LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
REST OF STATE
******
**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**458.07*435.17*500.45
#**G0186**395.09*375.34*431.64
**G0339**2482.57*2358.44*2712.21
**G0340**1867.06*1773.71*2039.77
**G0398**113.15*107.49*123.61
**G0398*TC*77.01*73.16*84.13
**G0398*26*36.14*34.33*39.48
**G0399**85.82*81.53*93.76
**G0399*TC*45.38*43.11*49.58
**G0399*26*40.44*38.42*44.18
**G0400**86.65*82.32*94.67
**G0400*TC*49.08*46.63*53.62
**G0400*26*37.57*35.69*41.04
**G0460**691.52*656.94*755.48
#**G0460**112.74*107.10*123.17
**G0498**126.99*120.64*138.74
**G0552**128.87*122.43*140.79
**G6017**71.06*67.51*77.64
**0042T**202.54*192.41*221.27
**0054T**217.44*206.57*237.56
**0055T**217.44*206.57*237.56
**0071T**522.23*496.12*570.54
**0072T**522.23*496.12*570.54
**0075T*26*909.86*864.37*994.03
**0076T**1004.67*954.44*1097.61
**0095T**586.61*557.28*640.87
**0098T**657.43*624.56*718.24
**0101T**279.50*265.53*305.36
#**0101T**207.12*196.76*226.27
**0102T**279.50*265.53*305.36
#**0102T**207.12*196.76*226.27
**0106T**28.19*26.78*30.80
**0107T**28.19*26.78*30.80
**0108T**28.19*26.78*30.80
**0109T**28.19*26.78*30.80
**0110T**28.19*26.78*30.80
**0164T**640.98*608.93*700.27
**0165T**656.53*623.70*717.26
**0184T**762.38*724.26*832.90
**0198T**74.80*71.06*81.72
#**0198T**29.49*28.02*32.22
**0200T**1508.63*1433.20*1648.18
#**0200T**378.42*359.50*413.43
**0201T**2262.94*2149.79*2472.26
#**0201T**567.64*539.26*620.15
**0207T**128.90*122.46*140.83
**0208T**34.23*32.52*37.40
**0209T**41.35*39.28*45.17
**0210T**25.97*24.67*28.37
**0211T**40.21*38.20*43.93
**0212T**33.44*31.77*36.54
#**0212T**29.45*27.98*32.18
**0213T**171.71*163.12*187.59
#**0213T**97.61*92.73*106.64
**0214T**88.39*83.97*96.57
#**0214T**55.61*52.83*60.75
**0215T**88.07*83.67*96.22
#**0215T**55.87*53.08*61.04
**0216T**157.98*150.08*172.59
#**0216T**84.17*79.96*91.95
**0217T**81.69*77.61*89.25
#**0217T**47.49*45.12*51.89
**0218T**80.77*76.73*88.24
#**0218T**47.71*45.32*52.12
**0219T**1225.78*1164.49*1339.16
**0220T**1206.35*1146.03*1317.93
**0221T**1480.99*1406.94*1617.98
**0222T**366.64*348.31*400.56
**0232T**791.71*752.12*864.94
#**0232T**84.41*80.19*92.22
**0234T**7014.07*6663.37*7662.88
#**0234T**548.90*521.46*599.68
**0235T**7014.07*6663.37*7662.88
#**0235T**548.90*521.46*599.68
**0236T**7172.17*6813.56*7835.59
#**0236T**637.46*605.59*696.43
**0237T**7172.17*6813.56*7835.59
#**0237T**637.46*605.59*696.43
**0238T**7172.17*6813.56*7835.59
#**0238T**637.46*605.59*696.43
**0266T**835.55*793.77*912.84
**0267T**148.88*141.44*162.66
**0268T**309.44*293.97*338.07
**0269T**789.19*749.73*862.19
**0270T**148.88*141.44*162.66
**0271T**309.44*293.97*338.07
**0272T**49.03*46.58*53.57
**0273T**63.43*60.26*69.30
**0274T**1034.93*983.18*1130.66
**0278T**13.53*12.85*14.78
**0308T**1268.24*1204.83*1385.55
**0329T**74.80*71.06*81.72
#**0329T**29.49*28.02*32.22
**0330T**39.25*37.29*42.88
**0331T**158.33*150.41*172.97
**0332T**267.18*253.82*291.89
**0347T**133.22*126.56*145.54
**0348T**29.05*27.60*31.74
**0349T**30.40*28.88*33.21
**0350T**31.25*29.69*34.14
**0351T**145.70*138.42*159.18
**0352T**39.94*37.94*43.63
**0353T**145.70*138.42*159.18
**0354T**39.94*37.94*43.63
**0358T**22.55*21.42*24.63
**0362T**83.70*79.52*91.45
#**0362T**61.47*58.40*67.16
**0378T**23.32*22.15*25.47
**0394T**218.60*207.67*238.82
**0395T**539.04*512.09*588.90
**0397T**43.24*41.08*47.24
**0408T**475.04*451.29*518.98
**0409T**326.98*310.63*357.22
**0410T**339.79*322.80*371.22
**0411T**339.79*322.80*371.22
**0412T**212.18*201.57*231.81
**0413T**443.79*421.60*484.84
**0414T**340.86*323.82*372.39
**0415T**285.06*270.81*311.43
**0416T**313.54*297.86*342.54
**0417T**73.79*70.10*80.62
**0418T**49.03*46.58*53.57
**0419T**406.88*386.54*444.52
#**0419T**331.93*315.33*362.63
**0420T**580.67*551.64*634.39
#**0420T**487.77*463.38*532.89
**0421T**1382.68*1313.55*1510.58
#**0421T**646.02*613.72*705.78
**0437T**199.26*189.30*217.70
**0439T**62.93*59.78*68.75
**0440T**220.61*209.58*241.02
#**0440T**111.47*105.90*121.79
**0441T**220.61*209.58*241.02
#**0441T**111.47*105.90*121.79
**0442T**220.61*209.58*241.02
#**0442T**111.47*105.90*121.79
**0449T**687.35*652.98*750.93
**0464T**57.84*54.95*63.19
**0472T**59.31*56.34*64.79
**0473T**49.03*46.58*53.57
**0479T**46.64*44.31*50.96
**0480T**61.93*58.83*67.65
#**0480T**23.32*22.15*25.47
**0483T**1115.39*1059.62*1218.56
**0484T**1449.10*1376.65*1583.15
**0485T**21.16*20.10*23.12
**0485T*TC*7.58*7.20*8.28
**0485T*26*13.90*13.21*15.19
**0486T**42.33*40.21*46.24
**0486T*TC*14.85*14.11*16.23
**0486T*26*27.47*26.10*30.02
**0488T**57.34*54.47*62.64
#**0488T**46.22*43.91*50.50
**0505T**9783.83*9294.64*10688.84
#**0505T**560.69*532.66*612.56
**0507T**19.92*18.92*21.76
**0507T*TC*17.13*16.27*18.71
**0507T*26*2.79*2.65*3.05
**0510T**539.83*512.84*589.77
#**0510T**391.07*371.52*427.25
**0512T**279.50*265.53*305.36
#**0512T**207.12*196.76*226.27
**0513T**83.85*79.66*91.61
#**0513T**62.14*59.03*67.88
**0515T**475.04*451.29*518.98
**0516T**437.84*415.95*478.34
**0517T**309.44*293.97*338.07
**0518T**212.18*201.57*231.81
**0519T**310.46*294.94*339.18
**0520T**437.84*415.95*478.34
**0521T**49.03*46.58*53.57
**0521T*TC*30.24*28.73*33.04
**0521T*26*18.79*17.85*20.53
**0522T**59.31*56.34*64.79
**0522T*TC*30.52*28.99*33.34
**0522T*26*28.78*27.34*31.44
**0523T**136.34*129.52*148.95
**0524T**1364.57*1296.34*1490.79
#**0524T**166.26*157.95*181.64
**0525T**439.61*417.63*480.27
**0526T**339.79*322.80*371.22
**0527T**297.19*282.33*324.68
**0528T**59.31*56.34*64.79
**0528T*TC*30.52*28.99*33.34
**0528T*26*28.78*27.34*31.44
**0529T**49.03*46.58*53.57
**0529T*TC*30.24*28.73*33.04
**0529T*26*18.79*17.85*20.53
**0530T**582.31*553.19*636.17
**0531T**443.79*421.60*484.84
**0532T**310.46*294.94*339.18
**0543T**1449.10*1376.65*1583.15
**0544T**1656.41*1573.59*1809.63
**0545T**1656.41*1573.59*1809.63
**0546T**64.22*61.01*70.16
**0552T**6.25*5.94*6.83
**0565T**558.61*530.68*610.28
#**0565T**474.83*451.09*518.75
**0566T**89.68*85.20*97.98
#**0566T**55.20*52.44*60.31
**0569T**1656.41*1573.59*1809.63
**0570T**390.06*370.56*426.14
**0571T**513.64*487.96*561.15
**0572T**418.63*397.70*457.36
**0573T**319.58*303.60*349.14
**0574T**368.94*350.49*403.06
**0575T**59.31*56.34*64.79
**0576T**49.03*46.58*53.57
**0577T**173.29*164.63*189.32
**0578T**27.23*25.87*29.75
**0579T**17.13*16.27*18.71
**0580T**196.34*186.52*214.50
**0581T**1881.28*1787.22*2055.30
#**0581T**197.09*187.24*215.33
**0582T**1391.59*1322.01*1520.31
#**0582T**354.57*336.84*387.37
**0583T**1302.02*1236.92*1422.46
#**0583T**121.61*115.53*132.86
**0587T**376.17*357.36*410.96
#**0587T**274.72*260.98*300.13
**0588T**304.49*289.27*332.66
#**0588T**214.16*203.45*233.97
**0589T**43.95*41.75*48.01
#**0589T**35.97*34.17*39.30
**0590T**51.75*49.16*56.53
#**0590T**36.93*35.08*40.34
**0596T**2235.23*2123.47*2441.99
#**0596T**123.58*117.40*135.01
**0597T**123.58*117.40*135.01
**0598T**128.42*122.00*140.30
**0599T**87.22*82.86*95.29
**0600T**3031.60*2880.02*3312.02
#**0600T**682.00*647.90*745.09
**0601T**1355.66*1287.88*1481.06
**0604T**17.45*16.58*19.07
**0605T**37.93*36.03*41.43
**0606T**53.39*50.72*58.33
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**171.28*162.72*187.13
**0611T**35.97*34.17*39.30
**0614T**340.65*323.62*372.16
**0615T**42.57*40.44*46.51
**0619T**574.08*545.38*627.19
#**0619T**441.85*419.76*482.72
**0620T**1414.22*1343.51*1545.04
**0627T**224.92*213.67*245.72
#**0627T**92.12*87.51*100.64
**0628T**67.48*64.11*73.73
#**0628T**27.64*26.26*30.20
**0629T**224.92*213.67*245.72
#**0629T**92.12*87.51*100.64
**0630T**67.48*64.11*73.73
#**0630T**27.64*26.26*30.20
**0631T**70.94*67.39*77.50
**0632T**532.84*506.20*582.13
**0633T**175.20*166.44*191.41
*C*0633T*TC*93.79*89.10*102.47
**0633T*26*55.16*52.40*60.26
**0634T**175.20*166.44*191.41
**0634T*TC*120.04*114.04*131.15
**0634T*26*55.16*52.40*60.26
**0635T**175.20*166.44*191.41
**0635T*TC*120.04*114.04*131.15
**0635T*26*55.16*52.40*60.26
**0636T**175.20*166.44*191.41
**0636T*TC*120.04*114.04*131.15
**0636T*26*55.16*52.40*60.26
**0637T**175.20*166.44*191.41
**0637T*TC*120.04*114.04*131.15
**0637T*26*55.16*52.40*60.26
**0638T**175.20*166.44*191.41
**0638T*TC*120.04*114.04*131.15
**0638T*26*55.16*52.40*60.26
**0639T**70.94*67.39*77.50
**0640T**19.92*18.92*21.76
**0640T*TC*17.13*16.27*18.71
**0640T*26*2.79*2.65*3.05
**0644T**986.62*937.29*1077.88
#**0644T**226.31*214.99*247.24
**0646T**1656.41*1573.59*1809.63
**0650T**52.25*49.64*57.09
**0652T**252.29*239.68*275.63
#**0652T**112.94*107.29*123.38
**0653T**324.76*308.52*354.80
#**0653T**126.99*120.64*138.74
**0654T**131.21*124.65*143.35
**0655T**1382.68*1313.55*1510.58
#**0655T**646.02*613.72*705.78
**0658T**80.68*76.65*88.15
**0659T**2247.35*2134.98*2455.23
#**0659T**407.00*386.65*444.65
**0660T**687.35*652.98*750.93
**0671T**923.34*877.17*1008.75
**0673T**2873.44*2729.77*3139.24
#**0673T**341.74*324.65*373.35
**0699T**101.97*96.87*111.40
#**0699T**84.02*79.82*91.79
**0707T**321.89*305.80*351.67
#**0707T**247.23*234.87*270.10
**0714T**1184.82*1125.58*1294.42
#**0714T**331.04*314.49*361.66
**0738T**65.61*62.33*71.68
**0739T**1382.68*1313.55*1510.58
#**0739T**646.02*613.72*705.78
**0740T**17.45*16.58*19.07
**0741T**37.93*36.03*41.43
**0742T**80.15*76.14*87.56
**0742T*TC*62.36*59.24*68.13
**0742T*26*17.79*16.90*19.44
**0743T**47.42*45.05*51.81
**0744T**831.60*790.02*908.52
**0745T**221.94*210.84*242.47
**0746T**211.13*200.57*230.66
**0747T**837.28*795.42*914.73
**0748T**169.49*161.02*185.17
**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**3.89*3.70*4.26
**0765T**7.53*7.15*8.22
**0771T**24.61*23.38*26.89
**0772T**24.61*23.38*26.89
**0773T**20.67*19.64*22.59
**0774T**20.67*19.64*22.59
**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**358.60*340.67*391.77
**0779T*TC*334.59*317.86*365.54
**0779T*26*24.01*22.81*26.23
**0780T**20.67*19.64*22.59
**0783T**12.29*11.68*13.43
**0784T**1775.67*1686.89*1939.92
#**0784T**303.79*288.60*331.89
**0785T**213.68*203.00*233.45
#**0785T**133.03*126.38*145.34
**0786T**633.42*601.75*692.01
#**0786T**282.33*268.21*308.44
**0787T**213.68*203.00*233.45
#**0787T**133.03*126.38*145.34
**0788T**17.40*16.53*19.01
#**0788T**17.12*16.26*18.70
**0789T**21.75*20.66*23.76
#**0789T**21.40*20.33*23.38
**0790T**1788.52*1699.09*1953.95
**0791T**8.28*7.87*9.05
**0793T**532.84*506.20*582.13
**0794T**130.35*123.83*142.40
**0795T**656.76*623.92*717.51
**0796T**437.84*415.95*478.34
**0797T**437.84*415.95*478.34
**0798T**697.02*662.17*761.50
**0799T**464.68*441.45*507.67
**0800T**463.61*440.43*506.49
**0801T**902.52*857.39*986.00
**0802T**451.26*428.70*493.01
**0803T**451.26*428.70*493.01
**0804T**69.18*65.72*75.58
**0804T*TC*35.37*33.60*38.64
**0804T*26*33.81*32.12*36.94
**0805T**2465.35*2342.08*2693.39
#**0805T**304.98*289.73*333.19
**0806T**3287.14*3122.78*3591.20
#**0806T**406.64*386.31*444.26
**0807T**38.05*36.15*41.57
**0807T*TC*23.97*22.77*26.19
**0807T*26*14.08*13.38*15.39
**0808T**38.05*36.15*41.57
**0808T*TC*23.97*22.77*26.19
**0808T*26*14.08*13.38*15.39
**0810T**1029.64*978.16*1124.88
**0811T**17.45*16.58*19.07
**0813T**2078.30*1974.39*2270.55
#**0813T**164.99*156.74*180.25
**0814T**377.52*358.64*412.44
#**0814T**284.19*269.98*310.48
**0820T**144.33*137.11*157.68
#**0820T**128.37*121.95*140.24
**0821T**144.33*137.11*157.68
#**0821T**128.37*121.95*140.24
**0822T**122.68*116.55*134.03
#**0822T**109.12*103.66*119.21
**0823T**656.76*623.92*717.51
**0824T**697.02*662.17*761.50
**0825T**902.52*857.39*986.00
**0826T**59.31*56.34*64.79
**0826T*TC*30.52*28.99*33.34
**0826T*26*28.78*27.34*31.44
**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**19.92*18.92*21.76
**0859T*TC*17.13*16.27*18.71
**0859T*26*2.79*2.65*3.05
**0864T**279.50*265.53*305.36
#**0864T**207.12*196.76*226.27
**0867T**1481.02*1406.97*1618.02
#**0867T**413.80*393.11*452.08
**0868T**358.60*340.67*391.77
**0868T*TC*334.59*317.86*365.54
**0868T*26*24.01*22.81*26.23
**0869T**321.89*305.80*351.67
#**0869T**247.23*234.87*270.10
**0876T**127.64*121.26*139.45
**0876T*TC*104.40*99.18*114.06
**0876T*26*25.18*23.92*27.51
**0884T**877.38*833.51*958.54
#**0884T**174.21*165.50*190.33
**0885T**587.65*558.27*642.01
#**0885T**280.45*266.43*306.39
**0886T**480.70*456.67*525.17
#**0886T**97.64*92.76*106.67
**0897T**51.48*48.91*56.25
**0897T*TC*45.66*43.38*49.89
**0897T*26*7.53*7.15*8.22
**0898T**61.28*58.22*66.95
**0898T*TC*52.50*49.88*57.36
**0898T*26*8.78*8.34*9.59
**0899T**114.49*108.77*125.09
**0899T*TC*73.64*69.96*80.45
**0899T*26*39.15*37.19*42.77
**0900T**112.78*107.14*123.21
**0900T*TC*73.64*69.96*80.45
**0900T*26*39.15*37.19*42.77
**10011**366.77*348.43*400.69
#**10011**100.89*95.85*110.23
**10012**207.66*197.28*226.87
#**10012**68.31*64.89*74.62
**15847**327.31*310.94*357.58
**21742**1080.50*1026.48*1180.45
**21743**1280.83*1216.79*1399.31
**32855**331.01*314.46*361.63
**32856**423.10*401.95*462.24
**33928**3110.46*2954.94*3398.18
**33929**1165.01*1106.76*1272.77
**33933**507.00*481.65*553.90
**33944**513.77*488.08*561.29
**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**627.11*595.75*685.11
**43648**493.98*469.28*539.67
#**43648**226.14*214.83*247.05
**43881**614.08*583.38*670.89
#**43881**564.16*535.95*616.34
**43882**647.84*615.45*707.77
#**43882**594.12*564.41*649.07
**47143**400.79*380.75*437.86
**47144**475.96*452.16*519.98
**47145**450.90*428.36*492.61
**48551**250.17*237.66*273.31
**50323**151.40*143.83*165.40
**50325**240.02*228.02*262.22
**53451**705.19*669.93*770.42
**53452**352.60*334.97*385.22
**53453**599.36*569.39*654.80
**53454**51.30*48.74*56.05
#**53454**32.78*31.14*35.81
**63043**533.80*507.11*583.18
**63044**475.51*451.73*519.49
**64596**1775.67*1686.89*1939.92
#**64596**303.79*288.60*331.89
**64597**532.90*506.26*582.20
#**64597**91.33*86.76*99.77
**64598**213.68*203.00*233.45
#**64598**133.03*126.38*145.34
**65757**113.08*107.43*123.54
**66983**602.27*572.16*657.98
**66987**705.03*669.78*770.25
**66988**582.36*553.24*636.23
*C*70170**226.38*215.06*247.32
*C*70170*TC*212.91*202.26*232.60
**70555**241.72*229.63*264.07
**70555*TC*130.92*124.37*143.03
*C*70557**622.89*591.75*680.51
*C*70557*TC*483.06*458.91*527.75
*C*70558**311.49*295.92*340.31
*C*70558*TC*156.77*148.93*171.27
*C*70559**304.51*289.28*332.67
*C*70559*TC*156.77*148.93*171.27
*C*74190**503.53*478.35*550.10
*C*74190*TC*483.06*458.91*527.75
**74235**132.23*125.62*144.46
**74235*TC*79.61*75.63*86.97
**74300**74.91*71.16*81.83
**74300*TC*62.69*59.56*68.49
**74301**23.15*21.99*25.29
**74301*TC*13.76*13.07*15.03
**74328**175.06*166.31*191.26
**74328*TC*153.81*146.12*168.04
**74329**126.86*120.52*138.60
**74329*TC*105.32*100.05*115.06
**74330**262.59*249.46*286.88
**74330*TC*237.57*225.69*259.54
**74340**86.58*82.25*94.59
**74340*TC*62.75*59.61*68.55
**74355**86.58*82.25*94.59
**74355*TC*52.75*50.11*57.63
**74360**86.58*82.25*94.59
**74360*TC*61.57*58.49*67.26
**74363**175.06*166.31*191.26
**74363*TC*137.85*130.96*150.60
*C*74445**143.62*136.44*156.91
*C*74445*TC*93.79*89.10*102.47
*C*74450**227.32*215.95*248.34
*C*74450*TC*212.91*202.26*232.60
*C*74470**506.61*481.28*553.47
*C*74470*TC*483.06*458.91*527.75
**74742**233.47*221.80*255.07
**74742*TC*206.52*196.19*225.62
*C*74775**240.47*228.45*262.72
*C*74775*TC*212.91*202.26*232.60
*C*75801**584.63*555.40*638.71
*C*75801*TC*544.62*517.39*595.00
*C*75803**1420.16*1349.15*1551.52
*C*75803*TC*1368.47*1300.05*1495.06
*C*75805**2809.12*2668.66*3068.96
*C*75805*TC*2773.10*2634.45*3029.62
*C*75807**2822.00*2680.90*3083.04
*C*75807*TC*2773.10*2634.45*3029.62
*C*75810**2818.85*2677.91*3079.60
*C*75810*TC*2773.10*2634.45*3029.62
**75894**796.82*756.98*870.53
**75894*TC*729.88*693.39*797.40
*C*75898**2857.86*2714.97*3122.22
*C*75898*TC*2773.10*2634.45*3029.62
**75970**389.60*370.12*425.64
**75970*TC*354.61*336.88*387.41
**76125**35.87*34.08*39.19
**76125*TC*23.37*22.20*25.53
**76390**183.41*174.24*200.38
**76390*TC*134.21*127.50*146.63
**76390*26*49.20*46.74*53.75
**76932**76.86*73.02*83.97
**76932*TC*44.10*41.90*48.19
**76940**147.38*140.01*161.01
**76940*TC*53.27*50.61*58.20
**76941**106.40*101.08*116.24
**76941*TC*47.28*44.92*51.66
**76945**75.96*72.16*82.98
**76945*TC*46.50*44.18*50.81
*C*76975**250.32*237.80*273.47
*C*76975*TC*212.91*202.26*232.60
**76998**175.06*166.31*191.26
**76998*TC*131.42*124.85*143.58
**77013**374.21*355.50*408.83
**77013*TC*203.58*193.40*222.41
**77022**423.32*402.15*462.47
**77022*TC*237.51*225.63*259.47
**77520**783.77*744.58*856.27
**77522**783.77*744.58*856.27
**77523**899.97*854.97*983.22
**77525**1016.17*965.36*1110.16
*C*78282**368.29*349.88*402.36
*C*78282*TC*353.97*336.27*386.71
**78414**514.99*489.24*562.63
**78414*TC*495.56*470.78*541.40
*C*78429**1358.60*1290.67*1484.27
*C*78429*TC*1284.97*1220.72*1403.83
*C*78430**1354.51*1286.78*1479.80
*C*78430*TC*1284.97*1220.72*1403.83
*C*78431**2063.87*1960.68*2254.78
*C*78431*TC*1982.59*1883.46*2165.98
*C*78432**1719.78*1633.79*1878.86
*C*78432*TC*1630.36*1548.84*1781.17
*C*78433**1813.98*1723.28*1981.77
*C*78433*TC*1718.42*1632.50*1877.38
**78434**619.38*588.41*676.67
**78434*TC*592.38*562.76*647.17
*C*78459**1218.38*1157.46*1331.08
*C*78459*TC*1150.18*1092.67*1256.57
*C*78491**1351.84*1284.25*1476.89
*C*78491*TC*1284.97*1220.72*1403.83
*C*78492**1362.45*1294.33*1488.48
*C*78492*TC*1284.97*1220.72*1403.83
*C*78608**1349.05*1281.60*1473.84
*C*78608*TC*1284.97*1220.72*1403.83
*C*78811**1216.44*1155.62*1328.96
*C*78811*TC*1150.18*1092.67*1256.57
*C*78812**1368.18*1299.77*1494.74
*C*78812*TC*1284.97*1220.72*1403.83
*C*78813**1369.88*1301.39*1496.60
*C*78813*TC*1284.97*1220.72*1403.83
*C*78814**1379.55*1310.57*1507.16
*C*78814*TC*1284.97*1220.72*1403.83
*C*78815**1390.79*1321.25*1519.44
*C*78815*TC*1284.97*1220.72*1403.83
*C*78816**1391.53*1321.95*1520.24
*C*78816*TC*1284.97*1220.72*1403.83
**79300**237.04*225.19*258.97
**79300*TC*177.24*168.38*193.64
**79445**237.04*225.19*258.97
**79445*TC*134.38*127.66*146.81
**86485**15.20*14.44*16.61
**90867**265.42*252.15*289.97
#**90867**125.64*119.36*137.26
**90868**180.81*171.77*197.54
#**90868**104.32*99.10*113.97
**90869**215.58*204.80*235.52
#**90869**146.04*138.74*159.55
**92978**220.90*209.86*241.34
**92978*TC*133.92*127.22*146.30
**92979**135.48*128.71*148.02
**92979*TC*66.08*62.78*72.20
*C*93315**598.55*568.62*653.91
*C*93315*TC*483.06*458.91*527.75
**93317**193.90*184.21*211.84
**93317*TC*112.62*106.99*123.04
*C*93318**577.32*548.45*630.72
*C*93318*TC*483.06*458.91*527.75
**93571**220.04*209.04*240.40
**93571*TC*153.78*146.09*168.00
**93572**133.42*126.75*145.76
**93572*TC*85.38*81.11*93.28
**93600**3557.81*3379.92*3886.91
**93600*TC*3452.02*3279.42*3771.33
**93602**3557.81*3379.92*3886.91
**93602*TC*3453.19*3280.53*3772.61
**93603**3557.81*3379.92*3886.91
**93603*TC*3453.19*3280.53*3772.61
**93609**2134.69*2027.96*2332.15
**93609*TC*1886.21*1791.90*2060.69
**93610**3357.81*3189.92*3668.41
**93610*TC*3210.45*3049.93*3507.42
**93612**3357.81*3189.92*3668.41
**93612*TC*3412.01*3241.41*3727.62
**93615**45.50*43.23*49.71
**93615*TC*13.16*12.50*14.38
**93619**7115.62*6759.84*7773.82
**93619*TC*6765.63*6427.35*7391.45
**93620**7115.62*6759.84*7773.82
**93620*TC*6551.85*6224.26*7157.90
**93621**7115.62*6759.84*7773.82
**93621*TC*7040.82*6688.78*7692.10
**93622**7115.62*6759.84*7773.82
**93622*TC*6960.38*6612.36*7604.21
**93623**2134.69*2027.96*2332.15
**93623*TC*2084.73*1980.49*2277.56
**93624**3557.81*3379.92*3886.91
**93624*TC*3138.54*2981.61*3428.85
**93631**7115.62*6759.84*7773.82
**93631*TC*6754.83*6417.09*7379.65
**93640**1133.95*1077.25*1238.84
**93640*TC*972.93*924.28*1062.92
**93641**1133.95*1077.25*1238.84
**93641*TC*280.31*266.29*306.23
**93662**343.36*326.19*375.12
**93662*TC*280.57*266.54*306.52
**94642**33.33*31.66*36.41
**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**909.86*864.37*994.03
**95965*TC*542.50*515.38*592.69
**96020**374.35*355.63*408.97
**97151**48.13*45.72*52.58
#**97151**41.82*39.73*45.69
**97152**39.67*37.69*43.34
#**97152**35.55*33.77*38.84
**97153**33.05*31.40*36.11
#**97153**29.34*27.87*32.05
**97154**4.31*4.09*4.70
#**97154**3.95*3.75*4.31
**97155**31.63*30.05*34.56
#**97155**28.07*26.67*30.67
**97156**33.39*31.72*36.48
#**97156**29.69*28.21*32.44
**97157**9.71*9.22*10.60
#**97157**8.86*8.42*9.68
**97158**5.02*4.77*5.49
#**97158**4.59*4.36*5.01
**98978**37.93*36.03*41.43
# - 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.