T**703.69*668.51*768.79
**0601T**1403.50*1333.33*1533.33
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**192.74*183.10*210.57
**0611T**39.85*37.86*43.54
**0614T**356.25*338.44*389.21
**0615T**46.33*44.01*50.61
**0616T**648.95*616.50*708.98
**0617T**724.92*688.67*791.97
**0618T**877.62*833.74*958.80
**0619T**639.91*607.91*699.10
#**0619T**465.37*442.10*508.42
**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**254.07*241.37*277.58
#**0627T**96.89*92.05*105.86
**0628T**76.22*72.41*83.27
#**0628T**29.07*27.62*31.76
**0629T**254.07*241.37*277.58
#**0629T**96.89*92.05*105.86
**0630T**76.22*72.41*83.27
#**0630T**29.07*27.62*31.76
**0631T**80.76*76.72*88.23
**0632T**550.33*522.81*601.23
**0633T**197.97*188.07*216.28
*C*0633T*TC*104.73*99.49*114.41
**0633T*26*57.59*54.71*62.92
**0634T**197.97*188.07*216.28
**0634T*TC*140.38*133.36*153.36
**0634T*26*57.59*54.71*62.92
**0635T**197.97*188.07*216.28
**0635T*TC*140.38*133.36*153.36
**0635T*26*57.59*54.71*62.92
**0636T**197.97*188.07*216.28
**0636T*TC*140.38*133.36*153.36
**0636T*26*57.59*54.71*62.92
**0637T**197.97*188.07*216.28
**0637T*TC*140.38*133.36*153.36
**0637T*26*57.59*54.71*62.92
**0638T**197.97*188.07*216.28
**0638T*TC*140.38*133.36*153.36
**0638T*26*57.59*54.71*62.92
**0639T**80.76*76.72*88.23
**0640T**22.85*21.71*24.97
**0640T*TC*19.93*18.93*21.77
**0640T*26*2.92*2.77*3.19
**0644T**1137.94*1081.04*1243.20
#**0644T**229.94*218.44*251.21
**0646T**1709.76*1624.27*1867.91
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**58.71*55.77*64.14
**0652T**282.31*268.19*308.42
#**0652T**118.59*112.66*129.56
**0653T**369.03*350.58*403.17
#**0653T**133.92*127.22*146.30
**0654T**137.43*130.56*150.14
**0655T**1577.09*1498.24*1722.98
#**0655T**676.96*643.11*739.58
**0658T**93.27*88.61*101.90
**0659T**2637.07*2505.22*2881.00
#**0659T**415.38*394.61*453.80
**0671T**1003.69*953.51*1096.54
**0673T**3367.80*3199.41*3679.32
#**0673T**352.38*334.76*384.97
**0699T**110.49*104.97*120.72
#**0699T**88.87*84.43*97.09
**0707T**364.70*346.47*398.44
#**0707T**274.00*260.30*299.35
**0714T**1380.50*1311.48*1508.20
#**0714T**350.37*332.85*382.78
**0730T**268.19*254.78*293.00
#**0730T**240.14*228.13*262.35
**0738T**69.31*65.84*75.72
**0739T**1577.09*1498.24*1722.98
#**0739T**676.96*643.11*739.58
**0740T**19.55*18.57*21.36
**0741T**46.45*44.13*50.75
**0742T**92.29*87.68*100.83
**0742T*TC*73.60*69.92*80.41
**0742T*26*18.68*17.75*20.41
**0743T**52.39*49.77*57.24
**0744T**849.99*807.49*928.61
**0745T**252.45*239.83*275.80
**0746T**220.50*209.48*240.90
**0747T**976.23*927.42*1066.53
**0748T**178.81*169.87*195.35
**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**427.56*406.18*467.11
**0756T**109.85*104.36*120.01
**0757T**79.91*75.91*87.30
**0758T**88.52*84.09*96.70
**0759T**132.39*125.77*144.64
**0760T**97.80*92.91*106.85
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**115.55*109.77*126.24
**0764T**4.22*4.01*4.61
**0765T**7.89*7.50*8.63
**0771T**25.64*24.36*28.01
**0772T**25.64*24.36*28.01
**0773T**22.96*21.81*25.08
**0774T**22.96*21.81*25.08
**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**429.70*408.22*469.45
**0779T*TC*404.34*384.12*441.74
**0779T*26*25.36*24.09*27.70
**0780T**22.96*21.81*25.08
**0783T**14.03*13.33*15.33
**0784T**2084.19*1979.98*2276.98
#**0784T**316.66*300.83*345.95
**0785T**237.92*226.02*259.92
#**0785T**141.33*134.26*154.40
**0786T**719.35*683.38*785.89
#**0786T**295.64*280.86*322.99
**0787T**237.92*226.02*259.92
#**0787T**141.33*134.26*154.40
**0788T**18.35*17.43*20.04
#**0788T**17.70*16.82*19.34
**0789T**25.25*23.99*27.59
#**0789T**22.12*21.01*24.16
**0790T**1875.83*1782.04*2049.35
**0791T**8.89*8.45*9.72
**0793T**550.33*522.81*601.23
**0794T**130.35*123.83*142.40
**0795T**684.32*650.10*747.62
**0796T**456.21*433.40*498.41
**0797T**456.21*433.40*498.41
**0798T**722.58*686.45*789.42
**0799T**481.72*457.63*526.27
**0800T**481.72*457.63*526.27
**0801T**937.93*891.03*1024.68
**0802T**468.97*445.52*512.35
**0803T**468.97*445.52*512.35
**0804T**77.16*73.30*84.30
**0804T*TC*41.54*39.46*45.38
**0804T*26*35.62*33.84*38.92
**0805T**2906.27*2760.96*3175.10
#**0805T**313.91*298.21*342.94
**0806T**3875.02*3681.27*4233.46
#**0806T**418.54*397.61*457.25
**0807T**41.86*39.77*45.74
**0807T*TC*27.46*26.09*30.00
**0807T*26*14.40*13.68*15.73
**0808T**41.86*39.77*45.74
**0808T*TC*27.46*26.09*30.00
**0808T*26*14.40*13.68*15.73
**0810T**1108.49*1053.07*1211.03
**0811T**19.55*18.57*21.36
**0813T**2552.20*2424.59*2788.28
#**0813T**174.31*165.59*190.43
**0814T**455.88*433.09*498.05
#**0814T**342.50*325.38*374.19
**0818T**357.30*339.44*390.36
#**0818T**224.69*213.46*245.48
**0820T**145.10*137.85*158.53
#**0820T**127.75*121.36*139.56
**0821T**145.10*137.85*158.53
#**0821T**127.75*121.36*139.56
**0822T**123.34*117.17*134.75
#**0822T**108.59*103.16*118.63
**0823T**684.32*650.10*747.62
**0824T**722.58*686.45*789.42
**0825T**937.93*891.03*1024.68
**0826T**65.97*62.67*72.07
**0826T*TC*35.97*34.17*39.30
**0826T*26*30.00*28.50*32.78
**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**22.85*21.71*24.97
**0859T*TC*19.93*18.93*21.77
**0859T*26*2.92*2.77*3.19
**0864T**308.28*292.87*336.80
#**0864T**221.51*210.43*241.99
**10011**418.79*397.85*457.53
#**10011**104.77*99.53*114.46
**10012**230.61*219.08*251.94
#**10012**69.50*66.03*75.93
**15847**343.22*326.06*374.97
**21742**1119.32*1063.35*1222.85
**21743**1282.99*1218.84*1401.67
**32855**355.66*337.88*388.56
**32856**435.03*413.28*475.27
**33928**3184.85*3025.61*3479.45
**33929**1193.13*1133.47*1303.49
**33933**545.30*518.04*595.75
**33944**545.30*518.04*595.75
**34841**2129.34*2022.87*2326.30
**34842**2355.13*2237.37*2572.98
**34843**2580.92*2451.87*2819.65
**34844**2806.69*2666.36*3066.31
**34845**2129.34*2022.87*2326.30
**34846**2355.13*2237.37*2572.98
**34847**2580.92*2451.87*2819.65
**34848**2806.69*2666.36*3066.31
**43496**2125.52*2019.24*2322.13
**43647**442.49*420.37*483.43
**43648**537.21*510.35*586.90
#**43648**242.33*230.21*264.74
**43881**685.47*651.20*748.88
#**43881**628.80*597.36*686.96
**43882**726.52*690.19*793.72
#**43882**665.51*632.23*727.06
**47143**425.67*404.39*465.05
**47144**505.48*480.21*552.24
**47145**478.87*454.93*523.17
**48551**270.77*257.23*295.81
**49906**2045.59*1943.31*2234.81
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**740.39*703.37*808.88
**53452**370.20*351.69*404.44
**53453**629.30*597.84*687.52
**53454**55.70*52.92*60.86
#**53454**34.42*32.70*37.61
**54440**750.69*713.16*820.13
**63043**554.58*526.85*605.88
**63044**523.31*497.14*571.71
**64596**2084.19*1979.98*2276.98
#**64596**316.66*300.83*345.95
**64597**625.26*594.00*683.10
#**64597**95.00*90.25*103.79
**64598**237.92*226.02*259.92
#**64598**141.33*134.26*154.40
**65757**116.95*111.10*127.77
**66983**648.95*616.50*708.98
**66987**748.97*711.52*818.25
**66988**623.43*592.26*681.10
*C*70170**247.54*235.16*270.43
*C*70170*TC*233.42*221.75*255.01
**70555**233.47*221.80*255.07
**70555*TC*118.27*112.36*129.21
*C*70557**673.56*639.88*735.86
*C*70557*TC*525.50*499.23*574.11
*C*70558**338.35*321.43*369.64
*C*70558*TC*175.13*166.37*191.33
*C*70559**327.95*311.55*358.28
*C*70559*TC*175.13*166.37*191.33
*C*74190**546.86*519.52*597.45
*C*74190*TC*525.50*499.23*574.11
**74235**144.02*136.82*157.34
**74235*TC*89.08*84.63*97.32
**74300**83.60*79.42*91.33
**74300*TC*70.80*67.26*77.35
**74301**25.67*24.39*28.05
**74301*TC*16.13*15.32*17.62
**74328**175.06*166.31*191.26
**74328*TC*152.67*145.04*166.80
**74329**139.72*132.73*152.64
**74329*TC*117.01*111.16*127.83
**74330**262.59*249.46*286.88
**74330*TC*236.28*224.47*258.14
**74340**86.58*82.25*94.59
**74340*TC*61.92*58.82*67.64
**74355**86.58*82.25*94.59
**74355*TC*51.39*48.82*56.14
**74360**86.58*82.25*94.59
**74360*TC*60.37*57.35*65.95
**74363**175.06*166.31*191.26
**74363*TC*134.95*128.20*147.43
*C*74445**156.80*148.96*171.30
*C*74445*TC*104.73*99.49*114.41
*C*74450**248.58*236.15*271.57
*C*74450*TC*233.42*221.75*255.01
*C*74470**549.51*522.03*600.33
*C*74470*TC*525.50*499.23*574.11
**74742**233.47*221.80*255.07
**74742*TC*205.17*194.91*224.15
*C*74775**262.05*248.95*286.29
*C*74775*TC*233.42*221.75*255.01
*C*75801**639.53*607.55*698.68
*C*75801*TC*598.52*568.59*653.88
*C*75803**1580.11*1501.10*1726.27
*C*75803*TC*1525.83*1449.54*1666.97
*C*75805**3074.49*2920.77*3358.89
*C*75805*TC*3036.98*2885.13*3317.90
*C*75807**3087.89*2933.50*3373.53
*C*75807*TC*3036.98*2885.13*3317.90
*C*75810**3083.52*2929.34*3368.74
*C*75810*TC*3036.98*2885.13*3317.90
**75894**888.17*843.76*970.32
**75894*TC*819.76*778.77*895.59
*C*75898**3124.11*2967.90*3413.09
*C*75898*TC*3036.98*2885.13*3317.90
**75970**433.74*412.05*473.86
**75970*TC*397.30*377.44*434.06
**76125**39.21*37.25*42.84
**76125*TC*26.41*25.09*28.85
**76390**203.46*193.29*222.28
**76390*TC*152.16*144.55*166.23
**76390*26*51.30*48.74*56.05
**76932**83.76*79.57*91.51
**76932*TC*49.17*46.71*53.72
**76940**154.85*147.11*169.18
**76940*TC*58.29*55.38*63.69
**76941**114.57*108.84*125.17
**76941*TC*52.21*49.60*57.04
**76945**82.83*78.69*90.49
**76945*TC*51.79*49.20*56.58
*C*76975**272.94*259.29*298.18
*C*76975*TC*233.42*221.75*255.01
**76998**175.06*166.31*191.26
**76998*TC*130.22*123.71*142.27
**77013**418.57*397.64*457.29
**77013*TC*242.09*229.99*264.49
**77022**468.81*445.37*512.18
**77022*TC*276.03*262.23*301.56
**77371**613.67*582.99*670.44
**77520**890.35*845.83*972.70
**77522**890.35*845.83*972.70
**77523**1022.34*971.22*1116.90
**77525**1154.30*1096.59*1261.08
*C*78282**407.74*387.35*445.45
*C*78282*TC*392.88*373.24*429.23
**78414**514.99*489.24*562.63
**78414*TC*494.53*469.80*540.27
*C*78429**1566.96*1488.61*1711.90
*C*78429*TC*1490.47*1415.95*1628.34
*C*78430**1563.36*1485.19*1707.97
*C*78430*TC*1490.47*1415.95*1628.34
*C*78431**2335.53*2218.75*2551.56
*C*78431*TC*2250.46*2137.94*2458.63
*C*78432**1941.32*1844.25*2120.89
*C*78432*TC*1850.33*1757.81*2021.48
*C*78433**2050.07*1947.57*2239.71
*C*78433*TC*1950.52*1852.99*2130.94
**78434**700.66*665.63*765.47
**78434*TC*672.63*639.00*734.85
*C*78459**1423.80*1352.61*1555.50
*C*78459*TC*1352.94*1285.29*1478.08
*C*78491**1560.04*1482.04*1704.35
*C*78491*TC*1490.47*1415.95*1628.34
*C*78492**1572.21*1493.60*1717.64
*C*78492*TC*1490.47*1415.95*1628.34
*C*78608**1557.34*1479.47*1701.39
*C*78608*TC*1490.47*1415.95*1628.34
*C*78811**1421.75*1350.66*1553.26
*C*78811*TC*1352.94*1285.29*1478.08
*C*78812**1577.37*1498.50*1723.28
*C*78812*TC*1490.47*1415.95*1628.34
*C*78813**1579.37*1500.40*1725.46
*C*78813*TC*1490.47*1415.95*1628.34
*C*78814**1588.91*1509.46*1735.88
*C*78814*TC*1490.47*1415.95*1628.34
*C*78815**1600.10*1520.10*1748.12
*C*78815*TC*1490.47*1415.95*1628.34
*C*78816**1601.16*1521.10*1749.27
*C*78816*TC*1490.47*1415.95*1628.34
**79300**237.04*225.19*258.97
**79300*TC*175.17*166.41*191.37
**79445**237.04*225.19*258.97
**79445*TC*131.50*124.93*143.67
**86485**17.28*16.42*18.88
**90867**293.72*279.03*320.88
#**90867**133.11*126.45*145.42
**90868**197.18*187.32*215.42
#**90868**103.47*98.30*113.05
**90869**272.16*258.55*297.33
#**90869**157.23*149.37*171.78
**90952**490.23*465.72*535.58
**90953**349.44*331.97*381.77
**92978**241.58*229.50*263.93
**92978*TC*152.00*144.40*166.06
**92979**146.88*139.54*160.47
**92979*TC*75.74*71.95*82.74
*C*93315**647.13*614.77*706.99
*C*93315*TC*525.50*499.23*574.11
**93317**210.83*200.29*230.33
**93317*TC*126.40*120.08*138.09
*C*93318**623.16*592.00*680.80
*C*93318*TC*525.50*499.23*574.11
**93571**240.60*228.57*262.86
**93571*TC*172.39*163.77*188.34
**93572**144.63*137.40*158.01
**93572*TC*94.98*90.23*103.76
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.06*3275.66*3767.01
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.93*3277.43*3769.04
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.93*3277.43*3769.04
**93609**2134.69*2027.96*2332.15
**93609*TC*1877.20*1783.34*2050.84
**93610**3557.81*3379.92*3886.91
**93610*TC*3405.42*3235.15*3720.42
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.57*3237.19*3722.77
**93615**49.34*46.87*53.90
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6751.96*6414.36*7376.51
**93620**7115.62*6759.84*7773.82
**93620*TC*6532.23*6205.62*7136.46
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.05*6686.15*7689.07
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.57*6607.79*7598.96
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.31*1966.79*2261.81
**93624**3557.81*3379.92*3886.91
**93624*TC*3331.68*3165.10*3639.87
**93631**7115.62*6759.84*7773.82
**93631*TC*6743.22*6406.06*7366.97
**93640**1133.95*1077.25*1238.84
**93640*TC*967.37*919.00*1056.85
**93641**1133.95*1077.25*1238.84
**93641*TC*842.86*800.72*920.83
**93662**418.79*397.85*457.53
**93662*TC*351.19*333.63*383.67
**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**931.39*884.82*1017.54
**95965*TC*534.17*507.46*583.58
**95966**536.47*509.65*586.10
**95966*TC*345.30*328.04*377.25
**95967**451.16*428.60*492.89
**95967*TC*285.34*271.07*311.73
**96020**372.54*353.91*407.00
**96020*TC*220.35*209.33*240.73
**96547**733.12*696.46*800.93
#**96547**131.61*125.03*143.78
**96548**366.56*348.23*400.46
#**96548**65.81*62.52*71.90
**97151**48.96*46.51*53.49
#**97151**43.40*41.23*47.41
**97152**41.62*39.54*45.47
#**97152**36.89*35.05*40.31
**97153**33.16*31.50*36.23
#**97153**29.07*27.62*31.76
**97154**4.50*4.28*4.92
#**97154**4.08*3.88*4.46
**97155**33.16*31.50*36.23
#**97155**29.07*27.62*31.76
**97156**34.99*33.24*38.23
#**97156**30.73*29.19*33.57
**97157**10.20*9.69*11.14
#**97157**9.22*8.76*10.07
**97158**5.24*4.98*5.73
#**97158**4.75*4.51*5.19
**98978**46.45*44.13*50.75
# - 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.