TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
HOUSTON
******
**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**456.65*433.82*498.89
#**G0186**392.93*373.28*429.27
**G0339**2836.59*2694.76*3098.97
**G0340**2133.34*2026.67*2330.67
**G0398**134.97*128.22*147.45
**G0398*TC*96.17*91.36*105.06
**G0398*26*38.80*36.86*42.39
**G0399**93.94*89.24*102.63
**G0399*TC*51.17*48.61*55.90
**G0399*26*43.10*40.95*47.09
**G0400**96.87*92.03*105.83
**G0400*TC*56.75*53.91*62.00
**G0400*26*40.12*38.11*43.83
**G0460**791.32*751.75*864.51
#**G0460**124.29*118.08*135.79
**G0465**791.32*751.75*864.51
#**G0465**124.29*118.08*135.79
**G0498**146.17*138.86*159.69
**G6017**78.07*74.17*85.30
**0042T**225.94*214.64*246.84
**0054T**246.90*234.56*269.74
**0055T**246.90*234.56*269.74
**0071T**588.96*559.51*643.44
**0072T**588.96*559.51*643.44
**0075T**1026.26*974.95*1121.19
**0075T*TC*1026.26*974.95*1121.19
**0075T*26*1021.02*969.97*1115.47
**0076T**1059.96*1006.96*1158.00
**0076T*TC*847.97*805.57*926.41
**0076T*26*211.99*201.39*231.60
**0095T**672.56*638.93*734.77
**0098T**753.56*715.88*823.26
**0100T**1905.19*1809.93*2081.42
**0101T**314.28*298.57*343.36
#**0101T**227.25*215.89*248.27
**0102T**314.28*298.57*343.36
#**0102T**227.25*215.89*248.27
**0106T**33.45*31.78*36.55
**0107T**33.45*31.78*36.55
**0108T**33.45*31.78*36.55
**0109T**33.45*31.78*36.55
**0110T**33.45*31.78*36.55
**0164T**734.52*697.79*802.46
**0165T**752.78*715.14*822.41
**0174T**9.92*9.42*10.83
**0184T**845.80*803.51*924.04
**0198T**84.23*80.02*92.02
#**0198T**31.69*30.11*34.63
**0200T**1768.68*1680.25*1932.29
#**0200T**413.60*392.92*451.86
**0201T**2653.02*2520.37*2898.43
#**0201T**620.40*589.38*677.79
**0207T**121.70*115.62*132.96
**0208T**37.57*35.69*41.04
**0209T**45.46*43.19*49.67
**0210T**28.71*27.27*31.36
**0211T**44.47*42.25*48.59
**0212T**36.28*34.47*39.64
#**0212T**31.35*29.78*34.25
**0213T**193.21*183.55*211.08
#**0213T**106.17*100.86*115.99
**0214T**97.91*93.01*106.96
#**0214T**59.82*56.83*65.35
**0215T**98.24*93.33*107.33
#**0215T**60.80*57.76*66.42
**0216T**177.59*168.71*194.02
#**0216T**91.22*86.66*99.66
**0217T**91.35*86.78*99.80
#**0217T**51.28*48.72*56.03
**0218T**91.35*86.78*99.80
#**0218T**52.27*49.66*57.11
**0219T**1391.47*1321.90*1520.19
**0220T**1363.65*1295.47*1489.79
**0221T**1667.62*1584.24*1821.88
**0222T**414.22*393.51*452.54
**0232T**791.32*751.75*864.51
#**0232T**124.29*118.08*135.79
**0234T**8468.98*8045.53*9252.36
#**0234T**609.79*579.30*666.20
**0235T**8468.98*8045.53*9252.36
#**0235T**609.79*579.30*666.20
**0236T**8620.50*8189.48*9417.90
#**0236T**703.84*668.65*768.95
**0237T**8620.50*8189.48*9417.90
#**0237T**703.84*668.65*768.95
**0238T**8620.50*8189.48*9417.90
#**0238T**703.84*668.65*768.95
**0253T**888.60*844.17*970.80
**0266T**932.39*885.77*1018.64
**0267T**164.49*156.27*179.71
**0268T**346.41*329.09*378.45
**0269T**882.47*838.35*964.10
**0270T**164.49*156.27*179.71
**0271T**346.41*329.09*378.45
**0272T**55.60*52.82*60.74
**0273T**71.41*67.84*78.02
**0274T**1167.32*1108.95*1275.29
**0278T**14.35*13.63*15.67
**0308T**1397.90*1328.01*1527.21
**0329T**84.23*80.02*92.02
#**0329T**31.69*30.11*34.63
**0330T**38.21*36.30*41.75
**0331T**181.85*172.76*198.67
**0332T**310.22*294.71*338.92
**0347T**146.67*139.34*160.24
**0348T**32.85*31.21*35.89
**0349T**34.82*33.08*38.04
**0350T**35.47*33.70*38.76
**0351T**167.99*159.59*183.53
**0352T**42.73*40.59*46.68
**0353T**167.99*159.59*183.53
**0354T**42.73*40.59*46.68
**0358T**26.74*25.40*29.21
**0362T**91.46*86.89*99.92
#**0362T**66.17*62.86*72.29
**0378T**24.88*23.64*27.19
**0394T**247.89*235.50*270.83
**0395T**601.71*571.62*657.36
**0397T**46.97*44.62*51.31
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**529.57*503.09*578.55
**0409T**365.43*347.16*399.23
**0410T**379.52*360.54*414.62
**0411T**379.52*360.54*414.62
**0412T**237.97*226.07*259.98
**0413T**494.75*470.01*540.51
**0414T**381.23*362.17*416.50
**0415T**317.96*302.06*347.37
**0416T**350.97*333.42*383.43
**0417T**82.94*78.79*90.61
**0418T**55.60*52.82*60.74
**0419T**451.82*429.23*493.61
#**0419T**363.80*345.61*397.45
**0420T**645.98*613.68*705.73
#**0420T**537.27*510.41*586.97
**0421T**1607.52*1527.14*1756.21
#**0421T**704.68*669.45*769.87
**0437T**219.96*208.96*240.30
**0439T**72.39*68.77*79.09
**0440T**248.51*236.08*271.49
#**0440T**120.42*114.40*131.56
**0441T**248.51*236.08*271.49
#**0441T**120.42*114.40*131.56
**0442T**248.51*236.08*271.49
#**0442T**120.42*114.40*131.56
**0449T**761.93*723.83*832.40
**0464T**66.73*63.39*72.90
**0472T**66.65*63.32*72.82
**0473T**55.60*52.82*60.74
**0479T**62.82*59.68*68.63
**0480T**77.23*73.37*84.38
#**0480T**31.41*29.84*34.32
**0483T**1241.03*1178.98*1355.83
**0484T**1608.83*1528.39*1757.65
**0485T**23.38*22.21*25.54
**0485T*TC*8.84*8.40*9.66
**0485T*26*15.01*14.26*16.40
**0486T**46.77*44.43*51.09
**0486T*TC*17.21*16.35*18.80
**0486T*26*29.56*28.08*32.29
**0488T**63.03*59.88*68.86
#**0488T**50.23*47.72*54.88
**0505T**11083.22*10529.06*12108.42
#**0505T**560.31*532.29*612.13
**0507T**23.27*22.11*25.43
**0507T*TC*20.17*19.16*22.03
**0507T*26*3.11*2.95*3.39
**0510T**611.01*580.46*667.53
#**0510T**433.67*411.99*473.79
**0512T**314.28*298.57*343.36
#**0512T**227.25*215.89*248.27
**0513T**94.28*89.57*103.01
#**0513T**68.17*64.76*74.47
**0515T**529.57*503.09*578.55
**0516T**488.76*464.32*533.97
**0517T**346.41*329.09*378.45
**0518T**237.97*226.07*259.98
**0519T**347.39*330.02*379.52
**0520T**488.76*464.32*533.97
**0521T**55.60*52.82*60.74
**0521T*TC*35.60*33.82*38.89
**0521T*26*19.99*18.99*21.84
**0522T**66.65*63.32*72.82
**0522T*TC*36.26*34.45*39.62
**0522T*26*30.39*28.87*33.20
**0523T**153.74*146.05*167.96
**0524T**1628.98*1547.53*1779.66
#**0524T**183.58*174.40*200.56
**0525T**489.09*464.64*534.34
**0526T**379.52*360.54*414.62
**0527T**330.74*314.20*361.33
**0528T**66.65*63.32*72.82
**0528T*TC*36.26*34.45*39.62
**0528T*26*30.39*28.87*33.20
**0529T**55.60*52.82*60.74
**0529T*TC*35.60*33.82*38.89
**0529T*26*19.99*18.99*21.84
**0530T**650.06*617.56*710.19
**0531T**494.75*470.01*540.51
**0532T**347.39*330.02*379.52
**0540T**177.48*168.61*193.90
**0543T**1608.83*1528.39*1757.65
**0544T**1845.65*1753.37*2016.38
**0545T**1845.65*1753.37*2016.38
**0546T**71.15*67.59*77.73
**0552T**6.72*6.38*7.34
**0553T**2444.82*2322.58*2670.97
#**0553T**408.26*387.85*446.03
**0565T**624.33*593.11*682.08
#**0565T**526.13*499.82*574.79
**0566T**100.59*95.56*109.89
#**0566T**60.19*57.18*65.76
**0569T**1845.65*1753.37*2016.38
**0570T**433.51*411.83*473.60
**0571T**572.56*543.93*625.52
**0572T**466.64*443.31*509.81
**0573T**355.40*337.63*388.27
**0574T**412.91*392.26*451.10
**0575T**66.65*63.32*72.82
**0576T**55.60*52.82*60.74
**0577T**189.30*179.84*206.82
**0578T**29.32*27.85*32.03
**0579T**21.15*20.09*23.10
**0580T**219.61*208.63*239.92
**0581T**2247.57*2135.19*2455.47
#**0581T**219.88*208.89*240.22
**0582T**1643.78*1561.59*1795.83
#**0582T**388.87*369.43*424.84
**0583T**1496.16*1421.35*1634.55
#**0583T**134.65*127.92*147.11
**0587T**447.36*424.99*488.74
#**0587T**301.54*286.46*329.43
**0588T**368.11*349.70*402.16
#**0588T**235.09*223.34*256.84
**0589T**48.50*46.08*52.99
#**0589T**38.98*37.03*42.58
**0590T**57.18*54.32*62.47
#**0590T**40.43*38.41*44.17
**0596T**2235.23*2123.47*2441.99
#**0596T**131.59*125.01*143.76
**0597T**672.69*639.06*734.92
#**0597T**131.59*125.01*143.76
**0598T**149.46*141.99*163.29
**0599T**99.41*94.44*108.61
**0600T**3548.75*3371.31*3877.01
#**0600T**732.84*696.20*800.63
**0601T**1512.52*1436.89*1652.42
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**194.98*185.23*213.01
**0611T**40.33*38.31*44.06
**0614T**380.58*361.55*415.78
**0615T**46.95*44.60*51.29
**0616T**660.60*627.57*721.71
**0617T**740.34*703.32*808.82
**0618T**896.37*851.55*979.28
**0619T**657.69*624.81*718.53
#**0619T**482.62*458.49*527.26
**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**257.90*245.01*281.76
#**0627T**100.25*95.24*109.53
**0628T**77.37*73.50*84.53
#**0628T**30.08*28.58*32.87
**0629T**257.90*245.01*281.76
#**0629T**100.25*95.24*109.53
**0630T**77.37*73.50*84.53
#**0630T**30.08*28.58*32.87
**0631T**81.88*77.79*89.46
**0632T**592.85*563.21*647.69
**0633T**199.88*189.89*218.37
*C*0633T*TC*105.23*99.97*114.97
**0633T*26*58.72*55.78*64.15
**0634T**199.88*189.89*218.37
**0634T*TC*141.16*134.10*154.22
**0634T*26*58.72*55.78*64.15
**0635T**199.88*189.89*218.37
**0635T*TC*141.16*134.10*154.22
**0635T*26*58.72*55.78*64.15
**0636T**199.88*189.89*218.37
**0636T*TC*141.16*134.10*154.22
**0636T*26*58.72*55.78*64.15
**0637T**199.88*189.89*218.37
**0637T*TC*141.16*134.10*154.22
**0637T*26*58.72*55.78*64.15
**0638T**199.88*189.89*218.37
**0638T*TC*141.16*134.10*154.22
**0638T*26*58.72*55.78*64.15
**0639T**81.88*77.79*89.46
**0640T**23.27*22.11*25.43
**0640T*TC*20.17*19.16*22.03
**0640T*26*3.11*2.95*3.39
**0644T**1159.10*1101.15*1266.32
#**0644T**248.38*235.96*271.35
**0646T**1845.65*1753.37*2016.38
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.37*56.40*64.86
**0652T**287.64*273.26*314.25
#**0652T**123.43*117.26*134.85
**0653T**375.31*356.54*410.02
#**0653T**139.50*132.53*152.41
**0654T**143.55*136.37*156.83
**0655T**1607.52*1527.14*1756.21
#**0655T**704.68*669.45*769.87
**0658T**93.73*89.04*102.40
**0659T**2678.60*2544.67*2926.37
#**0659T**450.24*427.73*491.89
**0671T**1024.35*973.13*1119.10
**0673T**3396.70*3226.87*3710.90
#**0673T**372.24*353.63*406.67
**0699T**112.66*107.03*123.08
#**0699T**90.98*86.43*99.39
**0707T**372.01*353.41*406.42
#**0707T**281.04*266.99*307.04
**0714T**1396.02*1326.22*1525.15
#**0714T**362.80*344.66*396.36
**0730T**271.64*258.06*296.77
#**0730T**243.51*231.33*266.03
**0738T**70.83*67.29*77.38
**0739T**1607.52*1527.14*1756.21
#**0739T**704.68*669.45*769.87
**0740T**19.97*18.97*21.82
**0741T**46.77*44.43*51.09
**0742T**93.07*88.42*101.68
**0742T*TC*74.09*70.39*80.95
**0742T*26*18.97*18.02*20.72
**0743T**53.05*50.40*57.96
**0744T**926.51*880.18*1012.21
**0745T**254.47*241.75*278.01
**0746T**223.98*212.78*244.70
**0747T**983.67*934.49*1074.66
**0748T**187.73*178.34*205.09
**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**430.01*408.51*469.79
**0756T**110.48*104.96*120.70
**0757T**80.49*76.47*87.94
**0758T**89.10*84.65*97.35
**0759T**133.27*126.61*145.60
**0760T**98.39*93.47*107.49
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**116.18*110.37*126.93
**0764T**4.33*4.11*4.73
**0765T**8.08*7.68*8.83
**0771T**26.84*25.50*29.33
**0772T**26.84*25.50*29.33
**0773T**23.19*22.03*25.33
**0774T**23.19*22.03*25.33
**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**431.48*409.91*471.40
**0779T*TC*405.74*385.45*443.27
**0779T*26*25.74*24.45*28.12
**0780T**23.19*22.03*25.33
**0783T**14.26*13.55*15.58
**0784T**2101.07*1996.02*2295.42
#**0784T**328.23*311.82*358.59
**0785T**243.84*231.65*266.40
#**0785T**146.96*139.61*160.55
**0786T**734.33*697.61*802.25
#**0786T**309.35*293.88*337.96
**0787T**243.84*231.65*266.40
#**0787T**146.96*139.61*160.55
**0788T**18.92*17.97*20.67
#**0788T**18.26*17.35*19.95
**0789T**27.45*26.08*29.99
#**0789T**22.82*21.68*24.93
**0790T**1944.68*1847.45*2124.57
**0791T**9.08*8.63*9.92
**0793T**592.85*563.21*647.69
**0794T**130.35*123.83*142.40
**0795T**733.14*696.48*800.95
**0796T**488.76*464.32*533.97
**0797T**488.76*464.32*533.97
**0798T**777.37*738.50*849.28
**0799T**518.24*492.33*566.18
**0800T**518.24*492.33*566.18
**0801T**1007.01*956.66*1100.16
**0802T**503.50*478.33*550.08
**0803T**503.50*478.33*550.08
**0804T**77.86*73.97*85.07
**0804T*TC*41.84*39.75*45.71
**0804T*26*36.01*34.21*39.34
**0805T**2931.38*2784.81*3202.53
#**0805T**331.25*314.69*361.89
**0806T**3908.51*3713.08*4270.04
#**0806T**441.66*419.58*482.52
**0807T**42.68*40.55*46.63
**0807T*TC*27.72*26.33*30.28
**0807T*26*14.96*14.21*16.34
**0808T**42.68*40.55*46.63
**0808T*TC*27.72*26.33*30.28
**0808T*26*14.96*14.21*16.34
**0810T**1133.30*1076.64*1238.14
**0811T**19.97*18.97*21.82
**0813T**2572.00*2443.40*2809.91
#**0813T**186.99*177.64*204.29
**0814T**465.02*441.77*508.04
#**0814T**351.30*333.74*383.80
**0818T**368.11*349.70*402.16
#**0818T**235.09*223.34*256.84
**0820T**147.02*139.67*160.62
#**0820T**129.61*123.13*141.60
**0821T**147.02*139.67*160.62
#**0821T**129.61*123.13*141.60
**0822T**124.96*118.71*136.52
#**0822T**110.17*104.66*120.36
**0823T**733.14*696.48*800.95
**0824T**777.37*738.50*849.28
**0825T**1007.01*956.66*1100.16
**0826T**66.65*63.32*72.82
**0826T*TC*36.26*34.45*39.62
**0826T*26*30.39*28.87*33.20
**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**23.27*22.11*25.43
**0859T*TC*20.17*19.16*22.03
**0859T*26*3.11*2.95*3.39
**0864T**314.28*298.57*343.36
#**0864T**227.25*215.89*248.27
**10011**423.79*402.60*462.99
#**10011**108.83*103.39*118.90
**10012**234.93*223.18*256.66
#**10012**73.34*69.67*80.12
**15847**362.05*343.95*395.54
**21742**1199.03*1139.08*1309.94
**21743**1386.74*1317.40*1515.01
**32855**353.05*335.40*385.71
**32856**472.92*449.27*516.66
**33928**3464.34*3291.12*3784.79
**33929**1297.01*1232.16*1416.98
**33933**540.91*513.86*590.94
**33944**540.91*513.86*590.94
**34841**2120.10*2014.10*2316.22
**34842**2345.88*2228.59*2562.88
**34843**2571.65*2443.07*2809.53
**34844**2797.43*2657.56*3056.19
**34845**2120.10*2014.10*2316.22
**34846**2345.88*2228.59*2562.88
**34847**2571.65*2443.07*2809.53
**34848**2797.43*2657.56*3056.19
**43496**2116.94*2011.09*2312.75
**43647**442.49*420.37*483.43
**43648**536.22*509.41*585.82
#**43648**241.80*229.71*264.17
**43881**681.31*647.24*744.33
#**43881**624.29*593.08*682.04
**43882**722.94*686.79*789.81
#**43882**661.57*628.49*722.76
**47143**423.96*402.76*463.17
**47144**503.44*478.27*550.01
**47145**476.95*453.10*521.07
**48551**269.63*256.15*294.57
**49906**2040.16*1938.15*2228.87
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**770.03*731.53*841.26
**53452**385.01*365.76*420.62
**53453**654.46*621.74*715.00
**53454**56.88*54.04*62.15
#**53454**35.53*33.75*38.81
**54440**746.56*709.23*815.61
**63043**618.53*587.60*675.74
**63044**518.94*492.99*566.94
**64596**2101.07*1996.02*2295.42
#**64596**328.23*311.82*358.59
**64597**630.32*598.80*688.62
#**64597**98.47*93.55*107.58
**64598**243.84*231.65*266.40
#**64598**146.96*139.61*160.55
**65757**121.11*115.05*132.31
**66983**660.60*627.57*721.71
**66987**769.78*731.29*840.98
**66988**635.85*604.06*694.67
*C*70170**248.80*236.36*271.81
*C*70170*TC*234.30*222.59*255.98
**70555**233.47*221.80*255.07
**70555*TC*116.01*110.21*126.74
*C*70557**677.82*643.93*740.52
*C*70557*TC*527.25*500.89*576.02
*C*70558**341.75*324.66*373.36
*C*70558*TC*175.84*167.05*192.11
*C*70559**333.49*316.82*364.34
*C*70559*TC*175.84*167.05*192.11
*C*74190**549.17*521.71*599.97
*C*74190*TC*527.25*500.89*576.02
**74235**147.94*140.54*161.62
**74235*TC*91.87*87.28*100.37
**74300**84.36*80.14*92.16
**74300*TC*71.19*67.63*77.77
**74301**26.28*24.97*28.72
**74301*TC*16.65*15.82*18.19
**74328**175.06*166.31*191.26
**74328*TC*152.29*144.68*166.38
**74329**143.68*136.50*156.98
**74329*TC*120.58*114.55*131.73
**74330**262.59*249.46*286.88
**74330*TC*235.72*223.93*257.52
**74340**86.58*82.25*94.59
**74340*TC*61.35*58.28*67.02
**74355**86.58*82.25*94.59
**74355*TC*50.63*48.10*55.32
**74360**86.58*82.25*94.59
**74360*TC*59.45*56.48*64.95
**74363**175.06*166.31*191.26
**74363*TC*134.01*127.31*146.41
*C*74445**158.06*150.16*172.68
*C*74445*TC*105.23*99.97*114.97
*C*74450**249.66*237.18*272.76
*C*74450*TC*234.30*222.59*255.98
*C*74470**551.82*524.23*602.86
*C*74470*TC*527.25*500.89*576.02
**74742**233.47*221.80*255.07
**74742*TC*204.61*194.38*223.54
*C*74775**263.49*250.32*287.87
*C*74775*TC*234.30*222.59*255.98
*C*75801**643.89*611.70*703.46
*C*75801*TC*600.49*570.47*656.04
*C*75803**1586.00*1506.70*1732.71
*C*75803*TC*1530.59*1454.06*1672.17
*C*75805**3084.53*2930.30*3369.85
*C*75805*TC*3046.27*2893.96*3328.05
*C*75807**3098.66*2943.73*3385.29
*C*75807*TC*3046.27*2893.96*3328.05
*C*75810**3094.64*2939.91*3380.90
*C*75810*TC*3046.27*2893.96*3328.05
**75894**915.07*869.32*999.72
**75894*TC*841.71*799.62*919.56
*C*75898**3139.99*2982.99*3430.44
*C*75898*TC*3046.27*2893.96*3328.05
**75970**446.51*424.18*487.81
**75970*TC*408.96*388.51*446.79
**76125**40.39*38.37*44.13
**76125*TC*27.22*25.86*29.74
**76390**205.41*195.14*224.41
**76390*TC*152.99*145.34*167.14
**76390*26*52.42*49.80*57.27
**76932**86.11*81.80*94.07
**76932*TC*49.86*47.37*54.48
**76940**165.94*157.64*181.29
**76940*TC*64.42*61.20*70.38
**76941**117.49*111.62*128.36
**76941*TC*54.54*51.81*59.58
**76945**84.99*80.74*92.85
**76945*TC*53.74*51.05*58.71
*C*76975**274.40*260.68*299.78
*C*76975*TC*234.30*222.59*255.98
**76998**175.06*166.31*191.26
**76998*TC*127.28*120.92*139.06
**77013**421.12*400.06*460.07
**77013*TC*240.00*228.00*262.20
**77022**471.36*447.79*514.96
**77022*TC*274.45*260.73*299.84
**77371**617.25*586.39*674.35
**77520**895.59*850.81*978.43
**77522**895.59*850.81*978.43
**77523**1028.37*976.95*1123.49
**77525**1161.13*1103.07*1268.53
*C*78282**409.29*388.83*447.15
*C*78282*TC*394.24*374.53*430.71
**78414**514.99*489.24*562.63
**78414*TC*494.33*469.61*540.05
*C*78429**1572.75*1494.11*1718.23
*C*78429*TC*1495.12*1420.36*1633.41
*C*78430**1568.97*1490.52*1714.10
*C*78430*TC*1495.12*1420.36*1633.41
*C*78431**2343.61*2226.43*2560.39
*C*78431*TC*2257.39*2144.52*2466.20
*C*78432**1948.38*1850.96*2128.60
*C*78432*TC*1856.06*1763.26*2027.75
*C*78433**2057.62*1954.74*2247.95
*C*78433*TC*1956.56*1858.73*2137.54
**78434**703.08*667.93*768.12
**78434*TC*674.67*640.94*737.08
*C*78459**1429.17*1357.71*1561.37
*C*78459*TC*1357.18*1289.32*1482.72
*C*78491**1565.64*1487.36*1710.46
*C*78491*TC*1495.12*1420.36*1633.41
*C*78492**1578.02*1499.12*1723.99
*C*78492*TC*1495.12*1420.36*1633.41
*C*78608**1563.13*1484.97*1707.72
*C*78608*TC*1495.12*1420.36*1633.41
*C*78811**1427.31*1355.94*1559.33
*C*78811*TC*1357.18*1289.32*1482.72
*C*78812**1583.72*1504.53*1730.21
*C*78812*TC*1495.12*1420.36*1633.41
*C*78813**1585.71*1506.42*1732.38
*C*78813*TC*1495.12*1420.36*1633.41
*C*78814**1595.44*1515.67*1743.02
*C*78814*TC*1495.12*1420.36*1633.41
*C*78815**1606.83*1526.49*1755.46
*C*78815*TC*1495.12*1420.36*1633.41
*C*78816**1607.70*1527.32*1756.42
*C*78816*TC*1495.12*1420.36*1633.41
**79300**237.04*225.19*258.97
**79300*TC*174.78*166.04*190.95
**79445**237.04*225.19*258.97
**79445*TC*128.89*122.45*140.82
**86485**17.28*16.42*18.88
**90867**300.53*285.50*328.33
#**90867**139.44*132.47*152.34
**90868**202.26*192.15*220.97
#**90868**104.51*99.28*114.17
**90869**277.35*263.48*303.00
#**90869**162.19*154.08*177.19
**90952**489.95*465.45*535.27
**90953**349.30*331.84*381.62
**92978**247.54*235.16*270.43
**92978*TC*151.73*144.14*165.76
**92979**150.60*143.07*164.53
**92979*TC*74.70*70.97*81.62
*C*93315**650.61*618.08*710.79
*C*93315*TC*527.25*500.89*576.02
**93317**216.69*205.86*236.74
**93317*TC*130.03*123.53*142.06
*C*93318**627.17*595.81*685.18
*C*93318*TC*527.25*500.89*576.02
**93571**246.56*234.23*269.36
**93571*TC*173.77*165.08*189.84
**93572**148.17*140.76*161.87
**93572*TC*95.04*90.29*103.83
**93600**3557.81*3379.92*3886.91
**93600*TC*3440.72*3268.68*3758.98
**93602**3557.81*3379.92*3886.91
**93602*TC*3442.96*3270.81*3761.43
**93603**3557.81*3379.92*3886.91
**93603*TC*3442.96*3270.81*3761.43
**93609**2134.69*2027.96*2332.15
**93609*TC*1859.96*1766.96*2032.00
**93610**3557.81*3379.92*3886.91
**93610*TC*3395.51*3225.73*3709.59
**93612**3557.81*3379.92*3886.91
**93612*TC*3398.21*3228.30*3712.55
**93615**49.73*47.24*54.33
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6727.56*6391.18*7349.86
**93620**7115.62*6759.84*7773.82
**93620*TC*6492.78*6168.14*7093.36
**93621**7115.62*6759.84*7773.82
**93621*TC*7032.73*6681.09*7683.25
**93622**7115.62*6759.84*7773.82
**93622*TC*6944.75*6597.51*7587.14
**93623**2134.69*2027.96*2332.15
**93623*TC*2066.78*1963.44*2257.96
**93624**3557.81*3379.92*3886.91
**93624*TC*3315.56*3149.78*3622.25
**93631**7115.62*6759.84*7773.82
**93631*TC*6715.05*6379.30*7336.20
**93640**1133.95*1077.25*1238.84
**93640*TC*956.18*908.37*1044.63
**93641**1133.95*1077.25*1238.84
**93641*TC*822.69*781.56*898.79
**93662**426.68*405.35*466.15
**93662*TC*358.30*340.39*391.45
**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**938.11*891.20*1024.88
**95965*TC*534.17*507.46*583.58
**95966**541.34*514.27*591.41
**95966*TC*345.30*328.04*377.25
**95967**455.64*432.86*497.79
**95967*TC*285.34*271.07*311.73
**96020**375.58*356.80*410.32
**96020*TC*220.75*209.71*241.17
**96547**737.64*700.76*805.87
#**96547**134.32*127.60*146.74
**96548**368.82*350.38*402.94
#**96548**67.16*63.80*73.37
**97151**49.63*47.15*54.22
#**97151**44.05*41.85*48.13
**97152**42.19*40.08*46.09
#**97152**37.44*35.57*40.91
**97153**33.55*31.87*36.65
#**97153**29.44*27.97*32.17
**97154**4.68*4.45*5.12
#**97154**4.26*4.05*4.66
**97155**33.55*31.87*36.65
#**97155**29.44*27.97*32.17
**97156**35.37*33.60*38.64
#**97156**31.10*29.55*33.98
**97157**10.39*9.87*11.35
#**97157**9.41*8.94*10.28
**97158**5.43*5.16*5.93
#**97158**4.93*4.68*5.38
**98978**46.77*44.43*51.09
# - 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.