TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
FORT WORTH
******
**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**449.09*426.64*490.64
#**G0186**385.70*366.42*421.38
**G0339**2771.30*2632.74*3027.65
**G0340**2084.19*1979.98*2276.98
**G0398**133.53*126.85*145.88
**G0398*TC*95.36*90.59*104.18
**G0398*26*38.17*36.26*41.70
**G0399**92.72*88.08*101.29
**G0399*TC*50.59*48.06*55.27
**G0399*26*42.46*40.34*46.39
**G0400**95.63*90.85*104.48
**G0400*TC*56.14*53.33*61.33
**G0400*26*39.48*37.51*43.14
**G0460**781.47*742.40*853.76
#**G0460**117.76*111.87*128.65
**G0465**781.47*742.40*853.76
#**G0465**117.76*111.87*128.65
**G0498**144.31*137.09*157.65
**G6017**76.58*72.75*83.66
**0042T**223.79*212.60*244.49
**0054T**223.82*212.63*244.52
**0055T**223.82*212.63*244.52
**0071T**561.74*533.65*613.70
**0072T**561.74*533.65*613.70
**0075T**943.31*896.14*1030.56
**0075T*TC*943.31*896.14*1030.56
**0075T*26*942.15*895.04*1029.30
**0076T**1041.16*989.10*1137.47
**0076T*TC*832.93*791.28*909.97
**0076T*26*208.22*197.81*227.48
**0095T**609.63*579.15*666.02
**0098T**682.21*648.10*745.32
**0100T**1862.18*1769.07*2034.43
**0101T**308.03*292.63*336.52
#**0101T**221.43*210.36*241.91
**0102T**308.03*292.63*336.52
#**0102T**221.43*210.36*241.91
**0106T**32.96*31.31*36.01
**0107T**32.96*31.31*36.01
**0108T**32.96*31.31*36.01
**0109T**32.96*31.31*36.01
**0110T**32.96*31.31*36.01
**0164T**666.57*633.24*728.23
**0165T**682.89*648.75*746.06
**0174T**9.64*9.16*10.53
**0184T**807.20*766.84*881.87
**0198T**83.53*79.35*91.25
#**0198T**31.24*29.68*34.13
**0200T**1742.84*1655.70*1904.06
#**0200T**394.52*374.79*431.01
**0201T**2614.26*2483.55*2856.08
#**0201T**591.77*562.18*646.51
**0207T**121.70*115.62*132.96
**0208T**37.22*35.36*40.66
**0209T**45.07*42.82*49.24
**0210T**28.40*26.98*31.03
**0211T**44.08*41.88*48.16
**0212T**35.81*34.02*39.12
#**0212T**30.91*29.36*33.76
**0213T**189.42*179.95*206.94
#**0213T**102.82*97.68*112.33
**0214T**95.54*90.76*104.37
#**0214T**57.63*54.75*62.96
**0215T**95.87*91.08*104.74
#**0215T**58.61*55.68*64.03
**0216T**174.35*165.63*190.47
#**0216T**88.41*83.99*96.59
**0217T**89.32*84.85*97.58
#**0217T**49.46*46.99*54.04
**0218T**89.32*84.85*97.58
#**0218T**50.44*47.92*55.11
**0219T**1285.51*1221.23*1404.41
**0220T**1263.72*1200.53*1380.61
**0221T**1550.54*1473.01*1693.96
**0222T**378.54*359.61*413.55
**0232T**781.47*742.40*853.76
#**0232T**117.76*111.87*128.65
**0234T**8385.97*7966.67*9161.67
#**0234T**565.95*537.65*618.30
**0235T**8385.97*7966.67*9161.67
#**0235T**565.95*537.65*618.30
**0236T**8532.78*8106.14*9322.06
#**0236T**655.58*622.80*716.22
**0237T**8532.78*8106.14*9322.06
#**0237T**655.58*622.80*716.22
**0238T**8532.78*8106.14*9322.06
#**0238T**655.58*622.80*716.22
**0253T**868.70*825.27*949.06
**0266T**873.09*829.44*953.86
**0267T**153.56*145.88*167.76
**0268T**325.23*308.97*355.32
**0269T**827.26*785.90*903.79
**0270T**153.56*145.88*167.76
**0271T**325.23*308.97*355.32
**0272T**55.02*52.27*60.11
**0273T**70.45*66.93*76.97
**0274T**1082.44*1028.32*1182.57
**0278T**14.13*13.42*15.43
**0308T**1366.89*1298.55*1493.33
**0329T**83.53*79.35*91.25
#**0329T**31.24*29.68*34.13
**0330T**38.21*36.30*41.75
**0331T**179.85*170.86*196.49
**0332T**307.13*291.77*335.54
**0347T**138.08*131.18*150.86
**0348T**32.37*30.75*35.36
**0349T**34.33*32.61*37.50
**0350T**34.98*33.23*38.21
**0351T**166.55*158.22*181.95
**0352T**42.07*39.97*45.97
**0353T**166.55*158.22*181.95
**0354T**42.07*39.97*45.97
**0358T**26.44*25.12*28.89
**0362T**89.45*84.98*97.73
#**0362T**64.29*61.08*70.24
**0378T**24.29*23.08*26.54
**0394T**245.25*232.99*267.94
**0395T**594.54*564.81*649.53
**0397T**45.98*43.68*50.23
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**495.91*471.11*541.78
**0409T**343.52*326.34*375.29
**0410T**357.21*339.35*390.25
**0411T**357.21*339.35*390.25
**0412T**225.21*213.95*246.04
**0413T**464.47*441.25*507.44
**0414T**358.11*340.20*391.23
**0415T**298.21*283.30*325.80
**0416T**331.21*314.65*361.85
**0417T**81.93*77.83*89.50
**0418T**55.02*52.27*60.11
**0419T**441.21*419.15*482.02
#**0419T**353.63*335.95*386.34
**0420T**626.40*595.08*684.34
#**0420T**518.23*492.32*566.17
**0421T**1575.93*1497.13*1721.70
#**0421T**677.59*643.71*740.27
**0437T**207.49*197.12*226.69
**0439T**70.43*66.91*76.95
**0440T**243.97*231.77*266.54
#**0440T**116.52*110.69*127.29
**0441T**243.97*231.77*266.54
#**0441T**116.52*110.69*127.29
**0442T**243.97*231.77*266.54
#**0442T**116.52*110.69*127.29
**0449T**746.07*708.77*815.09
**0464T**66.10*62.80*72.22
**0472T**65.87*62.58*71.97
**0473T**55.02*52.27*60.11
**0479T**61.77*58.68*67.48
**0480T**76.47*72.65*83.55
#**0480T**30.88*29.34*33.74
**0483T**1150.57*1093.04*1257.00
**0484T**1491.79*1417.20*1629.78
**0485T**23.12*21.96*25.25
**0485T*TC*8.63*8.20*9.43
**0485T*26*14.79*14.05*16.16
**0486T**46.24*43.93*50.52
**0486T*TC*16.96*16.11*18.53
**0486T*26*29.28*27.82*31.99
**0488T**61.64*58.56*67.34
#**0488T**48.90*46.46*53.43
**0505T**10790.31*10250.79*11788.41
#**0505T**537.75*510.86*587.49
**0507T**22.83*21.69*24.94
**0507T*TC*19.90*18.91*21.75
**0507T*26*2.93*2.78*3.20
**0510T**591.02*561.47*645.69
#**0510T**414.55*393.82*452.89
**0512T**308.03*292.63*336.52
#**0512T**221.43*210.36*241.91
**0513T**92.41*87.79*100.96
#**0513T**66.43*63.11*72.58
**0515T**495.91*471.11*541.78
**0516T**457.87*434.98*500.23
**0517T**325.23*308.97*355.32
**0518T**225.21*213.95*246.04
**0519T**326.20*309.89*356.37
**0520T**457.87*434.98*500.23
**0521T**55.02*52.27*60.11
**0521T*TC*35.26*33.50*38.53
**0521T*26*19.76*18.77*21.59
**0522T**65.87*62.58*71.97
**0522T*TC*35.92*34.12*39.24
**0522T*26*29.95*28.45*32.72
**0523T**148.81*141.37*162.58
**0524T**1609.31*1528.84*1758.17
#**0524T**171.12*162.56*186.94
**0525T**458.20*435.29*500.58
**0526T**357.21*339.35*390.25
**0527T**310.60*295.07*339.33
**0528T**65.87*62.58*71.97
**0528T*TC*35.92*34.12*39.24
**0528T*26*29.95*28.45*32.72
**0529T**55.02*52.27*60.11
**0529T*TC*35.26*33.50*38.53
**0529T*26*19.76*18.77*21.59
**0530T**610.49*579.97*666.97
**0531T**464.47*441.25*507.44
**0532T**326.20*309.89*356.37
**0540T**173.52*164.84*189.57
**0543T**1491.79*1417.20*1629.78
**0544T**1717.15*1631.29*1875.98
**0545T**1717.15*1631.29*1875.98
**0546T**70.52*66.99*77.04
**0552T**6.53*6.20*7.13
**0553T**2404.68*2284.45*2627.12
#**0553T**378.27*359.36*413.26
**0565T**601.20*571.14*656.81
#**0565T**503.49*478.32*550.07
**0566T**97.71*92.82*106.74
#**0566T**57.51*54.63*62.82
**0569T**1717.15*1631.29*1875.98
**0570T**402.25*382.14*439.46
**0571T**536.60*509.77*586.24
**0572T**436.66*414.83*477.05
**0573T**333.69*317.01*364.56
**0574T**386.57*367.24*422.33
**0575T**65.87*62.58*71.97
**0576T**55.02*52.27*60.11
**0577T**186.92*177.57*204.21
**0578T**28.56*27.13*31.20
**0579T**20.88*19.84*22.82
**0580T**207.26*196.90*226.44
**0581T**2221.06*2110.01*2426.51
#**0581T**203.48*193.31*222.31
**0582T**1624.03*1542.83*1774.25
#**0582T**375.38*356.61*410.10
**0583T**1496.16*1421.35*1634.55
#**0583T**130.32*123.80*142.37
**0587T**433.52*411.84*473.62
#**0587T**288.43*274.01*315.11
**0588T**357.36*339.49*390.41
#**0588T**225.01*213.76*245.82
**0589T**47.17*44.81*51.53
#**0589T**37.69*35.81*41.18
**0590T**55.64*52.86*60.79
#**0590T**38.98*37.03*42.58
**0596T**2235.23*2123.47*2441.99
#**0596T**128.19*121.78*140.05
**0597T**672.69*639.06*734.92
#**0597T**128.19*121.78*140.05
**0598T**148.41*140.99*162.14
**0599T**98.76*93.82*107.89
**0600T**3506.20*3330.89*3830.52
#**0600T**704.32*669.10*769.47
**0601T**1409.39*1338.92*1539.76
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**192.47*182.85*210.28
**0611T**39.81*37.82*43.49
**0614T**357.46*339.59*390.53
**0615T**46.27*43.96*50.55
**0616T**648.29*615.88*708.26
**0617T**724.41*688.19*791.42
**0618T**877.01*833.16*958.13
**0619T**639.86*607.87*699.05
#**0619T**465.66*442.38*508.74
**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**253.79*241.10*277.27
#**0627T**96.93*92.08*105.89
**0628T**76.14*72.33*83.18
#**0628T**29.08*27.63*31.77
**0629T**253.79*241.10*277.27
#**0629T**96.93*92.08*105.89
**0630T**76.14*72.33*83.18
#**0630T**29.08*27.63*31.77
**0631T**80.67*76.64*88.14
**0632T**552.60*524.97*603.72
**0633T**197.66*187.78*215.95
*C*0633T*TC*104.54*99.31*114.21
**0633T*26*57.53*54.65*62.85
**0634T**197.66*187.78*215.95
**0634T*TC*140.13*133.12*153.09
**0634T*26*57.53*54.65*62.85
**0635T**197.66*187.78*215.95
**0635T*TC*140.13*133.12*153.09
**0635T*26*57.53*54.65*62.85
**0636T**197.66*187.78*215.95
**0636T*TC*140.13*133.12*153.09
**0636T*26*57.53*54.65*62.85
**0637T**197.66*187.78*215.95
**0637T*TC*140.13*133.12*153.09
**0637T*26*57.53*54.65*62.85
**0638T**197.66*187.78*215.95
**0638T*TC*140.13*133.12*153.09
**0638T*26*57.53*54.65*62.85
**0639T**80.67*76.64*88.14
**0640T**22.83*21.69*24.94
**0640T*TC*19.90*18.91*21.75
**0640T*26*2.93*2.78*3.20
**0644T**1137.12*1080.26*1242.30
#**0644T**230.94*219.39*252.30
**0646T**1717.15*1631.29*1875.98
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**58.62*55.69*64.04
**0652T**282.09*267.99*308.19
#**0652T**118.70*112.77*129.69
**0653T**368.69*350.26*402.80
#**0653T**134.06*127.36*146.46
**0654T**137.60*130.72*150.33
**0655T**1575.93*1497.13*1721.70
#**0655T**677.59*643.71*740.27
**0658T**93.10*88.45*101.72
**0659T**2634.57*2502.84*2878.27
#**0659T**417.32*396.45*455.92
**0671T**1002.94*952.79*1095.71
**0673T**3362.56*3194.43*3673.59
#**0673T**353.18*335.52*385.85
**0699T**110.39*104.87*120.60
#**0699T**88.83*84.39*97.05
**0707T**364.46*346.24*398.18
#**0707T**273.94*260.24*299.28
**0714T**1378.62*1309.69*1506.14
#**0714T**350.55*333.02*382.97
**0730T**261.87*248.78*286.10
#**0730T**234.66*222.93*256.37
**0738T**69.25*65.79*75.66
**0739T**1575.93*1497.13*1721.70
#**0739T**677.59*643.71*740.27
**0740T**19.54*18.56*21.34
**0741T**46.37*44.05*50.66
**0742T**92.14*87.53*100.66
**0742T*TC*73.48*69.81*80.28
**0742T*26*18.66*17.73*20.39
**0743T**52.32*49.70*57.16
**0744T**854.43*811.71*933.47
**0745T**252.06*239.46*275.38
**0746T**220.21*209.20*240.58
**0747T**974.67*925.94*1064.83
**0748T**179.13*170.17*195.70
**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**426.74*405.40*466.21
**0756T**109.64*104.16*119.78
**0757T**79.78*75.79*87.16
**0758T**88.36*83.94*96.53
**0759T**132.15*125.54*144.37
**0760T**97.62*92.74*106.65
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**115.33*109.56*125.99
**0764T**4.22*4.01*4.61
**0765T**7.88*7.49*8.61
**0771T**25.67*24.39*28.05
**0772T**25.67*24.39*28.05
**0773T**22.92*21.77*25.04
**0774T**22.92*21.77*25.04
**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**428.87*407.43*468.54
**0779T*TC*403.55*383.37*440.88
**0779T*26*25.32*24.05*27.66
**0780T**22.92*21.77*25.04
**0783T**14.02*13.32*15.32
**0784T**2080.83*1976.79*2273.31
#**0784T**316.83*300.99*346.14
**0785T**237.86*225.97*259.87
#**0785T**141.45*134.38*154.54
**0786T**718.92*682.97*785.42
#**0786T**296.06*281.26*323.45
**0787T**237.86*225.97*259.87
#**0787T**141.45*134.38*154.54
**0788T**18.35*17.43*20.04
#**0788T**17.70*16.82*19.34
**0789T**25.38*24.11*27.73
#**0789T**22.13*21.02*24.17
**0790T**1876.84*1783.00*2050.45
**0791T**8.88*8.44*9.71
**0793T**552.60*524.97*603.72
**0794T**130.35*123.83*142.40
**0795T**686.81*652.47*750.34
**0796T**457.87*434.98*500.23
**0797T**457.87*434.98*500.23
**0798T**725.49*689.22*792.60
**0799T**483.66*459.48*528.40
**0800T**483.66*459.48*528.40
**0801T**941.53*894.45*1028.62
**0802T**470.77*447.23*514.31
**0803T**470.77*447.23*514.31
**0804T**77.03*73.18*84.16
**0804T*TC*41.47*39.40*45.31
**0804T*26*35.56*33.78*38.85
**0805T**2901.75*2756.66*3170.16
#**0805T**314.57*298.84*343.67
**0806T**3869.00*3675.55*4226.88
#**0806T**419.43*398.46*458.23
**0807T**41.83*39.74*45.70
**0807T*TC*27.42*26.05*29.96
**0807T*26*14.41*13.69*15.74
**0808T**41.83*39.74*45.70
**0808T*TC*27.42*26.05*29.96
**0808T*26*14.41*13.69*15.74
**0810T**1107.79*1052.40*1210.26
**0811T**19.54*18.56*21.34
**0813T**2548.09*2420.69*2783.79
#**0813T**174.97*166.22*191.15
**0814T**455.57*432.79*497.71
#**0814T**342.42*325.30*374.10
**0818T**357.36*339.49*390.41
#**0818T**225.01*213.76*245.82
**0820T**144.87*137.63*158.27
#**0820T**127.55*121.17*139.35
**0821T**144.87*137.63*158.27
#**0821T**127.55*121.17*139.35
**0822T**123.14*116.98*134.53
#**0822T**108.42*103.00*118.45
**0823T**686.81*652.47*750.34
**0824T**725.49*689.22*792.60
**0825T**941.53*894.45*1028.62
**0826T**65.87*62.58*71.97
**0826T*TC*35.92*34.12*39.24
**0826T*26*29.95*28.45*32.72
**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**22.83*21.69*24.94
**0859T*TC*19.90*18.91*21.75
**0859T*26*2.93*2.78*3.20
**0864T**308.03*292.63*336.52
#**0864T**221.43*210.36*241.91
**10011**418.23*397.32*456.92
#**10011**104.84*99.60*114.54
**10012**230.43*218.91*251.75
#**10012**69.65*66.17*76.10
**15847**343.99*326.79*375.81
**21742**1123.36*1067.19*1227.27
**21743**1288.72*1224.28*1407.92
**32855**343.94*326.74*375.75
**32856**437.20*415.34*477.64
**33928**3200.82*3040.78*3496.90
**33929**1199.04*1139.09*1309.95
**33933**526.57*500.24*575.28
**33944**526.57*500.24*575.28
**34841**2056.06*1953.26*2246.25
**34842**2281.84*2167.75*2492.91
**34843**2507.62*2382.24*2739.58
**34844**2733.39*2596.72*2986.23
**34845**2056.06*1953.26*2246.25
**34846**2281.84*2167.75*2492.91
**34847**2507.62*2382.24*2739.58
**34848**2733.39*2596.72*2986.23
**43496**2063.25*1960.09*2254.10
**43647**442.49*420.37*483.43
**43648**523.86*497.67*572.32
#**43648**236.68*224.85*258.58
**43881**660.57*627.54*721.67
#**43881**604.86*574.62*660.81
**43882**701.13*666.07*765.98
#**43882**641.15*609.09*700.45
**47143**411.70*391.12*449.79
**47144**488.91*464.46*534.13
**47145**463.17*440.01*506.01
**48551**263.06*249.91*287.40
**49906**1988.70*1889.27*2172.66
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**741.04*703.99*809.59
**53452**370.52*351.99*404.79
**53453**629.84*598.35*688.10
**53454**55.66*52.88*60.81
#**53454**34.42*32.70*37.61
**54440**729.23*692.77*796.69
**63043**558.80*530.86*610.49
**63044**503.26*478.10*549.82
**64596**2080.83*1976.79*2273.31
#**64596**316.83*300.99*346.14
**64597**624.25*593.04*682.00
#**64597**95.05*90.30*103.85
**64598**237.86*225.97*259.87
#**64598**141.45*134.38*154.54
**65757**117.02*111.17*127.85
**66983**648.29*615.88*708.26
**66987**748.81*711.37*818.08
**66988**622.88*591.74*680.50
*C*70170**247.08*234.73*269.94
*C*70170*TC*232.97*221.32*254.52
**70555**233.47*221.80*255.07
**70555*TC*118.39*112.47*129.34
*C*70557**672.34*638.72*734.53
*C*70557*TC*524.46*498.24*572.98
*C*70558**337.81*320.92*369.06
*C*70558*TC*174.80*166.06*190.97
*C*70559**327.63*311.25*357.94
*C*70559*TC*174.80*166.06*190.97
*C*74190**545.81*518.52*596.30
*C*74190*TC*524.46*498.24*572.98
**74235**143.74*136.55*157.03
**74235*TC*88.85*84.41*97.07
**74300**83.39*79.22*91.10
**74300*TC*70.59*67.06*77.12
**74301**25.64*24.36*28.01
**74301*TC*16.11*15.30*17.60
**74328**175.06*166.31*191.26
**74328*TC*152.70*145.07*166.83
**74329**139.58*132.60*152.49
**74329*TC*116.89*111.05*127.71
**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*51.42*48.85*56.18
**74360**86.58*82.25*94.59
**74360*TC*60.36*57.34*65.94
**74363**175.06*166.31*191.26
**74363*TC*134.97*128.22*147.45
*C*74445**156.53*148.70*171.01
*C*74445*TC*104.54*99.31*114.21
*C*74450**248.11*235.70*271.06
*C*74450*TC*232.97*221.32*254.52
*C*74470**548.45*521.03*599.18
*C*74470*TC*524.46*498.24*572.98
**74742**233.47*221.80*255.07
**74742*TC*205.20*194.94*224.18
*C*74775**261.57*248.49*285.76
*C*74775*TC*232.97*221.32*254.52
*C*75801**638.45*606.53*697.51
*C*75801*TC*597.34*567.47*652.59
*C*75803**1577.03*1498.18*1722.91
*C*75803*TC*1522.80*1446.66*1663.66
*C*75805**3068.39*2914.97*3352.22
*C*75805*TC*3030.92*2879.37*3311.28
*C*75807**3081.82*2927.73*3366.89
*C*75807*TC*3030.92*2879.37*3311.28
*C*75810**3077.49*2923.62*3362.16
*C*75810*TC*3030.92*2879.37*3311.28
**75894**888.20*843.79*970.36
**75894*TC*819.54*778.56*895.34
*C*75898**3118.40*2962.48*3406.85
*C*75898*TC*3030.92*2879.37*3311.28
**75970**433.68*412.00*473.80
**75970*TC*397.24*377.38*433.99
**76125**39.16*37.20*42.78
**76125*TC*26.36*25.04*28.80
**76390**202.90*192.76*221.67
**76390*TC*151.90*144.31*165.96
**76390*26*51.00*48.45*55.72
**76932**83.61*79.43*91.34
**76932*TC*48.97*46.52*53.50
**76940**154.97*147.22*169.30
**76940*TC*58.24*55.33*63.63
**76941**114.24*108.53*124.81
**76941*TC*52.00*49.40*56.81
**76945**82.66*78.53*90.31
**76945*TC*51.69*49.11*56.48
*C*76975**272.43*258.81*297.63
*C*76975*TC*232.97*221.32*254.52
**76998**175.06*166.31*191.26
**76998*TC*130.08*123.58*142.12
**77013**417.47*396.60*456.09
**77013*TC*241.07*229.02*263.37
**77022**467.22*443.86*510.44
**77022*TC*274.61*260.88*300.01
**77371**602.93*572.78*658.70
**77520**874.92*831.17*955.85
**77522**874.92*831.17*955.85
**77523**1004.63*954.40*1097.56
**77525**1134.33*1077.61*1239.25
*C*78282**406.95*386.60*444.59
*C*78282*TC*392.11*372.50*428.38
**78414**514.99*489.24*562.63
**78414*TC*494.57*469.84*540.32
*C*78429**1563.88*1485.69*1708.54
*C*78429*TC*1487.50*1413.13*1625.10
*C*78430**1560.28*1482.27*1704.61
*C*78430*TC*1487.50*1413.13*1625.10
*C*78431**2330.91*2214.36*2546.51
*C*78431*TC*2245.98*2133.68*2453.73
*C*78432**1937.50*1840.63*2116.72
*C*78432*TC*1846.64*1754.31*2017.46
*C*78433**2046.04*1943.74*2235.30
*C*78433*TC*1946.64*1849.31*2126.71
**78434**699.27*664.31*763.96
**78434*TC*671.29*637.73*733.39
*C*78459**1421.01*1349.96*1552.45
*C*78459*TC*1350.25*1282.74*1475.15
*C*78491**1556.96*1479.11*1700.98
*C*78491*TC*1487.50*1413.13*1625.10
*C*78492**1569.12*1490.66*1714.26
*C*78492*TC*1487.50*1413.13*1625.10
*C*78608**1554.29*1476.58*1698.07
*C*78608*TC*1487.50*1413.13*1625.10
*C*78811**1418.99*1348.04*1550.25
*C*78811*TC*1350.25*1282.74*1475.15
*C*78812**1574.31*1495.59*1719.93
*C*78812*TC*1487.50*1413.13*1625.10
*C*78813**1576.30*1497.49*1722.11
*C*78813*TC*1487.50*1413.13*1625.10
*C*78814**1585.84*1506.55*1732.53
*C*78814*TC*1487.50*1413.13*1625.10
*C*78815**1597.02*1517.17*1744.75
*C*78815*TC*1487.50*1413.13*1625.10
*C*78816**1598.05*1518.15*1745.87
*C*78816*TC*1487.50*1413.13*1625.10
**79300**237.04*225.19*258.97
**79300*TC*175.31*166.54*191.52
**79445**237.04*225.19*258.97
**79445*TC*131.56*124.98*143.73
**86485**17.28*16.42*18.88
**90867**293.61*278.93*320.77
#**90867**133.32*126.65*145.65
**90868**197.13*187.27*215.36
#**90868**103.28*98.12*112.84
**90869**271.93*258.33*297.08
#**90869**157.27*149.41*171.82
**90952**482.10*458.00*526.70
**90953**343.43*326.26*375.20
**92978**241.11*229.05*263.41
**92978*TC*151.22*143.66*165.21
**92979**146.51*139.18*160.06
**92979*TC*75.15*71.39*82.10
*C*93315**645.91*613.61*705.65
*C*93315*TC*524.46*498.24*572.98
**93317**210.41*199.89*229.87
**93317*TC*126.02*119.72*137.68
*C*93318**622.06*590.96*679.60
*C*93318*TC*524.46*498.24*572.98
**93571**240.13*228.12*262.34
**93571*TC*171.70*163.12*187.59
**93572**144.25*137.04*157.60
**93572*TC*94.42*89.70*103.16
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.71*3275.32*3766.62
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.61*3277.13*3768.70
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.61*3277.13*3768.70
**93609**2134.69*2027.96*2332.15
**93609*TC*1876.38*1782.56*2049.94
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.96*3234.71*3719.92
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.15*3236.79*3722.31
**93615**49.27*46.81*53.83
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6750.79*6413.25*7375.24
**93620**7115.62*6759.84*7773.82
**93620*TC*6530.32*6203.80*7134.37
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.79*6685.90*7688.79
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.05*6607.30*7598.40
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.17*1966.66*2261.66
**93624**3557.81*3379.92*3886.91
**93624*TC*3330.87*3164.33*3638.98
**93631**7115.62*6759.84*7773.82
**93631*TC*6741.75*6404.66*7365.36
**93640**1133.95*1077.25*1238.84
**93640*TC*966.84*918.50*1056.28
**93641**1133.95*1077.25*1238.84
**93641*TC*841.87*799.78*919.75
**93662**412.79*392.15*450.97
**93662*TC*345.31*328.04*377.25
**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**925.58*879.30*1011.20
**95965*TC*528.85*502.41*577.77
**95966**536.37*509.55*585.98
**95966*TC*345.30*328.04*377.25
**95967**451.10*428.55*492.83
**95967*TC*285.34*271.07*311.73
**96020**376.62*357.79*411.46
**96020*TC*224.62*213.39*245.40
**96547**731.81*695.22*799.50
#**96547**131.50*124.93*143.67
**96548**365.91*347.61*399.75
#**96548**65.75*62.46*71.83
**97151**48.89*46.45*53.42
#**97151**43.33*41.16*47.33
**97152**41.55*39.47*45.39
#**97152**36.83*34.99*40.24
**97153**33.10*31.45*36.17
#**97153**29.02*27.57*31.71
**97154**4.50*4.28*4.92
#**97154**4.09*3.89*4.47
**97155**33.10*31.45*36.17
#**97155**29.02*27.57*31.71
**97156**34.92*33.17*38.15
#**97156**30.67*29.14*33.51
**97157**10.19*9.68*11.13
#**97157**9.21*8.75*10.06
**97158**5.24*4.98*5.73
#**97158**4.75*4.51*5.19
**98978**46.37*44.05*50.66
# - 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.