ARKANSAS MEDICARE CARRIER - 07102
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
STATEWIDE
******
**A2001**1287.50*1223.13*1406.60
**A2002**344.73*327.49*376.61
**A2004**12.78*12.14*13.96
**A2005**267.80*254.41*292.57
**A2007**84.75*80.51*92.59
**A2008**92.91*88.26*101.50
**A2009**91.05*86.50*99.48
**A2013**1390.50*1320.98*1519.13
**A2014**61.16*58.10*66.82
**A2015**1236.00*1174.20*1350.33
**A2021**1387.93*1318.53*1516.31
**A2022**1467.75*1394.36*1603.51
**A2023**16.74*15.90*18.29
**A2024**2008.50*1908.08*2194.29
**A2025**257.50*244.63*281.32
**A2029**515.00*489.25*562.64
**A9500**134.67*127.94*147.13
**A9502**129.61*123.13*141.60
**A9505**77.23*73.37*84.38
**A9521**1742.80*1655.66*1904.01
**A9524**141.09*134.04*154.15
**A9537**9.45*8.98*10.33
**A9543**73939.13*70242.17*80778.50
**A9547**2399.68*2279.70*2621.66
**A9554**33.25*31.59*36.33
**A9558**290.82*276.28*317.72
**A9586**3257.44*3094.57*3558.76
**G0186**445.44*423.17*486.65
#**G0186**383.96*364.76*419.47
**G0339**2447.88*2325.49*2674.31
**G0340**1840.79*1748.75*2011.06
**G0398**110.40*104.88*120.61
**G0398*TC*74.89*71.15*81.82
**G0398*26*35.51*33.73*38.79
**G0399**83.77*79.58*91.52
**G0399*TC*44.01*41.81*48.08
**G0399*26*39.76*37.77*43.44
**G0400**84.52*80.29*92.33
**G0400*TC*47.63*45.25*52.04
**G0400*26*36.90*35.06*40.32
**G0460**671.50*637.93*733.62
#**G0460**106.52*101.19*116.37
**G0498**123.13*116.97*134.52
**G0552**128.87*122.43*140.79
**G6017**69.12*65.66*75.51
**0042T**198.20*188.29*216.53
**0054T**196.05*186.25*214.19
**0055T**196.05*186.25*214.19
**0071T**495.27*470.51*541.09
**0072T**495.27*470.51*541.09
**0075T*26*837.16*795.30*914.60
**0076T**987.28*937.92*1078.61
**0095T**527.78*501.39*576.60
**0098T**590.78*561.24*645.43
**0101T**271.51*257.93*296.62
#**0101T**200.85*190.81*219.43
**0102T**271.51*257.93*296.62
#**0102T**200.85*190.81*219.43
**0106T**27.27*25.91*29.80
**0107T**27.27*25.91*29.80
**0108T**27.27*25.91*29.80
**0109T**27.27*25.91*29.80
**0110T**27.27*25.91*29.80
**0164T**577.21*548.35*630.60
**0165T**591.10*561.55*645.78
**0184T**723.20*687.04*790.10
**0198T**73.20*69.54*79.97
#**0198T**28.97*27.52*31.65
**0200T**1463.50*1390.33*1598.88
#**0200T**360.23*342.22*393.55
**0201T**2195.24*2085.48*2398.30
#**0201T**540.35*513.33*590.33
**0207T**128.90*122.46*140.83
**0208T**33.27*31.61*36.35
**0209T**40.23*38.22*43.95
**0210T**25.20*23.94*27.53
**0211T**39.11*37.15*42.72
**0212T**32.82*31.18*35.86
#**0212T**28.92*27.47*31.59
**0213T**166.59*158.26*182.00
#**0213T**94.27*89.56*102.99
**0214T**85.32*81.05*93.21
#**0214T**53.33*50.66*58.26
**0215T**85.15*80.89*93.02
#**0215T**53.72*51.03*58.68
**0216T**153.11*145.45*167.27
#**0216T**81.06*77.01*88.56
**0217T**79.09*75.14*86.41
#**0217T**45.71*43.42*49.93
**0218T**78.47*74.55*85.73
#**0218T**46.21*43.90*50.49
**0219T**1123.75*1067.56*1227.69
**0220T**1109.11*1053.65*1211.70
**0221T**1369.20*1300.74*1495.85
**0222T**333.36*316.69*364.19
**0232T**772.40*733.78*843.85
#**0232T**81.96*77.86*89.54
**0234T**6820.60*6479.57*7451.51
#**0234T**509.53*484.05*556.66
**0235T**6820.60*6479.57*7451.51
#**0235T**509.53*484.05*556.66
**0236T**6972.66*6624.03*7617.63
#**0236T**593.72*564.03*648.63
**0237T**6972.66*6624.03*7617.63
#**0237T**593.72*564.03*648.63
**0238T**6972.66*6624.03*7617.63
#**0238T**593.72*564.03*648.63
**0266T**779.26*740.30*851.35
**0267T**138.70*131.77*151.54
**0268T**289.31*274.84*316.07
**0269T**736.51*699.68*804.63
**0270T**138.70*131.77*151.54
**0271T**289.31*274.84*316.07
**0272T**47.90*45.51*52.34
**0273T**61.93*58.83*67.65
**0274T**951.78*904.19*1039.82
**0278T**13.26*12.60*14.49
**0308T**1231.14*1169.58*1345.02
**0329T**73.20*69.54*79.97
#**0329T**28.97*27.52*31.65
**0330T**39.25*37.29*42.88
**0331T**154.18*146.47*168.44
**0332T**260.73*247.69*284.84
**0347T**124.85*118.61*136.40
**0348T**28.22*26.81*30.83
**0349T**29.52*28.04*32.25
**0350T**30.36*28.84*33.17
**0351T**142.27*135.16*155.43
**0352T**39.18*37.22*42.80
**0353T**142.27*135.16*155.43
**0354T**39.18*37.22*42.80
**0358T**21.87*20.78*23.90
**0362T**81.28*77.22*88.80
#**0362T**59.58*56.60*65.09
**0378T**22.71*21.57*24.81
**0394T**213.06*202.41*232.77
**0395T**525.13*498.87*573.70
**0397T**42.35*40.23*46.26
**0408T**443.07*420.92*484.06
**0409T**305.51*290.23*333.76
**0410T**318.07*302.17*347.50
**0411T**318.07*302.17*347.50
**0412T**199.42*189.45*217.87
**0413T**414.46*393.74*452.80
**0414T**318.67*302.74*348.15
**0415T**266.09*252.79*290.71
**0416T**293.98*279.28*321.17
**0417T**72.12*68.51*78.79
**0418T**47.90*45.51*52.34
**0419T**393.32*373.65*429.70
#**0419T**320.16*304.15*349.77
**0420T**558.35*530.43*609.99
#**0420T**467.67*444.29*510.93
**0421T**1338.14*1271.23*1461.91
#**0421T**619.04*588.09*676.30
**0437T**187.49*178.12*204.84
**0439T**60.55*57.52*66.15
**0440T**213.89*203.20*233.68
#**0440T**107.34*101.97*117.27
**0441T**213.89*203.20*233.68
#**0441T**107.34*101.97*117.27
**0442T**213.89*203.20*233.68
#**0442T**107.34*101.97*117.27
**0449T**667.71*634.32*729.47
**0464T**56.44*53.62*61.66
**0472T**57.97*55.07*63.33
**0473T**47.90*45.51*52.34
**0479T**45.60*43.32*49.82
**0480T**60.49*57.47*66.09
#**0480T**22.80*21.66*24.91
**0483T**1032.16*980.55*1127.63
**0484T**1340.71*1273.67*1464.72
**0485T**20.72*19.68*22.63
**0485T*TC*7.26*6.90*7.94
**0485T*26*13.63*12.95*14.89
**0486T**41.45*39.38*45.29
**0486T*TC*14.35*13.63*15.67
**0486T*26*27.09*25.74*29.60
**0488T**55.88*53.09*61.05
#**0488T**45.04*42.79*49.21
**0505T**9576.86*9098.02*10462.72
#**0505T**509.69*484.21*556.84
**0507T**19.20*18.24*20.98
**0507T*TC*16.58*15.75*18.11
**0507T*26*2.62*2.49*2.86
**0510T**516.88*491.04*564.70
#**0510T**371.67*353.09*406.05
**0512T**271.51*257.93*296.62
#**0512T**200.85*190.81*219.43
**0513T**81.45*77.38*88.99
#**0513T**60.26*57.25*65.84
**0515T**443.07*420.92*484.06
**0516T**408.47*388.05*446.26
**0517T**289.31*274.84*316.07
**0518T**199.42*189.45*217.87
**0519T**290.29*275.78*317.15
**0520T**408.47*388.05*446.26
**0521T**47.90*45.51*52.34
**0521T*TC*29.38*27.91*32.10
**0521T*26*18.53*17.60*20.24
**0522T**57.97*55.07*63.33
**0522T*TC*29.65*28.17*32.40
**0522T*26*28.31*26.89*30.92
**0523T**130.49*123.97*142.57
**0524T**1324.62*1258.39*1447.15
#**0524T**154.87*147.13*169.20
**0525T**409.92*389.42*447.83
**0526T**318.07*302.17*347.50
**0527T**277.58*263.70*303.26
**0528T**57.97*55.07*63.33
**0528T*TC*29.65*28.17*32.40
**0528T*26*28.31*26.89*30.92
**0529T**47.90*45.51*52.34
**0529T*TC*29.38*27.91*32.10
**0529T*26*18.53*17.60*20.24
**0530T**544.14*516.93*594.47
**0531T**414.46*393.74*452.80
**0532T**290.29*275.78*317.15
**0543T**1340.71*1273.67*1464.72
**0544T**1537.47*1460.60*1679.69
**0545T**1537.47*1460.60*1679.69
**0546T**62.98*59.83*68.80
**0552T**6.00*5.70*6.56
**0565T**532.67*506.04*581.95
#**0565T**450.89*428.35*492.60
**0566T**86.11*81.80*94.07
#**0566T**52.45*49.83*57.30
**0569T**1537.47*1460.60*1679.69
**0570T**361.22*343.16*394.63
**0571T**479.20*455.24*523.53
**0572T**389.92*370.42*425.98
**0573T**298.47*283.55*326.08
**0574T**344.21*327.00*376.05
**0575T**57.97*55.07*63.33
**0576T**47.90*45.51*52.34
**0577T**170.22*161.71*185.97
**0578T**26.48*25.16*28.93
**0579T**16.58*15.75*18.11
**0580T**184.17*174.96*201.20
**0581T**1825.89*1734.60*1994.79
#**0581T**181.84*172.75*198.66
**0582T**1352.87*1285.23*1478.01
#**0582T**340.58*323.55*372.08
**0583T**1269.06*1205.61*1386.45
#**0583T**116.78*110.94*127.58
**0587T**361.02*342.97*394.42
#**0587T**261.99*248.89*286.22
**0588T**292.32*277.70*319.36
#**0588T**204.14*193.93*223.02
**0589T**42.65*40.52*46.60
#**0589T**34.86*33.12*38.09
**0590T**50.14*47.63*54.77
#**0590T**35.67*33.89*38.97
**0596T**2235.23*2123.47*2441.99
#**0596T**120.45*114.43*131.59
**0597T**120.45*114.43*131.59
**0598T**125.00*118.75*136.56
**0599T**84.91*80.66*92.76
**0600T**2948.50*2801.08*3221.24
#**0600T**654.91*622.16*715.48
**0601T**1258.48*1195.56*1374.89
**0604T**16.75*15.91*18.30
**0605T**36.89*35.05*40.31
**0606T**52.10*49.50*56.93
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**167.05*158.70*182.51
**0611T**34.83*33.09*38.05
**0614T**318.48*302.56*347.94
**0615T**41.65*39.57*45.51
**0619T**552.96*525.31*604.11
#**0619T**423.88*402.69*463.09
**0620T**1414.22*1343.51*1545.04
**0627T**218.52*207.59*238.73
#**0627T**88.89*84.45*97.12
**0628T**65.56*62.28*71.62
#**0628T**26.67*25.34*29.14
**0629T**218.52*207.59*238.73
#**0629T**88.89*84.45*97.12
**0630T**65.56*62.28*71.62
#**0630T**26.67*25.34*29.14
**0631T**68.73*65.29*75.08
**0632T**495.11*470.35*540.90
**0633T**170.85*162.31*186.66
*C*0633T*TC*91.41*86.84*99.87
**0633T*26*53.96*51.26*58.95
**0634T**170.85*162.31*186.66
**0634T*TC*116.89*111.05*127.71
**0634T*26*53.96*51.26*58.95
**0635T**170.85*162.31*186.66
**0635T*TC*116.89*111.05*127.71
**0635T*26*53.96*51.26*58.95
**0636T**170.85*162.31*186.66
**0636T*TC*116.89*111.05*127.71
**0636T*26*53.96*51.26*58.95
**0637T**170.85*162.31*186.66
**0637T*TC*116.89*111.05*127.71
**0637T*26*53.96*51.26*58.95
**0638T**170.85*162.31*186.66
**0638T*TC*116.89*111.05*127.71
**0638T*26*53.96*51.26*58.95
**0639T**68.73*65.29*75.08
**0640T**19.20*18.24*20.98
**0640T*TC*16.58*15.75*18.11
**0640T*26*2.62*2.49*2.86
**0644T**952.36*904.74*1040.45
#**0644T**210.17*199.66*229.61
**0646T**1537.47*1460.60*1679.69
**0650T**50.98*48.43*55.69
**0652T**244.04*231.84*266.62
#**0652T**108.01*102.61*118.00
**0653T**314.73*298.99*343.84
#**0653T**121.67*115.59*132.93
**0654T**125.30*119.04*136.90
**0655T**1338.14*1271.23*1461.91
#**0655T**619.04*588.09*676.30
**0658T**78.61*74.68*85.88
**0659T**2173.17*2064.51*2374.19
#**0659T**376.68*357.85*411.53
**0660T**667.71*634.32*729.47
**0671T**896.83*851.99*979.79
**0673T**2794.97*2655.22*3053.50
#**0673T**323.62*307.44*353.56
**0699T**98.94*93.99*108.09
#**0699T**81.41*77.34*88.94
**0707T**311.73*296.14*340.56
#**0707T**238.84*226.90*260.94
**0714T**1151.49*1093.92*1258.01
#**0714T**318.07*302.17*347.50
**0738T**64.20*60.99*70.14
**0739T**1338.14*1271.23*1461.91
#**0739T**619.04*588.09*676.30
**0740T**16.75*15.91*18.30
**0741T**36.89*35.05*40.31
**0742T**78.22*74.31*85.46
**0742T*TC*60.71*57.67*66.32
**0742T*26*17.51*16.63*19.12
**0743T**46.09*43.79*50.36
**0744T**765.63*727.35*836.45
**0745T**215.65*204.87*235.60
**0746T**206.99*196.64*226.14
**0747T**813.47*772.80*888.72
**0748T**160.56*152.53*175.41
**0751T**0.01*0.01*0.01
**0752T**0.01*0.01*0.01
**0753T**0.01*0.01*0.01
**0754T**0.01*0.01*0.01
**0755T**0.01*0.01*0.01
**0756T**0.01*0.01*0.01
**0757T**0.01*0.01*0.01
**0758T**0.01*0.01*0.01
**0759T**0.01*0.01*0.01
**0760T**0.01*0.01*0.01
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**0.01*0.01*0.01
**0764T**3.75*3.56*4.09
**0765T**7.34*6.97*8.02
**0771T**23.51*22.33*25.68
**0772T**23.51*22.33*25.68
**0773T**20.18*19.17*22.05
**0774T**20.18*19.17*22.05
**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*3.75*3.56*4.09
**0779T**350.03*332.53*382.41
**0779T*TC*326.47*310.15*356.67
**0779T*26*23.55*22.37*25.73
**0780T**20.18*19.17*22.05
**0783T**11.85*11.26*12.95
**0784T**1728.81*1642.37*1888.73
#**0784T**292.01*277.41*319.02
**0785T**206.08*195.78*225.15
#**0785T**127.36*120.99*139.14
**0786T**612.25*581.64*668.89
#**0786T**269.54*256.06*294.47
**0787T**206.08*195.78*225.15
#**0787T**127.36*120.99*139.14
**0788T**16.83*15.99*18.39
#**0788T**16.55*15.72*18.08
**0789T**21.04*19.99*22.99
#**0789T**20.69*19.66*22.61
**0790T**1721.63*1635.55*1880.88
**0791T**8.04*7.64*8.79
**0793T**495.11*470.35*540.90
**0794T**130.35*123.83*142.40
**0795T**612.71*582.07*669.38
**0796T**408.47*388.05*446.26
**0797T**408.47*388.05*446.26
**0798T**648.23*615.82*708.19
**0799T**432.15*410.54*472.12
**0800T**430.82*409.28*470.67
**0801T**840.63*798.60*918.39
**0802T**420.31*399.29*459.18
**0803T**420.31*399.29*459.18
**0804T**67.69*64.31*73.96
**0804T*TC*34.38*32.66*37.56
**0804T*26*33.31*31.64*36.39
**0805T**2398.28*2278.37*2620.13
#**0805T**289.40*274.93*316.17
**0806T**3197.71*3037.82*3493.49
#**0806T**385.86*366.57*421.56
**0807T**36.80*34.96*40.20
**0807T*TC*23.26*22.10*25.42
**0807T*26*13.54*12.86*14.79
**0808T**36.80*34.96*40.20
**0808T*TC*23.26*22.10*25.42
**0808T*26*13.54*12.86*14.79
**0810T**999.59*949.61*1092.05
**0811T**16.75*15.91*18.30
**0813T**2023.74*1922.55*2210.93
#**0813T**156.04*148.24*170.48
**0814T**365.44*347.17*399.25
#**0814T**274.34*260.62*299.71
**0820T**142.11*135.00*155.25
#**0820T**126.53*120.20*138.23
**0821T**142.11*135.00*155.25
#**0821T**126.53*120.20*138.23
**0822T**120.79*114.75*131.96
#**0822T**107.55*102.17*117.50
**0823T**612.71*582.07*669.38
**0824T**648.23*615.82*708.19
**0825T**840.63*798.60*918.39
**0826T**57.97*55.07*63.33
**0826T*TC*29.65*28.17*32.40
**0826T*26*28.31*26.89*30.92
**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**19.20*18.24*20.98
**0859T*TC*16.58*15.75*18.11
**0859T*26*2.62*2.49*2.86
**0864T**271.51*257.93*296.62
#**0864T**200.85*190.81*219.43
**0867T**1439.37*1367.40*1572.51
#**0867T**397.58*377.70*434.36
**0868T**350.03*332.53*382.41
**0868T*TC*326.47*310.15*356.67
**0868T*26*23.55*22.37*25.73
**0869T**311.73*296.14*340.56
#**0869T**238.84*226.90*260.94
**0876T**123.56*117.38*134.99
**0876T*TC*101.48*96.41*110.87
**0876T*26*24.02*22.82*26.24
**0884T**852.11*809.50*930.93
#**0884T**165.71*157.42*181.03
**0885T**567.62*539.24*620.13
#**0885T**267.74*254.35*292.50
**0886T**458.99*436.04*501.45
#**0886T**93.40*88.73*102.04
**0897T**49.95*47.45*54.57
**0897T*TC*44.29*42.08*48.39
**0897T*26*7.34*6.97*8.02
**0898T**59.55*56.57*65.06
**0898T*TC*50.96*48.41*55.67
**0898T*26*8.58*8.15*9.37
**0899T**111.82*106.23*122.16
**0899T*TC*71.75*68.16*78.38
**0899T*26*38.39*36.47*41.94
**0900T**110.15*104.64*120.34
**0900T*TC*71.75*68.16*78.38
**0900T*26*38.39*36.47*41.94
**10011**356.64*338.81*389.63
#**10011**97.10*92.25*106.09
**10012**200.99*190.94*219.58
#**10012**64.96*61.71*70.97
**15847**309.14*293.68*337.73
**21742**1008.89*958.45*1102.22
**21743**1171.18*1112.62*1279.51
**32855**315.04*299.29*344.18
**32856**389.99*370.49*426.06
**33928**2868.50*2725.08*3133.84
**33929**1075.04*1021.29*1174.48
**33933**481.02*456.97*525.52
**33944**453.77*431.08*495.74
**34841**2457.23*2334.37*2684.53
**34842**2822.59*2681.46*3083.68
**34843**3070.96*2917.41*3355.02
**34844**3319.32*3153.35*3626.35
**34845**2457.23*2334.37*2684.53
**34846**2822.59*2681.46*3083.68
**34847**3070.96*2917.41*3355.02
**34848**3319.32*3153.35*3626.35
**43647**553.90*526.21*605.14
**43648**478.68*454.75*522.96
#**43648**219.95*208.95*240.29
**43881**579.14*550.18*632.71
#**43881**529.92*503.42*578.93
**43882**612.89*582.25*669.59
#**43882**559.91*531.91*611.70
**47143**372.81*354.17*407.30
**47144**442.71*420.57*483.66
**47145**419.40*398.43*458.19
**48551**240.49*228.47*262.74
**50323**145.43*138.16*158.88
**50325**212.01*201.41*231.62
**53451**676.03*642.23*738.56
**53452**338.02*321.12*369.29
**53453**574.47*545.75*627.61
**53454**49.91*47.41*54.52
#**53454**31.83*30.24*34.78
**63043**477.00*453.15*521.12
**63044**446.68*424.35*488.00
**64596**1728.81*1642.37*1888.73
#**64596**292.01*277.41*319.02
**64597**518.84*492.90*566.84
#**64597**87.80*83.41*95.92
**64598**206.08*195.78*225.15
#**64598**127.36*120.99*139.14
**65757**109.84*104.35*120.00
**66983**586.91*557.56*641.19
**66987**682.61*648.48*745.75
**66988**567.19*538.83*619.65
*C*70170**220.79*209.75*241.21
*C*70170*TC*207.69*197.31*226.91
**70555**241.72*229.63*264.07
**70555*TC*133.46*126.79*145.81
*C*70557**608.28*577.87*664.55
*C*70557*TC*471.40*447.83*515.00
*C*70558**304.25*289.04*332.40
*C*70558*TC*152.89*145.25*167.04
*C*70559**295.58*280.80*322.92
*C*70559*TC*152.89*145.25*167.04
*C*74190**491.33*466.76*536.77
*C*74190*TC*471.40*447.83*515.00
**74235**127.12*120.76*138.87
**74235*TC*75.55*71.77*82.54
**74300**72.94*69.29*79.68
**74300*TC*61.09*58.04*66.75
**74301**22.24*21.13*24.30
**74301*TC*13.05*12.40*14.26
**74328**175.06*166.31*191.26
**74328*TC*154.24*146.53*168.51
**74329**121.49*115.42*132.73
**74329*TC*100.39*95.37*109.68
**74330**262.59*249.46*286.88
**74330*TC*238.02*226.12*260.04
**74340**86.58*82.25*94.59
**74340*TC*63.32*60.15*69.17
**74355**86.58*82.25*94.59
**74355*TC*53.54*50.86*58.49
**74360**86.58*82.25*94.59
**74360*TC*62.32*59.20*68.08
**74363**175.06*166.31*191.26
**74363*TC*138.91*131.96*151.75
*C*74445**140.36*133.34*153.34
*C*74445*TC*91.41*86.84*99.87
*C*74450**221.87*210.78*242.40
*C*74450*TC*207.69*197.31*226.91
*C*74470**494.38*469.66*540.11
*C*74470*TC*471.40*447.83*515.00
**74742**233.47*221.80*255.07
**74742*TC*207.12*196.76*226.27
*C*74775**234.65*222.92*256.36
*C*74775*TC*207.69*197.31*226.91
*C*75801**569.33*540.86*621.99
*C*75801*TC*531.49*504.92*580.66
*C*75803**1386.35*1317.03*1514.58
*C*75803*TC*1335.71*1268.92*1459.26
*C*75805**2742.07*2604.97*2995.72
*C*75805*TC*2706.86*2571.52*2957.25
*C*75807**2754.50*2616.78*3009.30
*C*75807*TC*2706.86*2571.52*2957.25
*C*75810**2750.97*2613.42*3005.43
*C*75810*TC*2706.86*2571.52*2957.25
**75894**759.37*721.40*829.61
**75894*TC*697.00*662.15*761.47
*C*75898**2785.73*2646.44*3043.41
*C*75898*TC*2706.86*2571.52*2957.25
**75970**371.73*353.14*406.11
**75970*TC*337.65*320.77*368.89
**76125**34.36*32.64*37.54
**76125*TC*22.23*21.12*24.29
**76390**178.74*169.80*195.27
**76390*TC*130.72*124.18*142.81
**76390*26*48.02*45.62*52.46
**76932**73.82*70.13*80.65
**76932*TC*42.46*40.34*46.39
**76940**136.77*129.93*149.42
**76940*TC*47.36*44.99*51.74
**76941**102.74*97.60*112.24
**76941*TC*44.43*42.21*48.54
**76945**73.08*69.43*79.84
**76945*TC*44.01*41.81*48.08
*C*76975**244.41*232.19*267.02
*C*76975*TC*207.69*197.31*226.91
**76998**175.06*166.31*191.26
**76998*TC*134.04*127.34*146.44
**77013**365.30*347.04*399.10
**77013*TC*199.22*189.26*217.65
**77022**414.42*393.70*452.76
**77022*TC*233.19*221.53*254.76
**77520**772.52*733.89*843.97
**77522**772.52*733.89*843.97
**77523**887.13*842.77*969.19
**77525**1001.75*951.66*1094.41
*C*78282**359.52*341.54*392.77
*C*78282*TC*345.39*328.12*377.34
**78414**514.99*489.24*562.63
**78414*TC*495.58*470.80*541.42
*C*78429**1326.71*1260.37*1449.43
*C*78429*TC*1254.20*1191.49*1370.21
*C*78430**1322.80*1256.66*1445.16
*C*78430*TC*1254.20*1191.49*1370.21
*C*78431**2015.29*1914.53*2201.71
*C*78431*TC*1935.19*1838.43*2114.19
*C*78432**1679.24*1595.28*1834.57
*C*78432*TC*1591.36*1511.79*1738.56
*C*78433**1771.34*1682.77*1935.19
*C*78433*TC*1677.31*1593.44*1832.46
**78434**604.81*574.57*660.76
**78434*TC*578.25*549.34*631.74
*C*78459**1189.73*1130.24*1299.78
*C*78459*TC*1122.62*1066.49*1226.46
*C*78491**1319.97*1253.97*1442.07
*C*78491*TC*1254.20*1191.49*1370.21
*C*78492**1330.51*1263.98*1453.58
*C*78492*TC*1254.20*1191.49*1370.21
*C*78608**1317.19*1251.33*1439.03
*C*78608*TC*1254.20*1191.49*1370.21
*C*78811**1187.63*1128.25*1297.49
*C*78811*TC*1122.62*1066.49*1226.46
*C*78812**1335.78*1268.99*1459.34
*C*78812*TC*1254.20*1191.49*1370.21
*C*78813**1337.48*1270.61*1461.20
*C*78813*TC*1254.20*1191.49*1370.21
*C*78814**1346.79*1279.45*1471.37
*C*78814*TC*1254.20*1191.49*1370.21
*C*78815**1357.67*1289.79*1483.26
*C*78815*TC*1254.20*1191.49*1370.21
*C*78816**1358.72*1290.78*1484.40
*C*78816*TC*1254.20*1191.49*1370.21
**79300**237.04*225.19*258.97
**79300*TC*177.72*168.83*194.15
**79445**237.04*225.19*258.97
**79445*TC*137.25*130.39*149.95
**90867**255.88*243.09*279.55
#**90867**119.43*113.46*130.48
**90868**174.42*165.70*190.56
#**90868**99.76*94.77*108.99
**90869**208.36*197.94*227.63
#**90869**140.48*133.46*153.48
**92978**212.74*202.10*232.42
**92978*TC*131.29*124.73*143.44
**92979**130.63*124.10*142.72
**92979*TC*65.62*62.34*71.69
*C*93315**585.07*555.82*639.19
*C*93315*TC*471.40*447.83*515.00
**93317**186.38*177.06*203.62
**93317*TC*107.33*101.96*117.25
*C*93318**562.94*534.79*615.01
*C*93318*TC*471.40*447.83*515.00
**93571**211.87*201.28*231.47
**93571*TC*149.69*142.21*163.54
**93572**128.77*122.33*140.68
**93572*TC*83.67*79.49*91.41
**93600**3557.81*3379.92*3886.91
**93600*TC*3458.61*3285.68*3778.53
**93602**3557.81*3379.92*3886.91
**93602*TC*3459.61*3286.63*3779.62
**93603**3557.81*3379.92*3886.91
**93603*TC*3459.61*3286.63*3779.62
**93609**2134.69*2027.96*2332.15
**93609*TC*1901.40*1806.33*2077.28
**93610**3557.81*3379.92*3886.91
**93610*TC*3419.47*3248.50*3735.78
**93612**3557.81*3379.92*3886.91
**93612*TC*3420.42*3249.40*3736.81
**93615**44.25*42.04*48.35
**93615*TC*12.82*12.18*14.01
**93619**7115.62*6759.84*7773.82
**93619*TC*6786.91*6447.56*7414.69
**93620**7115.62*6759.84*7773.82
**93620*TC*6586.92*6257.57*7196.21
**93621**7115.62*6759.84*7773.82
**93621*TC*7045.44*6693.17*7697.15
**93622**7115.62*6759.84*7773.82
**93622*TC*6970.24*6621.73*7614.99
**93623**2134.69*2027.96*2332.15
**93623*TC*2087.73*1983.34*2280.84
**93624**3557.81*3379.92*3886.91
**93624*TC*3352.66*3185.03*3662.78
**93631**7115.62*6759.84*7773.82
**93631*TC*6779.38*6440.41*7406.47
**93640**1133.95*1077.25*1238.84
**93640*TC*982.95*933.80*1073.87
**93641**1133.95*1077.25*1238.84
**93641*TC*870.92*827.37*951.48
**93662**329.55*313.07*360.03
**93662*TC*268.26*254.85*293.08
**94642**29.42*27.95*32.14
**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**901.98*856.88*985.41
**95965*TC*545.26*518.00*595.70
**96020**377.70*358.82*412.64
**97151**47.44*45.07*51.83
#**97151**41.17*39.11*44.98
**97152**39.02*37.07*42.63
#**97152**35.00*33.25*38.24
**97153**32.59*30.96*35.60
#**97153**28.97*27.52*31.65
**97154**4.14*3.93*4.52
#**97154**3.78*3.59*4.13
**97155**31.18*29.62*34.06
#**97155**27.70*26.32*30.27
**97156**32.93*31.28*35.97
#**97156**29.32*27.85*32.03
**97157**9.51*9.03*10.38
#**97157**8.67*8.24*9.48
**97158**4.84*4.60*5.29
#**97158**4.42*4.20*4.83
**98978**36.89*35.05*40.31
# - 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 2024 BY THE AMERICAN MEDICAL ASSOCIATION.