LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
NEW ORLEANS
******
**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**479.01*455.06*523.32
#**G0186**412.17*391.56*450.29
**G0339**2763.05*2624.90*3018.64
**G0340**2078.06*1974.16*2270.28
**G0398**118.58*112.65*129.55
**G0398*TC*81.80*77.71*89.37
**G0398*26*36.78*34.94*40.18
**G0399**89.42*84.95*97.69
**G0399*TC*48.23*45.82*52.69
**G0399*26*41.18*39.12*44.99
**G0400**90.46*85.94*98.83
**G0400*TC*52.16*49.55*56.98
**G0400*26*38.29*36.38*41.84
**G0460**730.81*694.27*798.41
#**G0460**116.56*110.73*127.34
**G0498**134.62*127.89*147.07
**G0552**128.87*122.43*140.79
**G6017**74.07*70.37*80.93
**0042T**211.41*200.84*230.97
**0054T**228.26*216.85*249.38
**0055T**228.26*216.85*249.38
**0071T**542.09*514.99*592.24
**0072T**542.09*514.99*592.24
**0075T*26*947.15*899.79*1034.76
**0076T**1045.19*992.93*1141.87
**0095T**618.42*587.50*675.63
**0098T**693.05*658.40*757.16
**0101T**290.83*276.29*317.73
#**0101T**214.01*203.31*233.81
**0102T**290.83*276.29*317.73
#**0102T**214.01*203.31*233.81
**0106T**29.89*28.40*32.66
**0107T**29.89*28.40*32.66
**0108T**29.89*28.40*32.66
**0109T**29.89*28.40*32.66
**0110T**29.89*28.40*32.66
**0164T**675.81*642.02*738.32
**0165T**692.18*657.57*756.21
**0184T**792.90*753.26*866.25
**0198T**78.25*74.34*85.49
#**0198T**30.16*28.65*32.95
**0200T**1590.39*1510.87*1737.50
#**0200T**390.92*371.37*427.08
**0201T**2385.59*2266.31*2606.26
#**0201T**586.37*557.05*640.61
**0207T**128.90*122.46*140.83
**0208T**36.36*34.54*39.72
**0209T**43.93*41.73*47.99
**0210T**27.59*26.21*30.14
**0211T**42.72*40.58*46.67
**0212T**34.37*32.65*37.55
#**0212T**30.14*28.63*32.92
**0213T**179.25*170.29*195.83
#**0213T**100.61*95.58*109.92
**0214T**91.98*87.38*100.49
#**0214T**57.20*54.34*62.49
**0215T**91.61*87.03*100.08
#**0215T**57.43*54.56*62.74
**0216T**165.24*156.98*180.53
#**0216T**86.91*82.56*94.94
**0217T**85.08*80.83*92.95
#**0217T**48.79*46.35*53.30
**0218T**84.03*79.83*91.80
#**0218T**48.95*46.50*53.48
**0219T**1288.68*1224.25*1407.89
**0220T**1267.16*1203.80*1384.37
**0221T**1549.56*1472.08*1692.89
**0222T**383.99*364.79*419.51
**0232T**837.09*795.24*914.53
#**0232T**86.44*82.12*94.44
**0234T**7429.83*7058.34*8117.09
#**0234T**568.38*539.96*620.95
**0235T**7429.83*7058.34*8117.09
#**0235T**568.38*539.96*620.95
**0236T**7594.55*7214.82*8297.04
#**0236T**659.30*626.34*720.29
**0237T**7594.55*7214.82*8297.04
#**0237T**659.30*626.34*720.29
**0238T**7594.55*7214.82*8297.04
#**0238T**659.30*626.34*720.29
**0266T**869.56*826.08*949.99
**0267T**154.27*146.56*168.54
**0268T**322.28*306.17*352.10
**0269T**821.81*780.72*897.83
**0270T**154.27*146.56*168.54
**0271T**322.28*306.17*352.10
**0272T**51.25*48.69*55.99
**0273T**65.98*62.68*72.08
**0274T**1086.88*1032.54*1187.42
**0278T**13.90*13.21*15.19
**0308T**1312.55*1246.92*1433.96
**0329T**78.25*74.34*85.49
#**0329T**30.16*28.65*32.95
**0330T**39.25*37.29*42.88
**0331T**166.71*158.37*182.13
**0332T**281.11*267.05*307.11
**0347T**138.27*131.36*151.06
**0348T**30.51*28.98*33.33
**0349T**31.98*30.38*34.94
**0350T**32.88*31.24*35.93
**0351T**153.19*145.53*167.36
**0352T**40.91*38.86*44.69
**0353T**153.19*145.53*167.36
**0354T**40.91*38.86*44.69
**0358T**23.96*22.76*26.17
**0362T**86.62*82.29*94.63
#**0362T**63.03*59.88*68.86
**0378T**23.91*22.71*26.12
**0394T**230.21*218.70*251.51
**0395T**565.57*537.29*617.88
**0397T**44.24*42.03*48.33
**0408T**494.30*469.59*540.03
**0409T**340.66*323.63*372.17
**0410T**354.11*336.40*386.86
**0411T**354.11*336.40*386.86
**0412T**221.57*210.49*242.06
**0413T**462.17*439.06*504.92
**0414T**355.06*337.31*387.91
**0415T**296.90*282.06*324.37
**0416T**327.23*310.87*357.50
**0417T**76.78*72.94*83.88
**0418T**51.25*48.69*55.99
**0419T**424.27*403.06*463.52
#**0419T**344.73*327.49*376.61
**0420T**605.09*574.84*661.07
#**0420T**506.50*481.18*553.36
**0421T**1448.75*1376.31*1582.76
#**0421T**666.94*633.59*728.63
**0437T**206.77*196.43*225.89
**0439T**66.08*62.78*72.20
**0440T**230.98*219.43*252.34
#**0440T**115.15*109.39*125.80
**0441T**230.98*219.43*252.34
#**0441T**115.15*109.39*125.80
**0442T**230.98*219.43*252.34
#**0442T**115.15*109.39*125.80
**0449T**712.91*677.26*778.85
**0464T**60.76*57.72*66.38
**0472T**61.77*58.68*67.48
**0473T**51.25*48.69*55.99
**0479T**48.00*45.60*52.44
**0480T**64.98*61.73*70.99
#**0480T**24.00*22.80*26.22
**0483T**1158.31*1100.39*1265.45
**0484T**1504.65*1429.42*1643.83
**0485T**21.96*20.86*23.99
**0485T*TC*8.09*7.69*8.84
**0485T*26*14.25*13.54*15.57
**0486T**43.92*41.72*47.98
**0486T*TC*15.80*15.01*17.26
**0486T*26*28.12*26.71*30.72
**0488T**59.09*56.14*64.56
#**0488T**47.29*44.93*51.67
**0505T**10619.39*10088.42*11601.68
#**0505T**574.78*546.04*627.95
**0507T**21.12*20.06*23.07
**0507T*TC*18.22*17.31*19.91
**0507T*26*2.90*2.76*3.17
**0510T**564.89*536.65*617.15
#**0510T**407.02*386.67*444.67
**0512T**290.83*276.29*317.73
#**0512T**214.01*203.31*233.81
**0513T**87.25*82.89*95.32
#**0513T**64.20*60.99*70.14
**0515T**494.30*469.59*540.03
**0516T**455.65*432.87*497.80
**0517T**322.28*306.17*352.10
**0518T**221.57*210.49*242.06
**0519T**323.43*307.26*353.35
**0520T**455.65*432.87*497.80
**0521T**51.25*48.69*55.99
**0521T*TC*32.13*30.52*35.10
**0521T*26*19.12*18.16*20.88
**0522T**61.77*58.68*67.48
**0522T*TC*32.43*30.81*35.43
**0522T*26*29.33*27.86*32.04
**0523T**142.80*135.66*156.01
**0524T**1443.88*1371.69*1577.44
#**0524T**172.12*163.51*188.04
**0525T**457.61*434.73*499.94
**0526T**354.11*336.40*386.86
**0527T**309.70*294.22*338.35
**0528T**61.77*58.68*67.48
**0528T*TC*32.43*30.81*35.43
**0528T*26*29.33*27.86*32.04
**0529T**51.25*48.69*55.99
**0529T*TC*32.13*30.52*35.10
**0529T*26*19.12*18.16*20.88
**0530T**606.62*576.29*662.73
**0531T**462.17*439.06*504.92
**0532T**323.43*307.26*353.35
**0543T**1504.65*1429.42*1643.83
**0544T**1720.95*1634.90*1880.14
**0545T**1720.95*1634.90*1880.14
**0546T**66.74*63.40*72.91
**0552T**6.55*6.22*7.15
**0565T**584.11*554.90*638.14
#**0565T**495.19*470.43*540.99
**0566T**93.58*88.90*102.24
#**0566T**56.99*54.14*62.26
**0569T**1720.95*1634.90*1880.14
**0570T**404.87*384.63*442.32
**0571T**534.63*507.90*584.09
**0572T**435.75*413.96*476.05
**0573T**332.98*316.33*363.78
**0574T**384.08*364.88*419.61
**0575T**61.77*58.68*67.48
**0576T**51.25*48.69*55.99
**0577T**178.22*169.31*194.71
**0578T**27.86*26.47*30.44
**0579T**18.22*17.31*19.91
**0580T**204.89*194.65*223.85
**0581T**1992.74*1893.10*2177.07
#**0581T**205.32*195.05*224.31
**0582T**1467.74*1394.35*1603.50
#**0582T**367.16*348.80*401.12
**0583T**1379.52*1310.54*1507.12
#**0583T**126.76*120.42*138.48
**0587T**391.73*372.14*427.96
#**0587T**284.06*269.86*310.34
**0588T**317.67*301.79*347.06
#**0588T**221.79*210.70*242.31
**0589T**45.32*43.05*49.51
#**0589T**36.85*35.01*40.26
**0590T**53.60*50.92*58.56
#**0590T**37.87*35.98*41.38
**0596T**2235.23*2123.47*2441.99
#**0596T**125.71*119.42*137.33
**0597T**125.71*119.42*137.33
**0598T**135.91*129.11*148.48
**0599T**92.17*87.56*100.69
**0600T**3193.52*3033.84*3488.92
#**0600T**699.90*664.91*764.65
**0601T**1411.70*1341.12*1542.29
**0604T**18.59*17.66*20.31
**0605T**40.30*38.29*44.03
**0606T**55.75*52.96*60.90
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**179.17*170.21*195.74
**0611T**38.25*36.34*41.79
**0614T**354.80*337.06*387.62
**0615T**43.96*41.76*48.02
**0619T**597.74*567.85*653.03
#**0619T**457.41*434.54*499.72
**0620T**1414.22*1343.51*1545.04
**0627T**235.76*223.97*257.57
#**0627T**94.82*90.08*103.59
**0628T**70.73*67.19*77.27
#**0628T**28.45*27.03*31.08
**0629T**235.76*223.97*257.57
#**0629T**94.82*90.08*103.59
**0630T**70.73*67.19*77.27
#**0630T**28.45*27.03*31.08
**0631T**74.98*71.23*81.91
**0632T**553.70*526.02*604.92
**0633T**183.76*174.57*200.76
*C*0633T*TC*99.57*94.59*108.78
**0633T*26*56.29*53.48*61.50
**0634T**183.76*174.57*200.76
**0634T*TC*127.47*121.10*139.27
**0634T*26*56.29*53.48*61.50
**0635T**183.76*174.57*200.76
**0635T*TC*127.47*121.10*139.27
**0635T*26*56.29*53.48*61.50
**0636T**183.76*174.57*200.76
**0636T*TC*127.47*121.10*139.27
**0636T*26*56.29*53.48*61.50
**0637T**183.76*174.57*200.76
**0637T*TC*127.47*121.10*139.27
**0637T*26*56.29*53.48*61.50
**0638T**183.76*174.57*200.76
**0638T*TC*127.47*121.10*139.27
**0638T*26*56.29*53.48*61.50
**0639T**74.98*71.23*81.91
**0640T**21.12*20.06*23.07
**0640T*TC*18.22*17.31*19.91
**0640T*26*2.90*2.76*3.17
**0644T**1041.09*989.04*1137.40
#**0644T**234.18*222.47*255.84
**0646T**1720.95*1634.90*1880.14
**0650T**54.54*51.81*59.58
**0652T**264.61*251.38*289.09
#**0652T**116.71*110.87*127.50
**0653T**340.99*323.94*372.53
#**0653T**131.10*124.55*143.23
**0654T**135.53*128.75*148.06
**0655T**1448.75*1376.31*1582.76
#**0655T**666.94*633.59*728.63
**0658T**85.66*81.38*93.59
**0659T**2374.82*2256.08*2594.49
#**0659T**421.66*400.58*460.67
**0660T**712.91*677.26*778.85
**0671T**957.56*909.68*1046.13
**0673T**3039.62*2887.64*3320.79
#**0673T**352.74*335.10*385.37
**0699T**105.81*100.52*115.60
#**0699T**86.75*82.41*94.77
**0707T**337.15*320.29*368.33
#**0707T**257.91*245.01*281.76
**0714T**1249.09*1186.64*1364.64
#**0714T**342.98*325.83*374.70
**0738T**67.28*63.92*73.51
**0739T**1448.75*1376.31*1582.76
#**0739T**666.94*633.59*728.63
**0740T**18.59*17.66*20.31
**0741T**40.30*38.29*44.03
**0742T**84.33*80.11*92.13
**0742T*TC*66.23*62.92*72.36
**0742T*26*18.10*17.20*19.78
**0743T**49.84*47.35*54.45
**0744T**864.44*821.22*944.40
**0745T**235.80*224.01*257.61
**0746T**216.20*205.39*236.20
**0747T**889.59*845.11*971.88
**0748T**175.99*167.19*192.27
**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**4.05*3.85*4.43
**0765T**7.69*7.31*8.41
**0771T**25.32*24.05*27.66
**0772T**25.32*24.05*27.66
**0773T**21.62*20.54*23.62
**0774T**21.62*20.54*23.62
**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**379.66*360.68*414.78
**0779T*TC*355.14*337.38*387.99
**0779T*26*24.52*23.29*26.78
**0780T**21.62*20.54*23.62
**0783T**13.08*12.43*14.29
**0784T**1875.41*1781.64*2048.89
#**0784T**313.31*297.64*342.29
**0785T**223.66*212.48*244.35
#**0785T**138.07*131.17*150.85
**0786T**664.11*630.90*725.54
#**0786T**291.50*276.93*318.47
**0787T**223.66*212.48*244.35
#**0787T**138.07*131.17*150.85
**0788T**17.89*17.00*19.55
#**0788T**17.58*16.70*19.21
**0789T**22.36*21.24*24.43
#**0789T**21.98*20.88*24.01
**0790T**1840.21*1748.20*2010.43
**0791T**8.55*8.12*9.34
**0793T**553.70*526.02*604.92
**0794T**130.35*123.83*142.40
**0795T**683.48*649.31*746.71
**0796T**455.65*432.87*497.80
**0797T**455.65*432.87*497.80
**0798T**725.08*688.83*792.15
**0799T**483.38*459.21*528.09
**0800T**482.32*458.20*526.93
**0801T**939.04*892.09*1025.90
**0802T**469.52*446.04*512.95
**0803T**469.52*446.04*512.95
**0804T**72.00*68.40*78.66
**0804T*TC*37.57*35.69*41.04
**0804T*26*34.43*32.71*37.62
**0805T**2606.68*2476.35*2847.80
#**0805T**313.89*298.20*342.93
**0806T**3475.58*3301.80*3797.07
#**0806T**418.51*397.58*457.22
**0807T**39.93*37.93*43.62
**0807T*TC*25.48*24.21*27.84
**0807T*26*14.46*13.74*15.80
**0808T**39.93*37.93*43.62
**0808T*TC*25.48*24.21*27.84
**0808T*26*14.46*13.74*15.80
**0810T**1065.05*1011.80*1163.57
**0811T**18.59*17.66*20.31
**0813T**2201.43*2091.36*2405.06
#**0813T**170.85*162.31*186.66
**0814T**395.29*375.53*431.86
#**0814T**296.24*281.43*323.64
**0820T**146.75*139.41*160.32
#**0820T**129.81*123.32*141.82
**0821T**146.75*139.41*160.32
#**0821T**129.81*123.32*141.82
**0822T**124.73*118.49*136.26
#**0822T**110.34*104.82*120.54
**0823T**683.48*649.31*746.71
**0824T**725.08*688.83*792.15
**0825T**939.04*892.09*1025.90
**0826T**61.77*58.68*67.48
**0826T*TC*32.43*30.81*35.43
**0826T*26*29.33*27.86*32.04
**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**21.12*20.06*23.07
**0859T*TC*18.22*17.31*19.91
**0859T*26*2.90*2.76*3.17
**0864T**290.83*276.29*317.73
#**0864T**214.01*203.31*233.81
**0867T**1561.36*1483.29*1705.78
#**0867T**428.72*407.28*468.37
**0868T**379.66*360.68*414.78
**0868T*TC*355.14*337.38*387.99
**0868T*26*24.52*23.29*26.78
**0869T**337.15*320.29*368.33
#**0869T**257.91*245.01*281.76
**0876T**134.84*128.10*147.32
**0876T*TC*110.91*105.36*121.16
**0876T*26*25.87*24.58*28.27
**0884T**926.38*880.06*1012.07
#**0884T**180.11*171.10*196.77
**0885T**615.60*584.82*672.54
#**0885T**289.57*275.09*316.35
**0886T**509.84*484.35*557.00
#**0886T**101.14*96.08*110.49
**0897T**54.41*51.69*59.44
**0897T*TC*48.53*46.10*53.02
**0897T*26*7.69*7.31*8.41
**0898T**64.75*61.51*70.74
**0898T*TC*55.79*53.00*60.95
**0898T*26*8.96*8.51*9.79
**0899T**119.89*113.90*130.99
**0899T*TC*78.18*74.27*85.41
**0899T*26*39.89*37.90*43.59
**0900T**118.08*112.18*129.01
**0900T*TC*78.18*74.27*85.41
**0900T*26*39.89*37.90*43.59
**10011**385.58*366.30*421.25
#**10011**103.41*98.24*112.98
**10012**217.89*207.00*238.05
#**10012**69.99*66.49*76.46
**15847**340.89*323.85*372.43
**21742**1122.53*1066.40*1226.36
**21743**1338.63*1271.70*1462.46
**32855**348.71*331.27*380.96
**32856**439.91*417.91*480.60
**33928**3227.95*3066.55*3526.53
**33929**1208.79*1148.35*1320.60
**33933**534.43*507.71*583.87
**33944**567.86*539.47*620.39
**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**693.16*658.50*757.28
**43648**527.22*500.86*575.99
#**43648**238.19*226.28*260.22
**43881**669.48*636.01*731.41
#**43881**613.95*583.25*670.74
**43882**709.55*674.07*775.18
#**43882**649.76*617.27*709.86
**47143**425.19*403.93*464.52
**47144**504.90*479.66*551.61
**47145**478.34*454.42*522.58
**48551**265.61*252.33*290.18
**50323**160.15*152.14*174.96
**50325**265.30*252.04*289.85
**53451**728.42*692.00*795.80
**53452**364.21*346.00*397.90
**53453**619.18*588.22*676.45
**53454**53.24*50.58*58.17
#**53454**33.59*31.91*36.70
**63043**564.81*536.57*617.06
**63044**511.42*485.85*558.73
**64596**1875.41*1781.64*2048.89
#**64596**313.31*297.64*342.29
**64597**562.82*534.68*614.88
#**64597**94.19*89.48*102.90
**64598**223.66*212.48*244.35
#**64598**138.07*131.17*150.85
**65757**117.14*111.28*127.97
**66983**622.33*591.21*679.89
**66987**726.40*690.08*793.59
**66988**600.27*570.26*655.80
*C*70170**239.77*227.78*261.95
*C*70170*TC*225.99*214.69*246.89
**70555**241.72*229.63*264.07
**70555*TC*128.69*122.26*140.60
*C*70557**655.83*623.04*716.50
*C*70557*TC*512.71*487.07*560.13
*C*70558**324.83*308.59*354.88
*C*70558*TC*166.41*158.09*181.80
*C*70559**317.89*302.00*347.30
*C*70559*TC*166.41*158.09*181.80
*C*74190**533.59*506.91*582.95
*C*74190*TC*512.71*487.07*560.13
**74235**138.69*131.76*151.52
**74235*TC*85.02*80.77*92.89
**74300**78.97*75.02*86.27
**74300*TC*66.46*63.14*72.61
**74301**24.49*23.27*26.76
**74301*TC*14.90*14.16*16.28
**74328**175.06*166.31*191.26
**74328*TC*153.36*145.69*167.54
**74329**133.97*127.27*146.36
**74329*TC*111.97*106.37*122.33
**74330**262.59*249.46*286.88
**74330*TC*237.07*225.22*259.00
**74340**86.58*82.25*94.59
**74340*TC*62.24*59.13*68.00
**74355**86.58*82.25*94.59
**74355*TC*52.03*49.43*56.84
**74360**86.58*82.25*94.59
**74360*TC*60.96*57.91*66.60
**74363**175.06*166.31*191.26
**74363*TC*137.09*130.24*149.78
*C*74445**150.34*142.82*164.24
*C*74445*TC*99.57*94.59*108.78
*C*74450**240.67*228.64*262.94
*C*74450*TC*225.99*214.69*246.89
*C*74470**536.74*509.90*586.39
*C*74470*TC*512.71*487.07*560.13
**74742**233.47*221.80*255.07
**74742*TC*205.96*195.66*225.01
*C*74775**254.13*241.42*277.63
*C*74775*TC*225.99*214.69*246.89
*C*75801**619.38*588.41*676.67
*C*75801*TC*578.03*549.13*631.50
*C*75803**1505.11*1429.85*1644.33
*C*75803*TC*1452.39*1379.77*1586.74
*C*75805**2979.88*2830.89*3255.52
*C*75805*TC*2943.11*2795.95*3215.34
*C*75807**2992.95*2843.30*3269.80
*C*75807*TC*2943.11*2795.95*3215.34
*C*75810**2989.78*2840.29*3266.33
*C*75810*TC*2943.11*2795.95*3215.34
**75894**848.06*805.66*926.51
**75894*TC*778.58*739.65*850.60
*C*75898**3031.12*2879.56*3311.49
*C*75898*TC*2943.11*2795.95*3215.34
**75970**414.20*393.49*452.51
**75970*TC*378.53*359.60*413.54
**76125**37.75*35.86*41.24
**76125*TC*24.94*23.69*27.24
**76390**192.74*183.10*210.57
**76390*TC*142.51*135.38*155.69
**76390*26*50.23*47.72*54.88
**76932**80.67*76.64*88.14
**76932*TC*46.93*44.58*51.27
**76940**154.64*146.91*168.95
**76940*TC*57.70*54.82*63.04
**76941**110.79*105.25*121.04
**76941*TC*50.60*48.07*55.28
**76945**79.68*75.70*87.06
**76945*TC*49.77*47.28*54.37
*C*76975**264.20*250.99*288.64
*C*76975*TC*225.99*214.69*246.89
**76998**175.06*166.31*191.26
**76998*TC*129.96*123.46*141.98
**77013**394.43*374.71*430.92
**77013*TC*220.33*209.31*240.71
**77022**443.55*421.37*484.58
**77022*TC*253.88*241.19*277.37
**77520**872.41*828.79*953.11
**77522**872.41*828.79*953.11
**77523**1001.73*951.64*1094.39
**77525**1131.05*1074.50*1235.68
*C*78282**390.18*370.67*426.27
*C*78282*TC*375.70*356.92*410.46
**78414**514.99*489.24*562.63
**78414*TC*495.22*470.46*541.03
*C*78429**1438.60*1366.67*1571.67
*C*78429*TC*1363.77*1295.58*1489.92
*C*78430**1434.41*1362.69*1567.09
*C*78430*TC*1363.77*1295.58*1489.92
*C*78431**2186.83*2077.49*2389.11
*C*78431*TC*2104.15*1998.94*2298.78
*C*78432**1821.38*1730.31*1989.86
*C*78432*TC*1730.33*1643.81*1890.38
*C*78433**1920.98*1824.93*2098.67
*C*78433*TC*1823.78*1732.59*1992.48
**78434**656.33*623.51*717.04
**78434*TC*628.85*597.41*687.02
*C*78459**1290.09*1225.59*1409.43
*C*78459*TC*1220.72*1159.68*1333.63
*C*78491**1431.83*1360.24*1564.28
*C*78491*TC*1363.77*1295.58*1489.92
*C*78492**1442.62*1370.49*1576.06
*C*78492*TC*1363.77*1295.58*1489.92
*C*78608**1428.98*1357.53*1561.16
*C*78608*TC*1363.77*1295.58*1489.92
*C*78811**1288.20*1223.79*1407.36
*C*78811*TC*1220.72*1159.68*1333.63
*C*78812**1448.55*1376.12*1582.54
*C*78812*TC*1363.77*1295.58*1489.92
*C*78813**1450.21*1377.70*1584.36
*C*78813*TC*1363.77*1295.58*1489.92
*C*78814**1460.15*1387.14*1595.21
*C*78814*TC*1363.77*1295.58*1489.92
*C*78815**1471.68*1398.10*1607.82
*C*78815*TC*1363.77*1295.58*1489.92
*C*78816**1472.27*1398.66*1608.46
*C*78816*TC*1363.77*1295.58*1489.92
**79300**237.04*225.19*258.97
**79300*TC*176.67*167.84*193.02
**79445**237.04*225.19*258.97
**79445*TC*132.25*125.64*144.49
**86485**15.20*14.44*16.61
**90867**278.76*264.82*304.54
#**90867**130.41*123.89*142.47
**90868**188.67*179.24*206.13
#**90868**107.49*102.12*117.44
**90869**225.56*214.28*246.42
#**90869**151.77*144.18*165.81
**92978**231.95*220.35*253.40
**92978*TC*141.96*134.86*155.09
**92979**141.60*134.52*154.70
**92979*TC*69.80*66.31*76.26
*C*93315**630.23*598.72*688.53
*C*93315*TC*512.71*487.07*560.13
**93317**203.23*193.07*222.03
**93317*TC*120.17*114.16*131.28
*C*93318**609.03*578.58*665.37
*C*93318*TC*512.71*487.07*560.13
**93571**231.03*219.48*252.40
**93571*TC*162.53*154.40*177.56
**93572**139.38*132.41*152.27
**93572*TC*89.72*85.23*98.01
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.27*3275.86*3767.24
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.55*3277.07*3768.63
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.55*3277.07*3768.63
**93609**2134.69*2027.96*2332.15
**93609*TC*1877.48*1783.61*2051.15
**93610**3357.81*3189.92*3668.41
**93610*TC*3205.33*3045.06*3501.82
**93612**3357.81*3189.92*3668.41
**93612*TC*3207.18*3046.82*3503.84
**93615**47.57*45.19*51.97
**93615*TC*14.29*13.58*15.62
**93619**7115.62*6759.84*7773.82
**93619*TC*6753.43*6415.76*7378.12
**93620**7115.62*6759.84*7773.82
**93620*TC*6531.90*6205.31*7136.11
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.18*6686.27*7689.21
**93622**7115.62*6759.84*7773.82
**93622*TC*6954.80*6607.06*7598.12
**93623**2134.69*2027.96*2332.15
**93623*TC*2082.95*1978.80*2275.62
**93624**3557.81*3379.92*3886.91
**93624*TC*3330.92*3164.37*3639.03
**93631**7115.62*6759.84*7773.82
**93631*TC*6742.13*6405.02*7365.77
**93640**1133.95*1077.25*1238.84
**93640*TC*967.28*918.92*1056.76
**93641**1133.95*1077.25*1238.84
**93641*TC*843.84*801.65*921.90
**93662**362.42*344.30*395.95
**93662*TC*297.88*282.99*325.44
**94642**36.81*34.97*40.22
**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**918.45*872.53*1003.41
**95965*TC*539.75*512.76*589.67
**96020**370.86*352.32*405.17
**97151**48.91*46.46*53.43
#**97151**42.33*40.21*46.24
**97152**40.35*38.33*44.08
#**97152**35.98*34.18*39.31
**97153**33.57*31.89*36.67
#**97153**29.64*28.16*32.38
**97154**4.43*4.21*4.84
#**97154**4.04*3.84*4.42
**97155**32.14*30.53*35.11
#**97155**28.36*26.94*30.98
**97156**33.90*32.21*37.04
#**97156**29.97*28.47*32.74
**97157**9.91*9.41*10.82
#**97157**9.00*8.55*9.83
**97158**5.14*4.88*5.61
#**97158**4.69*4.46*5.13
**98978**40.30*38.29*44.03
# - 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.