TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
AUSTIN
******
**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**462.04*438.94*504.78
#**G0186**395.60*375.82*432.19
**G0339**2855.95*2713.15*3120.12
**G0340**2147.81*2040.42*2346.48
**G0398**138.25*131.34*151.04
**G0398*TC*99.92*94.92*109.16
**G0398*26*38.32*36.40*41.86
**G0399**95.31*90.54*104.12
**G0399*TC*53.00*50.35*57.90
**G0399*26*42.65*40.52*46.60
**G0400**98.51*93.58*107.62
**G0400*TC*58.82*55.88*64.26
**G0400*26*39.69*37.71*43.37
**G0460**814.28*773.57*889.61
#**G0460**118.66*112.73*129.64
**G0465**814.28*773.57*889.61
#**G0465**118.66*112.73*129.64
**G0498**150.77*143.23*164.71
**G6017**78.65*74.72*85.93
**0042T**230.74*219.20*252.08
**0054T**225.87*214.58*246.77
**0055T**225.87*214.58*246.77
**0071T**569.80*541.31*622.51
**0072T**569.80*541.31*622.51
**0075T**948.10*900.70*1035.81
**0075T*TC*948.10*900.70*1035.81
**0075T*26*948.10*900.70*1035.81
**0076T**1037.29*985.43*1133.24
**0076T*TC*829.81*788.32*906.57
**0076T*26*207.46*197.09*226.65
**0095T**617.96*587.06*675.12
**0098T**691.20*656.64*755.14
**0100T**1895.99*1801.19*2071.37
**0101T**315.80*300.01*345.01
#**0101T**225.04*213.79*245.86
**0102T**315.80*300.01*345.01
#**0102T**225.04*213.79*245.86
**0106T**34.43*32.71*37.62
**0107T**34.43*32.71*37.62
**0108T**34.43*32.71*37.62
**0109T**34.43*32.71*37.62
**0110T**34.43*32.71*37.62
**0164T**675.95*642.15*738.47
**0165T**692.43*657.81*756.48
**0174T**9.70*9.22*10.60
**0184T**820.13*779.12*895.99
**0198T**86.33*82.01*94.31
#**0198T**31.53*29.95*34.44
**0200T**1811.25*1720.69*1978.79
#**0200T**398.08*378.18*434.91
**0201T**2716.88*2581.04*2968.20
#**0201T**597.12*567.26*652.35
**0207T**121.70*115.62*132.96
**0208T**39.00*37.05*42.61
**0209T**47.22*44.86*51.59
**0210T**29.75*28.26*32.50
**0211T**46.19*43.88*50.46
**0212T**36.34*34.52*39.70
#**0212T**31.21*29.65*34.10
**0213T**194.79*185.05*212.81
#**0213T**104.03*98.83*113.65
**0214T**97.75*92.86*106.79
#**0214T**58.01*55.11*63.38
**0215T**98.09*93.19*107.17
#**0215T**59.04*56.09*64.50
**0216T**179.62*170.64*196.24
#**0216T**89.54*85.06*97.82
**0217T**91.57*86.99*100.04
#**0217T**49.78*47.29*54.38
**0218T**91.57*86.99*100.04
#**0218T**50.81*48.27*55.51
**0219T**1307.08*1241.73*1427.99
**0220T**1284.84*1220.60*1403.69
**0221T**1572.25*1493.64*1717.69
**0222T**382.05*362.95*417.39
**0232T**814.28*773.57*889.61
#**0232T**118.66*112.73*129.64
**0234T**8763.75*8325.56*9574.39
#**0234T**567.62*539.24*620.13
**0235T**8763.75*8325.56*9574.39
#**0235T**567.62*539.24*620.13
**0236T**8913.37*8467.70*9737.86
#**0236T**657.30*624.44*718.11
**0237T**8913.37*8467.70*9737.86
#**0237T**657.30*624.44*718.11
**0238T**8913.37*8467.70*9737.86
#**0238T**657.30*624.44*718.11
**0253T**890.78*846.24*973.18
**0266T**882.46*838.34*964.09
**0267T**154.35*146.63*168.62
**0268T**329.32*312.85*359.78
**0269T**836.98*795.13*914.40
**0270T**154.35*146.63*168.62
**0271T**329.32*312.85*359.78
**0272T**56.81*53.97*62.07
**0273T**72.34*68.72*79.03
**0274T**1100.37*1045.35*1202.15
**0278T**14.31*13.59*15.63
**0308T**1392.50*1322.88*1521.31
**0329T**86.33*82.01*94.31
#**0329T**31.53*29.95*34.44
**0330T**38.21*36.30*41.75
**0331T**186.87*177.53*204.16
**0332T**319.10*303.15*348.62
**0347T**139.34*132.37*152.23
**0348T**33.52*31.84*36.62
**0349T**35.61*33.83*38.90
**0350T**36.29*34.48*39.65
**0351T**172.96*164.31*188.96
**0352T**42.51*40.38*46.44
**0353T**172.96*164.31*188.96
**0354T**42.51*40.38*46.44
**0358T**27.70*26.32*30.27
**0362T**91.11*86.55*99.53
#**0362T**64.74*61.50*70.73
**0378T**24.49*23.27*26.76
**0394T**254.91*242.16*278.48
**0395T**615.44*584.67*672.37
**0397T**46.36*44.04*50.65
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**501.14*476.08*547.49
**0409T**347.92*330.52*380.10
**0410T**362.12*344.01*395.61
**0411T**362.12*344.01*395.61
**0412T**229.17*217.71*250.37
**0413T**470.08*446.58*513.57
**0414T**362.67*344.54*396.22
**0415T**301.78*286.69*329.69
**0416T**336.52*319.69*367.64
**0417T**84.17*79.96*91.95
**0418T**56.81*53.97*62.07
**0419T**452.53*429.90*494.39
#**0419T**360.74*342.70*394.11
**0420T**640.85*608.81*700.13
#**0420T**527.48*501.11*576.28
**0421T**1626.47*1545.15*1776.92
#**0421T**684.93*650.68*748.28
**0437T**209.61*199.13*229.00
**0439T**72.69*69.06*79.42
**0440T**251.62*239.04*274.90
#**0440T**118.04*112.14*128.96
**0441T**251.62*239.04*274.90
#**0441T**118.04*112.14*128.96
**0442T**251.62*239.04*274.90
#**0442T**118.04*112.14*128.96
**0449T**762.10*724.00*832.60
**0464T**68.57*65.14*74.91
**0472T**67.73*64.34*73.99
**0473T**56.81*53.97*62.07
**0479T**62.44*59.32*68.22
**0480T**79.00*75.05*86.31
#**0480T**31.22*29.66*34.11
**0483T**1156.66*1098.83*1263.65
**0484T**1499.27*1424.31*1637.96
**0485T**23.70*22.52*25.90
**0485T*TC*9.03*8.58*9.87
**0485T*26*14.96*14.21*16.34
**0486T**47.39*45.02*51.77
**0486T*TC*17.77*16.88*19.41
**0486T*26*29.63*28.15*32.37
**0488T**62.58*59.45*68.37
#**0488T**49.22*46.76*53.77
**0505T**11155.28*10597.52*12187.15
#**0505T**538.78*511.84*588.62
**0507T**23.81*22.62*26.01
**0507T*TC*20.85*19.81*22.78
**0507T*26*2.96*2.81*3.23
**0510T**606.72*576.38*662.84
#**0510T**421.76*400.67*460.77
**0512T**315.80*300.01*345.01
#**0512T**225.04*213.79*245.86
**0513T**94.74*90.00*103.50
#**0513T**67.51*64.13*73.75
**0515T**501.14*476.08*547.49
**0516T**462.85*439.71*505.67
**0517T**329.32*312.85*359.78
**0518T**229.17*217.71*250.37
**0519T**330.39*313.87*360.95
**0520T**462.85*439.71*505.67
**0521T**56.81*53.97*62.07
**0521T*TC*36.95*35.10*40.37
**0521T*26*19.86*18.87*21.70
**0522T**67.73*64.34*73.99
**0522T*TC*37.63*35.75*41.11
**0522T*26*30.10*28.60*32.89
**0523T**152.89*145.25*167.04
**0524T**1679.14*1595.18*1834.46
#**0524T**171.77*163.18*187.66
**0525T**463.19*440.03*506.03
**0526T**362.12*344.01*395.61
**0527T**314.57*298.84*343.67
**0528T**67.73*64.34*73.99
**0528T*TC*37.63*35.75*41.11
**0528T*26*30.10*28.60*32.89
**0529T**56.81*53.97*62.07
**0529T*TC*36.95*35.10*40.37
**0529T*26*19.86*18.87*21.70
**0530T**618.20*587.29*675.38
**0531T**470.08*446.58*513.57
**0532T**330.39*313.87*360.95
**0540T**175.80*167.01*192.06
**0543T**1499.27*1424.31*1637.96
**0544T**1729.15*1642.69*1889.09
**0545T**1729.15*1642.69*1889.09
**0546T**72.42*68.80*79.12
**0552T**6.72*6.38*7.34
**0553T**2503.12*2377.96*2734.65
#**0553T**379.26*360.30*414.35
**0565T**615.70*584.92*672.66
#**0565T**513.29*487.63*560.77
**0566T**100.10*95.10*109.37
#**0566T**57.98*55.08*63.34
**0569T**1729.15*1642.69*1889.09
**0570T**404.25*384.04*441.65
**0571T**542.52*515.39*592.70
**0572T**441.25*419.19*482.07
**0573T**337.89*321.00*369.15
**0574T**390.92*371.37*427.08
**0575T**67.73*64.34*73.99
**0576T**56.81*53.97*62.07
**0577T**189.87*180.38*207.44
**0578T**28.72*27.28*31.37
**0579T**21.88*20.79*23.91
**0580T**210.57*200.04*230.05
**0581T**2319.71*2203.72*2534.28
#**0581T**205.09*194.84*224.07
**0582T**1689.82*1605.33*1846.13
#**0582T**381.11*362.05*416.36
**0583T**1496.16*1421.35*1634.55
#**0583T**133.35*126.68*145.68
**0587T**443.67*421.49*484.71
#**0587T**291.59*277.01*318.56
**0588T**366.57*348.24*400.48
#**0588T**227.86*216.47*248.94
**0589T**47.84*45.45*52.27
#**0589T**37.91*36.01*41.41
**0590T**56.67*53.84*61.92
#**0590T**39.21*37.25*42.84
**0596T**2235.23*2123.47*2441.99
#**0596T**128.16*121.75*140.01
**0597T**672.69*639.06*734.92
#**0597T**128.16*121.75*140.01
**0598T**155.02*147.27*169.36
**0599T**103.02*97.87*112.55
**0600T**3643.98*3461.78*3981.05
#**0600T**707.35*671.98*772.78
**0601T**1423.12*1351.96*1554.75
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**198.73*188.79*217.11
**0611T**41.70*39.62*45.56
**0614T**361.96*343.86*395.44
**0615T**47.15*44.79*51.51
**0616T**660.12*627.11*721.18
**0617T**738.42*701.50*806.73
**0618T**894.27*849.56*976.99
**0619T**654.89*622.15*715.47
#**0619T**472.39*448.77*516.09
**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**262.29*249.18*286.56
#**0627T**97.89*93.00*106.95
**0628T**78.69*74.76*85.97
#**0628T**29.37*27.90*32.09
**0629T**262.29*249.18*286.56
#**0629T**97.89*93.00*106.95
**0630T**78.69*74.76*85.97
#**0630T**29.37*27.90*32.09
**0631T**84.01*79.81*91.78
**0632T**556.81*528.97*608.32
**0633T**204.64*194.41*223.57
*C*0633T*TC*109.56*104.08*119.69
**0633T*26*57.80*54.91*63.15
**0634T**204.64*194.41*223.57
**0634T*TC*146.85*139.51*160.44
**0634T*26*57.80*54.91*63.15
**0635T**204.64*194.41*223.57
**0635T*TC*146.85*139.51*160.44
**0635T*26*57.80*54.91*63.15
**0636T**204.64*194.41*223.57
**0636T*TC*146.85*139.51*160.44
**0636T*26*57.80*54.91*63.15
**0637T**204.64*194.41*223.57
**0637T*TC*146.85*139.51*160.44
**0637T*26*57.80*54.91*63.15
**0638T**204.64*194.41*223.57
**0638T*TC*146.85*139.51*160.44
**0638T*26*57.80*54.91*63.15
**0639T**84.01*79.81*91.78
**0640T**23.81*22.62*26.01
**0640T*TC*20.85*19.81*22.78
**0640T*26*2.96*2.81*3.23
**0644T**1181.17*1122.11*1290.43
#**0644T**231.40*219.83*252.80
**0646T**1729.15*1642.69*1889.09
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**60.40*57.38*65.99
**0652T**291.31*276.74*318.25
#**0652T**120.06*114.06*131.17
**0653T**381.45*362.38*416.74
#**0653T**135.53*128.75*148.06
**0654T**139.02*132.07*151.88
**0655T**1626.47*1545.15*1776.92
#**0655T**684.93*650.68*748.28
**0658T**97.57*92.69*106.59
**0659T**2742.23*2605.12*2995.89
#**0659T**418.34*397.42*457.03
**0671T**1024.33*973.11*1119.08
**0673T**3509.47*3334.00*3834.10
#**0673T**355.35*337.58*388.22
**0699T**112.78*107.14*123.21
#**0699T**90.17*85.66*98.51
**0707T**376.01*357.21*410.79
#**0707T**281.14*267.08*307.14
**0714T**1433.67*1361.99*1566.29
#**0714T**356.15*338.34*389.09
**0730T**269.12*255.66*294.01
#**0730T**240.17*228.16*262.38
**0738T**69.96*66.46*76.43
**0739T**1626.47*1545.15*1776.92
#**0739T**684.93*650.68*748.28
**0740T**20.46*19.44*22.36
**0741T**48.59*46.16*53.08
**0742T**95.73*90.94*104.58
**0742T*TC*77.00*73.15*84.12
**0742T*26*18.73*17.79*20.46
**0743T**54.22*51.51*59.24
**0744T**858.32*815.40*937.71
**0745T**264.11*250.90*288.54
**0746T**222.24*211.13*242.80
**0747T**1021.29*970.23*1115.76
**0748T**181.61*172.53*198.41
**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**441.72*419.63*482.57
**0756T**113.84*108.15*124.37
**0757T**83.12*78.96*90.80
**0758T**91.71*87.12*100.19
**0759T**137.44*130.57*150.16
**0760T**100.93*95.88*110.26
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**119.19*113.23*130.21
**0764T**4.32*4.10*4.72
**0765T**7.92*7.52*8.65
**0771T**25.81*24.52*28.20
**0772T**25.81*24.52*28.20
**0773T**23.66*22.48*25.85
**0774T**23.66*22.48*25.85
**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**448.45*426.03*489.93
**0779T*TC*422.95*401.80*462.07
**0779T*26*25.50*24.23*27.86
**0780T**23.66*22.48*25.85
**0783T**14.68*13.95*16.04
**0784T**2169.03*2060.58*2369.67
#**0784T**320.19*304.18*349.81
**0785T**244.87*232.63*267.52
#**0785T**143.83*136.64*157.14
**0786T**742.12*705.01*810.76
#**0786T**298.92*283.97*326.57
**0787T**244.87*232.63*267.52
#**0787T**143.83*136.64*157.14
**0788T**18.52*17.59*20.23
#**0788T**17.84*16.95*19.49
**0789T**25.62*24.34*27.99
#**0789T**22.30*21.19*24.37
**0790T**1893.02*1798.37*2068.13
**0791T**9.04*8.59*9.88
**0793T**556.81*528.97*608.32
**0794T**130.35*123.83*142.40
**0795T**694.27*659.56*758.49
**0796T**462.85*439.71*505.67
**0797T**462.85*439.71*505.67
**0798T**732.16*695.55*799.88
**0799T**488.11*463.70*533.26
**0800T**488.11*463.70*533.26
**0801T**950.95*903.40*1038.91
**0802T**475.48*451.71*519.47
**0803T**475.48*451.71*519.47
**0804T**79.20*75.24*86.53
**0804T*TC*43.45*41.28*47.47
**0804T*26*35.74*33.95*39.04
**0805T**3027.28*2875.92*3307.31
#**0805T**315.67*299.89*344.87
**0806T**4036.37*3834.55*4409.73
#**0806T**420.89*399.85*459.83
**0807T**43.22*41.06*47.22
**0807T*TC*28.73*27.29*31.38
**0807T*26*14.49*13.77*15.84
**0808T**43.22*41.06*47.22
**0808T*TC*28.73*27.29*31.38
**0808T*26*14.49*13.77*15.84
**0810T**1127.88*1071.49*1232.21
**0811T**20.46*19.44*22.36
**0813T**2663.87*2530.68*2910.28
#**0813T**176.60*167.77*192.94
**0814T**470.02*446.52*513.50
#**0814T**351.42*333.85*383.93
**0818T**366.57*348.24*400.48
#**0818T**227.86*216.47*248.94
**0820T**145.33*138.06*158.77
#**0820T**127.18*120.82*138.94
**0821T**145.33*138.06*158.77
#**0821T**127.18*120.82*138.94
**0822T**123.53*117.35*134.95
#**0822T**108.10*102.70*118.11
**0823T**694.27*659.56*758.49
**0824T**732.16*695.55*799.88
**0825T**950.95*903.40*1038.91
**0826T**67.73*64.34*73.99
**0826T*TC*37.63*35.75*41.11
**0826T*26*30.10*28.60*32.89
**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**23.81*22.62*26.01
**0859T*TC*20.85*19.81*22.78
**0859T*26*2.96*2.81*3.23
**0864T**315.80*300.01*345.01
#**0864T**225.04*213.79*245.86
**10011**433.71*412.02*473.82
#**10011**105.25*99.99*114.99
**10012**238.07*226.17*260.10
#**10012**69.56*66.08*75.99
**15847**349.47*332.00*381.80
**21742**1133.47*1076.80*1238.32
**21743**1299.84*1234.85*1420.08
**32855**339.53*322.55*370.93
**32856**439.60*417.62*480.26
**33928**3211.49*3050.92*3508.56
**33929**1203.03*1142.88*1314.31
**33933**519.19*493.23*567.21
**33944**519.19*493.23*567.21
**34841**2043.07*1940.92*2232.06
**34842**2268.85*2155.41*2478.72
**34843**2494.63*2369.90*2725.39
**34844**2720.42*2584.40*2972.06
**34845**2043.07*1940.92*2232.06
**34846**2268.85*2155.41*2478.72
**34847**2494.63*2369.90*2725.39
**34848**2720.42*2584.40*2972.06
**43496**2060.38*1957.36*2250.96
**43647**442.49*420.37*483.43
**43648**525.10*498.85*573.68
#**43648**236.08*224.28*257.92
**43881**660.92*627.87*722.05
#**43881**603.52*573.34*659.34
**43882**704.09*668.89*769.22
#**43882**642.30*610.19*701.72
**47143**410.01*389.51*447.94
**47144**486.91*462.56*531.94
**47145**461.29*438.23*503.96
**48551**262.01*248.91*286.25
**49906**1995.51*1895.73*2180.09
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**749.66*712.18*819.01
**53452**374.83*356.09*409.50
**53453**637.23*605.37*696.18
**53454**56.91*54.06*62.17
#**53454**34.65*32.92*37.86
**54440**721.44*685.37*788.18
**63043**567.76*539.37*620.28
**63044**499.10*474.15*545.27
**64596**2169.03*2060.58*2369.67
#**64596**320.19*304.18*349.81
**64597**650.71*618.17*710.90
#**64597**96.06*91.26*104.95
**64598**244.87*232.63*267.52
#**64598**143.83*136.64*157.14
**65757**119.12*113.16*130.13
**66983**660.12*627.11*721.18
**66987**758.20*720.29*828.33
**66988**632.35*600.73*690.84
*C*70170**258.35*245.43*282.24
*C*70170*TC*244.16*231.95*266.74
**70555**233.47*221.80*255.07
**70555*TC*117.94*112.04*128.85
*C*70557**698.87*663.93*763.52
*C*70557*TC*549.68*522.20*600.53
*C*70558**347.65*330.27*379.81
*C*70558*TC*183.20*174.04*200.15
*C*70559**336.86*320.02*368.02
*C*70559*TC*183.20*174.04*200.15
*C*74190**571.09*542.54*623.92
*C*74190*TC*549.68*522.20*600.53
**74235**148.05*140.65*161.75
**74235*TC*92.90*88.26*101.50
**74300**86.73*82.39*94.75
**74300*TC*73.87*70.18*80.71
**74301**26.65*25.32*29.12
**74301*TC*17.08*16.23*18.66
**74328**175.06*166.31*191.26
**74328*TC*152.56*144.93*166.67
**74329**144.67*137.44*158.06
**74329*TC*121.83*115.74*133.10
**74330**262.59*249.46*286.88
**74330*TC*236.16*224.35*258.00
**74340**86.58*82.25*94.59
**74340*TC*61.84*58.75*67.56
**74355**86.58*82.25*94.59
**74355*TC*51.25*48.69*55.99
**74360**86.58*82.25*94.59
**74360*TC*60.21*57.20*65.78
**74363**175.06*166.31*191.26
**74363*TC*134.82*128.08*147.29
*C*74445**161.78*153.69*176.74
*C*74445*TC*109.56*104.08*119.69
*C*74450**259.38*246.41*283.37
*C*74450*TC*244.16*231.95*266.74
*C*74470**573.74*545.05*626.81
*C*74470*TC*549.68*522.20*600.53
**74742**233.47*221.80*255.07
**74742*TC*205.06*194.81*224.03
*C*74775**272.90*259.26*298.15
*C*74775*TC*244.16*231.95*266.74
*C*75801**667.43*634.06*729.17
*C*75801*TC*626.05*594.75*683.96
*C*75803**1650.52*1567.99*1803.19
*C*75803*TC*1596.03*1516.23*1743.66
*C*75805**3214.34*3053.62*3511.66
*C*75805*TC*3176.68*3017.85*3470.53
*C*75807**3227.66*3066.28*3526.22
*C*75807*TC*3176.68*3017.85*3470.53
*C*75810**3223.17*3062.01*3521.31
*C*75810*TC*3176.68*3017.85*3470.53
**75894**926.89*880.55*1012.63
**75894*TC*857.76*814.87*937.10
*C*75898**3264.78*3101.54*3566.77
*C*75898*TC*3176.68*3017.85*3470.53
**75970**452.20*429.59*494.03
**75970*TC*415.69*394.91*454.15
**76125**40.43*38.41*44.17
**76125*TC*27.57*26.19*30.12
**76390**210.35*199.83*229.80
**76390*TC*159.18*151.22*173.90
**76390*26*51.17*48.61*55.90
**76932**86.15*81.84*94.12
**76932*TC*51.24*48.68*55.98
**76940**157.77*149.88*172.36
**76940*TC*60.57*57.54*66.17
**76941**116.87*111.03*127.68
**76941*TC*54.28*51.57*59.31
**76945**85.17*80.91*93.05
**76945*TC*54.03*51.33*59.03
*C*76975**283.91*269.71*310.17
*C*76975*TC*244.16*231.95*266.74
**76998**175.06*166.31*191.26
**76998*TC*129.86*123.37*141.88
**77013**434.43*412.71*474.62
**77013*TC*257.60*244.72*281.43
**77022**483.55*459.37*528.28
**77022*TC*290.18*275.67*317.02
**77371**621.24*590.18*678.71
**77520**901.54*856.46*984.93
**77522**901.54*856.46*984.93
**77523**1035.23*983.47*1130.99
**77525**1168.92*1110.47*1277.04
*C*78282**425.76*404.47*465.14
*C*78282*TC*410.96*390.41*448.97
**78414**514.99*489.24*562.63
**78414*TC*494.48*469.76*540.22
*C*78429**1635.59*1553.81*1786.88
*C*78429*TC*1559.04*1481.09*1703.25
*C*78430**1632.00*1550.40*1782.96
*C*78430*TC*1559.04*1481.09*1703.25
*C*78431**2439.23*2317.27*2664.86
*C*78431*TC*2353.99*2236.29*2571.73
*C*78432**2026.56*1925.23*2214.01
*C*78432*TC*1935.45*1838.68*2114.48
*C*78433**2139.94*2032.94*2337.88
*C*78433*TC*2040.26*1938.25*2228.99
**78434**731.76*695.17*799.45
**78434*TC*703.68*668.50*768.78
*C*78459**1486.14*1411.83*1623.60
*C*78459*TC*1415.18*1344.42*1546.08
*C*78491**1628.74*1547.30*1779.40
*C*78491*TC*1559.04*1481.09*1703.25
*C*78492**1641.01*1558.96*1792.80
*C*78492*TC*1559.04*1481.09*1703.25
*C*78608**1626.05*1544.75*1776.46
*C*78608*TC*1559.04*1481.09*1703.25
*C*78811**1484.15*1409.94*1621.43
*C*78811*TC*1415.18*1344.42*1546.08
*C*78812**1646.16*1563.85*1798.43
*C*78812*TC*1559.04*1481.09*1703.25
*C*78813**1648.11*1565.70*1800.56
*C*78813*TC*1559.04*1481.09*1703.25
*C*78814**1657.70*1574.82*1811.04
*C*78814*TC*1559.04*1481.09*1703.25
*C*78815**1668.94*1585.49*1823.31
*C*78815*TC*1559.04*1481.09*1703.25
*C*78816**1669.92*1586.42*1824.38
*C*78816*TC*1559.04*1481.09*1703.25
**79300**237.04*225.19*258.97
**79300*TC*175.49*166.72*191.73
**79445**237.04*225.19*258.97
**79445*TC*131.32*124.75*143.46
**86485**17.28*16.42*18.88
**90867**303.26*288.10*331.32
#**90867**135.27*128.51*147.79
**90868**202.23*192.12*220.94
#**90868**104.07*98.87*113.70
**90869**278.56*264.63*304.32
#**90869**160.44*152.42*175.28
**90952**479.76*455.77*524.14
**90953**342.08*324.98*373.73
**92978**248.76*236.32*271.77
**92978*TC*158.41*150.49*173.06
**92979**150.45*142.93*164.37
**92979*TC*78.73*74.79*86.01
*C*93315**671.62*638.04*733.75
*C*93315*TC*549.68*522.20*600.53
**93317**216.52*205.69*236.54
**93317*TC*131.79*125.20*143.98
*C*93318**647.64*615.26*707.55
*C*93318*TC*549.68*522.20*600.53
**93571**247.73*235.34*270.64
**93571*TC*178.96*170.01*195.51
**93572**148.10*140.70*161.81
**93572*TC*98.02*93.12*107.09
**93600**3557.81*3379.92*3886.91
**93600*TC*3446.97*3274.62*3765.81
**93602**3557.81*3379.92*3886.91
**93602*TC*3448.93*3276.48*3767.95
**93603**3557.81*3379.92*3886.91
**93603*TC*3448.93*3276.48*3767.95
**93609**2134.69*2027.96*2332.15
**93609*TC*1874.66*1780.93*2048.07
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.06*3233.86*3718.94
**93612**3557.81*3379.92*3886.91
**93612*TC*3406.33*3236.01*3721.41
**93615**49.47*47.00*54.05
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6748.40*6410.98*7372.63
**93620**7115.62*6759.84*7773.82
**93620*TC*6526.48*6200.16*7130.18
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.27*6685.41*7688.22
**93622**7115.62*6759.84*7773.82
**93622*TC*6953.98*6606.28*7597.22
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.17*1965.71*2260.57
**93624**3557.81*3379.92*3886.91
**93624*TC*3329.74*3163.25*3637.74
**93631**7115.62*6759.84*7773.82
**93631*TC*6740.17*6403.16*7363.63
**93640**1133.95*1077.25*1238.84
**93640*TC*965.79*917.50*1055.13
**93641**1133.95*1077.25*1238.84
**93641*TC*840.02*798.02*917.72
**93662**430.20*408.69*469.99
**93662*TC*362.33*344.21*395.84
**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**920.79*874.75*1005.96
**95965*TC*520.93*494.88*569.11
**95966**537.50*510.63*587.22
**95966*TC*345.30*328.04*377.25
**95967**452.01*429.41*493.82
**95967*TC*285.34*271.07*311.73
**96020**376.67*357.84*411.52
**96020*TC*224.20*212.99*244.94
**96547**762.73*724.59*833.28
#**96547**133.55*126.87*145.90
**96548**381.36*362.29*416.63
#**96548**66.77*63.43*72.94
**97151**49.05*46.60*53.59
#**97151**43.23*41.07*47.23
**97152**41.70*39.62*45.56
#**97152**36.75*34.91*40.15
**97153**33.19*31.53*36.26
#**97153**28.91*27.46*31.58
**97154**4.53*4.30*4.95
#**97154**4.09*3.89*4.47
**97155**33.19*31.53*36.26
#**97155**28.91*27.46*31.58
**97156**35.00*33.25*38.24
#**97156**30.55*29.02*33.37
**97157**10.24*9.73*11.19
#**97157**9.22*8.76*10.07
**97158**5.27*5.01*5.76
#**97158**4.76*4.52*5.20
**98978**48.59*46.16*53.08
# - 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.