TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**432.07*410.47*472.04
#**G0186**372.04*353.44*406.46
**G0339**2581.74*2452.65*2820.55
**G0340**1941.66*1844.58*2121.27
**G0398**127.76*121.37*139.58
**G0398*TC*90.35*85.83*98.70
**G0398*26*37.41*35.54*40.87
**G0399**89.23*84.77*97.49
**G0399*TC*47.95*45.55*52.38
**G0399*26*41.58*39.50*45.43
**G0400**91.87*87.28*100.37
**G0400*TC*53.22*50.56*58.14
**G0400*26*38.65*36.72*42.23
**G0460**744.08*706.88*812.91
#**G0460**115.62*109.84*126.32
**G0465**744.08*706.88*812.91
#**G0465**115.62*109.84*126.32
**G0498**137.12*130.26*149.80
**G6017**73.80*70.11*80.63
**0042T**214.78*204.04*234.65
**0054T**220.70*209.67*241.12
**0055T**220.70*209.67*241.12
**0071T**548.34*520.92*599.06
**0072T**548.34*520.92*599.06
**0075T**928.91*882.46*1014.83
**0075T*TC*928.91*882.46*1014.83
**0075T*26*928.91*882.46*1014.83
**0076T**1004.76*954.52*1097.70
**0076T*TC*803.81*763.62*878.16
**0076T*26*200.95*190.90*219.54
**0095T**599.20*569.24*654.63
**0098T**670.88*637.34*732.94
**0100T**1807.26*1716.90*1974.44
**0101T**297.28*282.42*324.78
#**0101T**215.28*204.52*235.20
**0102T**297.28*282.42*324.78
#**0102T**215.28*204.52*235.20
**0106T**31.34*29.77*34.24
**0107T**31.34*29.77*34.24
**0108T**31.34*29.77*34.24
**0109T**31.34*29.77*34.24
**0110T**31.34*29.77*34.24
**0164T**654.86*622.12*715.44
**0165T**670.98*637.43*733.04
**0174T**9.47*9.00*10.35
**0184T**786.92*747.57*859.71
**0198T**80.00*76.00*87.40
#**0198T**30.49*28.97*33.32
**0200T**1663.33*1580.16*1817.18
#**0200T**386.61*367.28*422.37
**0201T**2494.99*2370.24*2725.78
#**0201T**579.92*550.92*633.56
**0207T**121.70*115.62*132.96
**0208T**35.27*33.51*38.54
**0209T**42.70*40.57*46.66
**0210T**26.92*25.57*29.41
**0211T**41.77*39.68*45.63
**0212T**34.80*33.06*38.02
#**0212T**30.16*28.65*32.95
**0213T**182.37*173.25*199.24
#**0213T**100.37*95.35*109.65
**0214T**92.40*87.78*100.95
#**0214T**56.51*53.68*61.73
**0215T**92.71*88.07*101.28
#**0215T**57.43*54.56*62.74
**0216T**167.61*159.23*183.11
#**0216T**86.23*81.92*94.21
**0217T**86.24*81.93*94.22
#**0217T**48.49*46.07*52.98
**0218T**86.24*81.93*94.22
#**0218T**49.42*46.95*53.99
**0219T**1257.58*1194.70*1373.91
**0220T**1235.83*1174.04*1350.15
**0221T**1518.73*1442.79*1659.21
**0222T**372.87*354.23*407.36
**0232T**744.08*706.88*812.91
#**0232T**115.62*109.84*126.32
**0234T**7963.69*7565.51*8700.34
#**0234T**558.97*531.02*610.67
**0235T**7963.69*7565.51*8700.34
#**0235T**558.97*531.02*610.67
**0236T**8106.23*7700.92*8856.06
#**0236T**647.35*614.98*707.23
**0237T**8106.23*7700.92*8856.06
#**0237T**647.35*614.98*707.23
**0238T**8106.23*7700.92*8856.06
#**0238T**647.35*614.98*707.23
**0253T**813.52*772.84*888.77
**0266T**856.47*813.65*935.70
**0267T**151.32*143.75*165.31
**0268T**318.51*302.58*347.97
**0269T**810.80*770.26*885.80
**0270T**151.32*143.75*165.31
**0271T**318.51*302.58*347.97
**0272T**52.75*50.11*57.63
**0273T**67.86*64.47*74.14
**0274T**1058.60*1005.67*1156.52
**0278T**13.75*13.06*15.02
**0308T**1325.95*1259.65*1448.60
**0329T**80.00*76.00*87.40
#**0329T**30.49*28.97*33.32
**0330T**38.21*36.30*41.75
**0331T**171.60*163.02*187.47
**0332T**293.01*278.36*320.11
**0347T**135.53*128.75*148.06
**0348T**30.99*29.44*33.86
**0349T**32.81*31.17*35.85
**0350T**33.43*31.76*36.52
**0351T**158.93*150.98*173.63
**0352T**41.04*38.99*44.84
**0353T**158.93*150.98*173.63
**0354T**41.04*38.99*44.84
**0358T**25.06*23.81*27.38
**0362T**86.78*82.44*94.81
#**0362T**62.95*59.80*68.77
**0378T**23.75*22.56*25.94
**0394T**233.93*222.23*255.56
**0395T**568.99*540.54*621.62
**0397T**44.94*42.69*49.09
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**486.53*462.20*531.53
**0409T**336.31*319.49*367.41
**0410T**349.42*331.95*381.74
**0411T**349.42*331.95*381.74
**0412T**219.52*208.54*239.82
**0413T**455.04*432.29*497.13
**0414T**350.64*333.11*383.08
**0415T**292.20*277.59*319.23
**0416T**323.33*307.16*353.23
**0417T**78.87*74.93*86.17
**0418T**52.75*50.11*57.63
**0419T**425.86*404.57*465.26
#**0419T**342.93*325.78*374.65
**0420T**606.30*575.99*662.39
#**0420T**503.88*478.69*550.49
**0421T**1513.12*1437.46*1653.08
#**0421T**662.49*629.37*723.78
**0437T**203.43*193.26*222.25
**0439T**67.69*64.31*73.96
**0440T**234.33*222.61*256.00
#**0440T**113.65*107.97*124.17
**0441T**234.33*222.61*256.00
#**0441T**113.65*107.97*124.17
**0442T**234.33*222.61*256.00
#**0442T**113.65*107.97*124.17
**0449T**722.12*686.01*788.91
**0464T**63.13*59.97*68.97
**0472T**63.36*60.19*69.22
**0473T**52.75*50.11*57.63
**0479T**60.23*57.22*65.80
**0480T**73.28*69.62*80.06
#**0480T**30.11*28.60*32.89
**0483T**1134.59*1077.86*1239.54
**0484T**1471.33*1397.76*1607.42
**0485T**22.30*21.19*24.37
**0485T*TC*8.20*7.79*8.96
**0485T*26*14.41*13.69*15.74
**0486T**44.60*42.37*48.73
**0486T*TC*16.09*15.29*17.58
**0486T*26*28.51*27.08*31.14
**0488T**59.95*56.95*65.49
#**0488T**47.88*45.49*52.31
**0505T**10287.47*9773.10*11239.07
#**0505T**534.02*507.32*583.42
**0507T**21.74*20.65*23.75
**0507T*TC*18.87*17.93*20.62
**0507T*26*2.87*2.73*3.14
**0510T**570.73*542.19*623.52
#**0510T**403.64*383.46*440.98
**0512T**297.28*282.42*324.78
#**0512T**215.28*204.52*235.20
**0513T**89.18*84.72*97.43
#**0513T**64.58*61.35*70.55
**0515T**486.53*462.20*531.53
**0516T**449.09*426.64*490.64
**0517T**318.51*302.58*347.97
**0518T**219.52*208.54*239.82
**0519T**319.38*303.41*348.92
**0520T**449.09*426.64*490.64
**0521T**52.75*50.11*57.63
**0521T*TC*33.42*31.75*36.51
**0521T*26*19.34*18.37*21.13
**0522T**63.36*60.19*69.22
**0522T*TC*34.03*32.33*37.18
**0522T*26*29.32*27.85*32.03
**0523T**143.60*136.42*156.88
**0524T**1530.62*1454.09*1672.20
#**0524T**168.81*160.37*184.43
**0525T**449.40*426.93*490.97
**0526T**349.42*331.95*381.74
**0527T**304.12*288.91*332.25
**0528T**63.36*60.19*69.22
**0528T*TC*34.03*32.33*37.18
**0528T*26*29.32*27.85*32.03
**0529T**52.75*50.11*57.63
**0529T*TC*33.42*31.75*36.51
**0529T*26*19.34*18.37*21.13
**0530T**597.82*567.93*653.12
**0531T**455.04*432.29*497.13
**0532T**319.38*303.41*348.92
**0540T**169.02*160.57*184.66
**0543T**1471.33*1397.76*1607.42
**0544T**1690.45*1605.93*1846.82
**0545T**1690.45*1605.93*1846.82
**0546T**67.87*64.48*74.15
**0552T**6.29*5.98*6.88
**0553T**2292.57*2177.94*2504.63
#**0553T**373.78*355.09*408.35
**0565T**581.95*552.85*635.78
#**0565T**489.43*464.96*534.70
**0566T**94.45*89.73*103.19
#**0566T**56.39*53.57*61.61
**0569T**1690.45*1605.93*1846.82
**0570T**396.71*376.87*433.40
**0571T**526.21*499.90*574.89
**0572T**428.46*407.04*468.10
**0573T**326.79*310.45*357.02
**0574T**379.08*360.13*414.15
**0575T**63.36*60.19*69.22
**0576T**52.75*50.11*57.63
**0577T**181.51*172.43*198.29
**0578T**27.99*26.59*30.58
**0579T**19.80*18.81*21.63
**0580T**202.33*192.21*221.04
**0581T**2110.75*2005.21*2305.99
#**0581T**200.32*190.30*218.85
**0582T**1547.99*1470.59*1691.18
#**0582T**365.65*347.37*399.48
**0583T**1496.16*1421.35*1634.55
#**0583T**126.15*119.84*137.82
**0587T**419.54*398.56*458.34
#**0587T**282.15*268.04*308.25
**0588T**345.14*327.88*377.06
#**0588T**219.82*208.83*240.15
**0589T**45.94*43.64*50.19
#**0589T**36.96*35.11*40.38
**0590T**54.02*51.32*59.02
#**0590T**38.23*36.32*41.77
**0596T**2235.23*2123.47*2441.99
#**0596T**126.16*119.85*137.83
**0597T**672.69*639.06*734.92
#**0597T**126.16*119.85*137.83
**0598T**140.94*133.89*153.97
**0599T**93.90*89.21*102.59
**0600T**3345.06*3177.81*3654.48
#**0600T**691.98*657.38*755.99
**0601T**1384.41*1315.19*1512.47
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**184.58*175.35*201.65
**0611T**37.74*35.85*41.23
**0614T**350.05*332.55*382.43
**0615T**44.83*42.59*48.98
**0616T**628.82*597.38*686.99
**0617T**702.33*667.21*767.29
**0618T**850.08*807.58*928.72
**0619T**618.88*587.94*676.13
#**0619T**453.88*431.19*495.87
**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**243.30*231.14*265.81
#**0627T**94.77*90.03*103.53
**0628T**72.99*69.34*79.74
#**0628T**28.43*27.01*31.06
**0629T**243.30*231.14*265.81
#**0629T**94.77*90.03*103.53
**0630T**72.99*69.34*79.74
#**0630T**28.43*27.01*31.06
**0631T**76.86*73.02*83.97
**0632T**543.64*516.46*593.93
**0633T**189.12*179.66*206.61
*C*0633T*TC*99.01*94.06*108.17
**0633T*26*56.38*53.56*61.59
**0634T**189.12*179.66*206.61
**0634T*TC*132.74*126.10*145.02
**0634T*26*56.38*53.56*61.59
**0635T**189.12*179.66*206.61
**0635T*TC*132.74*126.10*145.02
**0635T*26*56.38*53.56*61.59
**0636T**189.12*179.66*206.61
**0636T*TC*132.74*126.10*145.02
**0636T*26*56.38*53.56*61.59
**0637T**189.12*179.66*206.61
**0637T*TC*132.74*126.10*145.02
**0637T*26*56.38*53.56*61.59
**0638T**189.12*179.66*206.61
**0638T*TC*132.74*126.10*145.02
**0638T*26*56.38*53.56*61.59
**0639T**76.86*73.02*83.97
**0640T**21.74*20.65*23.75
**0640T*TC*18.87*17.93*20.62
**0640T*26*2.87*2.73*3.14
**0644T**1086.25*1031.94*1186.73
#**0644T**228.19*216.78*249.30
**0646T**1690.45*1605.93*1846.82
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**56.31*53.49*61.51
**0652T**270.71*257.17*295.75
#**0652T**115.99*110.19*126.72
**0653T**353.24*335.58*385.92
#**0653T**131.06*124.51*143.19
**0654T**134.64*127.91*147.10
**0655T**1513.12*1437.46*1653.08
#**0655T**662.49*629.37*723.78
**0658T**88.18*83.77*96.34
**0659T**2511.88*2386.29*2744.23
#**0659T**412.38*391.76*450.52
**0671T**970.88*922.34*1060.69
**0673T**3196.63*3036.80*3492.32
#**0673T**347.06*329.71*379.17
**0699T**106.83*101.49*116.71
#**0699T**86.41*82.09*94.40
**0707T**350.06*332.56*382.44
#**0707T**264.34*251.12*288.79
**0714T**1314.71*1248.97*1436.32
#**0714T**341.24*324.18*372.81
**0730T**254.75*242.01*278.31
#**0730T**228.64*217.21*249.79
**0738T**67.60*64.22*73.85
**0739T**1513.12*1437.46*1653.08
#**0739T**662.49*629.37*723.78
**0740T**18.56*17.63*20.27
**0741T**43.94*41.74*48.00
**0742T**87.90*83.51*96.04
**0742T*TC*69.62*66.14*76.06
**0742T*26*18.29*17.38*19.99
**0743T**50.04*47.54*54.67
**0744T**843.57*801.39*921.60
**0745T**238.86*226.92*260.96
**0746T**214.98*204.23*234.86
**0747T**923.57*877.39*1009.00
**0748T**174.91*166.16*191.08
**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**408.20*387.79*445.96
**0756T**104.63*99.40*114.31
**0757T**75.93*72.13*82.95
**0758T**84.35*80.13*92.15
**0759T**125.95*119.65*137.60
**0760T**93.46*88.79*102.11
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**110.44*104.92*120.66
**0764T**4.08*3.88*4.46
**0765T**7.73*7.34*8.44
**0771T**25.22*23.96*27.55
**0772T**25.22*23.96*27.55
**0773T**21.98*20.88*24.01
**0774T**21.98*20.88*24.01
**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**406.90*386.56*444.54
**0779T*TC*382.15*363.04*417.50
**0779T*26*24.76*23.52*27.05
**0780T**21.98*20.88*24.01
**0783T**13.30*12.64*14.54
**0784T**1980.00*1881.00*2163.15
#**0784T**309.68*294.20*338.33
**0785T**228.96*217.51*250.14
#**0785T**137.68*130.80*150.42
**0786T**690.28*655.77*754.14
#**0786T**289.88*275.39*316.70
**0787T**228.96*217.51*250.14
#**0787T**137.68*130.80*150.42
**0788T**17.95*17.05*19.61
#**0788T**17.33*16.46*18.93
**0789T**24.96*23.71*27.27
#**0789T**21.66*20.58*23.67
**0790T**1837.17*1745.31*2007.11
**0791T**8.63*8.20*9.43
**0793T**543.64*516.46*593.93
**0794T**130.35*123.83*142.40
**0795T**673.64*639.96*735.95
**0796T**449.09*426.64*490.64
**0797T**449.09*426.64*490.64
**0798T**712.78*677.14*778.71
**0799T**475.19*451.43*519.14
**0800T**475.19*451.43*519.14
**0801T**924.28*878.07*1009.78
**0802T**462.14*439.03*504.88
**0803T**462.14*439.03*504.88
**0804T**74.09*70.39*80.95
**0804T*TC*39.29*37.33*42.93
**0804T*26*34.80*33.06*38.02
**0805T**2759.47*2621.50*3014.73
#**0805T**309.69*294.21*338.34
**0806T**3679.29*3495.33*4019.63
#**0806T**412.92*392.27*451.11
**0807T**40.13*38.12*43.84
**0807T*TC*25.99*24.69*28.39
**0807T*26*14.14*13.43*15.44
**0808T**40.13*38.12*43.84
**0808T*TC*25.99*24.69*28.39
**0808T*26*14.14*13.43*15.44
**0810T**1075.14*1021.38*1174.59
**0811T**18.56*17.63*20.27
**0813T**2418.93*2297.98*2642.68
#**0813T**171.83*163.24*187.73
**0814T**437.57*415.69*478.04
#**0814T**330.43*313.91*361.00
**0818T**345.14*327.88*377.06
#**0818T**219.82*208.83*240.15
**0820T**142.02*134.92*155.16
#**0820T**125.62*119.34*137.24
**0821T**142.02*134.92*155.16
#**0821T**125.62*119.34*137.24
**0822T**120.72*114.68*131.88
#**0822T**106.78*101.44*116.66
**0823T**673.64*639.96*735.95
**0824T**712.78*677.14*778.71
**0825T**924.28*878.07*1009.78
**0826T**63.36*60.19*69.22
**0826T*TC*34.03*32.33*37.18
**0826T*26*29.32*27.85*32.03
**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**21.74*20.65*23.75
**0859T*TC*18.87*17.93*20.62
**0859T*26*2.87*2.73*3.14
**0864T**297.28*282.42*324.78
#**0864T**215.28*204.52*235.20
**10011**399.76*379.77*436.74
#**10011**103.01*97.86*112.54
**10012**221.05*210.00*241.50
#**10012**68.81*65.37*75.18
**15847**335.55*318.77*366.59
**21742**1103.30*1048.14*1205.36
**21743**1267.34*1203.97*1384.57
**32855**332.85*316.21*363.64
**32856**431.22*409.66*471.11
**33928**3162.22*3004.11*3454.73
**33929**1184.50*1125.28*1294.07
**33933**509.92*484.42*557.08
**33944**509.92*484.42*557.08
**34841**2003.39*1903.22*2188.70
**34842**2229.18*2117.72*2435.38
**34843**2454.96*2332.21*2682.04
**34844**2680.75*2546.71*2928.72
**34845**2003.39*1903.22*2188.70
**34846**2229.18*2117.72*2435.38
**34847**2454.96*2332.21*2682.04
**34848**2680.75*2546.71*2928.72
**43496**1976.79*1877.95*2159.64
**43647**442.49*420.37*483.43
**43648**500.92*475.87*547.25
#**43648**227.64*216.26*248.70
**43881**629.52*598.04*687.75
#**43881**577.63*548.75*631.06
**43882**666.03*632.73*727.64
#**43882**610.17*579.66*666.61
**47143**399.92*379.92*436.91
**47144**474.88*451.14*518.81
**47145**449.89*427.40*491.51
**48551**252.82*240.18*276.21
**49906**1897.11*1802.25*2072.59
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**724.01*687.81*790.98
**53452**362.01*343.91*395.50
**53453**615.33*584.56*672.24
**53454**53.84*51.15*58.82
#**53454**33.73*32.04*36.85
**54440**705.66*670.38*770.94
**63043**548.52*521.09*599.25
**63044**483.57*459.39*528.30
**64596**1980.00*1881.00*2163.15
#**64596**309.68*294.20*338.33
**64597**594.00*564.30*648.95
#**64597**92.90*88.26*101.50
**64598**228.96*217.51*250.14
#**64598**137.68*130.80*150.42
**65757**113.74*108.05*124.26
**66983**628.82*597.38*686.99
**66987**730.18*693.67*797.72
**66988**605.68*575.40*661.71
*C*70170**234.46*222.74*256.15
*C*70170*TC*220.62*209.59*241.03
**70555**233.47*221.80*255.07
**70555*TC*184.39*175.17*201.45
*C*70557**641.06*609.01*700.36
*C*70557*TC*496.64*471.81*542.58
*C*70558**324.73*308.49*354.76
*C*70558*TC*165.54*157.26*180.85
*C*70559**315.41*299.64*344.59
*C*70559*TC*165.54*157.26*180.85
*C*74190**517.60*491.72*565.48
*C*74190*TC*496.64*471.81*542.58
**74235**138.22*131.31*151.01
**74235*TC*84.42*80.20*92.23
**74300**79.47*75.50*86.83
**74300*TC*66.92*63.57*73.11
**74301**24.48*23.26*26.75
**74301*TC*15.13*14.37*16.53
**74328**175.06*166.31*191.26
**74328*TC*153.18*145.52*167.35
**74329**133.63*126.95*145.99
**74329*TC*111.44*105.87*121.75
**74330**262.59*249.46*286.88
**74330*TC*236.84*225.00*258.75
**74340**86.58*82.25*94.59
**74340*TC*62.41*59.29*68.18
**74355**86.58*82.25*94.59
**74355*TC*52.12*49.51*56.94
**74360**86.58*82.25*94.59
**74360*TC*60.87*57.83*66.50
**74363**175.06*166.31*191.26
**74363*TC*135.74*128.95*148.29
*C*74445**149.94*142.44*163.81
*C*74445*TC*99.01*94.06*108.17
*C*74450**235.45*223.68*257.23
*C*74450*TC*220.62*209.59*241.03
*C*74470**520.19*494.18*568.31
*C*74470*TC*496.64*471.81*542.58
**74742**233.47*221.80*255.07
**74742*TC*205.77*195.48*224.80
*C*74775**248.65*236.22*271.65
*C*74775*TC*220.62*209.59*241.03
*C*75801**606.04*575.74*662.10
*C*75801*TC*565.64*537.36*617.96
*C*75803**1495.09*1420.34*1633.39
*C*75803*TC*1441.95*1369.85*1575.33
*C*75805**2906.70*2761.37*3175.58
*C*75805*TC*2869.98*2726.48*3135.45
*C*75807**2920.02*2774.02*3190.12
*C*75807*TC*2869.98*2726.48*3135.45
*C*75810**2915.94*2770.14*3185.66
*C*75810*TC*2869.98*2726.48*3135.45
**75894**846.31*803.99*924.59
**75894*TC*778.76*739.82*850.79
*C*75898**2956.06*2808.26*3229.50
*C*75898*TC*2869.98*2726.48*3135.45
**75970**413.43*392.76*451.67
**75970*TC*377.61*358.73*412.54
**76125**37.60*35.72*41.08
**76125*TC*25.05*23.80*27.37
**76390**193.80*184.11*211.73
**76390*TC*143.96*136.76*157.27
**76390*26*49.92*47.42*54.53
**76932**80.38*76.36*87.81
**76932*TC*46.41*44.09*50.70
**76940**150.99*143.44*164.96
**76940*TC*55.89*53.10*61.07
**76941**110.35*104.83*120.55
**76941*TC*49.46*46.99*54.04
**76945**79.45*75.48*86.80
**76945*TC*49.16*46.70*53.71
*C*76975**259.20*246.24*283.18
*C*76975*TC*220.62*209.59*241.03
**76998**175.06*166.31*191.26
**76998*TC*130.78*124.24*142.88
**77013**397.51*377.63*434.27
**77013*TC*224.25*213.04*245.00
**77022**446.62*424.29*487.93
**77022*TC*257.74*244.85*281.58
**77371**561.75*533.66*613.71
**77520**815.08*774.33*890.48
**77522**815.08*774.33*890.48
**77523**935.93*889.13*1022.50
**77525**1056.76*1003.92*1154.51
*C*78282**385.92*366.62*421.61
*C*78282*TC*371.32*352.75*405.66
**78414**514.99*489.24*562.63
**78414*TC*495.00*470.25*540.79
*C*78429**1483.47*1409.30*1620.70
*C*78429*TC*1408.53*1338.10*1538.82
*C*78430**1479.91*1405.91*1616.80
*C*78430*TC*1408.53*1338.10*1538.82
*C*78431**2209.96*2099.46*2414.38
*C*78431*TC*2126.73*2020.39*2323.45
*C*78432**1837.71*1745.82*2007.69
*C*78432*TC*1748.60*1661.17*1910.35
*C*78433**1940.78*1843.74*2120.30
*C*78433*TC*1843.29*1751.13*2013.80
**78434**662.99*629.84*724.32
**78434*TC*635.56*603.78*694.35
*C*78459**1347.98*1280.58*1472.67
*C*78459*TC*1278.57*1214.64*1396.84
*C*78491**1476.62*1402.79*1613.21
*C*78491*TC*1408.53*1338.10*1538.82
*C*78492**1488.49*1414.07*1626.18
*C*78492*TC*1408.53*1338.10*1538.82
*C*78608**1474.03*1400.33*1610.38
*C*78608*TC*1408.53*1338.10*1538.82
*C*78811**1345.99*1278.69*1470.49
*C*78811*TC*1278.57*1214.64*1396.84
*C*78812**1493.67*1418.99*1631.84
*C*78812*TC*1408.53*1338.10*1538.82
*C*78813**1495.65*1420.87*1634.00
*C*78813*TC*1408.53*1338.10*1538.82
*C*78814**1504.98*1429.73*1644.19
*C*78814*TC*1408.53*1338.10*1538.82
*C*78815**1515.93*1440.13*1656.15
*C*78815*TC*1408.53*1338.10*1538.82
*C*78816**1516.97*1441.12*1657.29
*C*78816*TC*1408.53*1338.10*1538.82
**79300**237.04*225.19*258.97
**79300*TC*176.30*167.49*192.61
**79445**237.04*225.19*258.97
**79445*TC*133.44*126.77*145.79
**86485**17.28*16.42*18.88
**90867**281.86*267.77*307.94
#**90867**130.08*123.58*142.12
**90868**190.29*180.78*207.90
#**90868**100.88*95.84*110.22
**90869**262.59*249.46*286.88
#**90869**152.54*144.91*166.65
**90952**466.62*443.29*509.78
**90953**331.67*315.09*362.35
**92978**231.49*219.92*252.91
**92978*TC*142.97*135.82*156.19
**92979**141.15*134.09*154.20
**92979*TC*71.23*67.67*77.82
*C*93315**615.63*584.85*672.58
*C*93315*TC*496.64*471.81*542.58
**93317**202.46*192.34*221.19
**93317*TC*119.67*113.69*130.74
*C*93318**592.37*562.75*647.16
*C*93318*TC*496.64*471.81*542.58
**93571**230.57*219.04*251.90
**93571*TC*163.19*155.03*178.28
**93572**138.99*132.04*151.85
**93572*TC*89.91*85.41*98.22
**93600**3557.81*3379.92*3886.91
**93600*TC*3449.55*3277.07*3768.63
**93602**3557.81*3379.92*3886.91
**93602*TC*3451.40*3278.83*3770.65
**93603**3557.81*3379.92*3886.91
**93603*TC*3451.40*3278.83*3770.65
**93609**2134.69*2027.96*2332.15
**93609*TC*1880.66*1786.63*2054.62
**93610**3557.81*3379.92*3886.91
**93610*TC*3407.44*3237.07*3722.63
**93612**3557.81*3379.92*3886.91
**93612*TC*3409.60*3239.12*3724.99
**93615**48.53*46.10*53.02
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6756.82*6418.98*7381.83
**93620**7115.62*6759.84*7773.82
**93620*TC*6539.96*6212.96*7144.90
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.07*6687.12*7690.19
**93622**7115.62*6759.84*7773.82
**93622*TC*6957.70*6609.82*7601.29
**93623**2134.69*2027.96*2332.15
**93623*TC*2071.73*1968.14*2263.36
**93624**3557.81*3379.92*3886.91
**93624*TC*3334.26*3167.55*3642.68
**93631**7115.62*6759.84*7773.82
**93631*TC*6746.97*6409.62*7371.06
**93640**1133.95*1077.25*1238.84
**93640*TC*969.56*921.08*1059.24
**93641**1133.95*1077.25*1238.84
**93641*TC*846.57*804.24*924.88
**93662**397.51*377.63*434.27
**93662*TC*331.50*314.93*362.17
**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**906.02*860.72*989.83
**95965*TC*518.27*492.36*566.21
**95966**532.48*505.86*581.74
**95966*TC*345.30*328.04*377.25
**95967**447.80*425.41*489.22
**95967*TC*285.34*271.07*311.73
**96020**376.72*357.88*411.56
**96020*TC*227.64*216.26*248.70
**96547**696.28*661.47*760.69
#**96547**127.85*121.46*139.68
**96548**348.14*330.73*380.34
#**96548**63.93*60.73*69.84
**97151**47.92*45.52*52.35
#**97151**42.66*40.53*46.61
**97152**40.73*38.69*44.49
#**97152**36.26*34.45*39.62
**97153**32.46*30.84*35.47
#**97153**28.59*27.16*31.23
**97154**4.42*4.20*4.83
#**97154**4.02*3.82*4.39
**97155**32.46*30.84*35.47
#**97155**28.59*27.16*31.23
**97156**34.25*32.54*37.42
#**97156**30.23*28.72*33.03
**97157**9.99*9.49*10.91
#**97157**9.06*8.61*9.90
**97158**5.15*4.89*5.62
#**97158**4.68*4.45*5.12
**98978**43.94*41.74*48.00
# - 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.