OKLAHOMA MEDICARE CARRIER - 04312
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**459.67*436.69*502.19
#**G0186**395.98*376.18*432.61
**G0339**2423.13*2301.97*2647.27
**G0340**1822.37*1731.25*1990.94
**G0398**113.83*108.14*124.36
**G0398*TC*77.77*73.88*84.96
**G0398*26*36.07*34.27*39.41
**G0399**86.16*81.85*94.13
**G0399*TC*45.77*43.48*50.00
**G0399*26*40.38*38.36*44.11
**G0400**87.03*82.68*95.08
**G0400*TC*49.52*47.04*54.10
**G0400*26*37.51*35.63*40.97
**G0460**696.39*661.57*760.81
#**G0460**111.04*105.49*121.31
**G0498**127.95*121.55*139.78
**G0552**128.87*122.43*140.79
**G6017**71.23*67.67*77.82
**0042T**203.73*193.54*222.57
**0054T**210.72*200.18*230.21
**0055T**210.72*200.18*230.21
**0071T**516.14*490.33*563.88
**0072T**516.14*490.33*563.88
**0075T*26*887.22*842.86*969.29
**0076T**965.90*917.61*1055.25
**0095T**568.91*540.46*621.53
**0098T**637.22*605.36*696.16
**0101T**279.78*265.79*305.66
#**0101T**206.57*196.24*225.68
**0102T**279.78*265.79*305.66
#**0102T**206.57*196.24*225.68
**0106T**28.37*26.95*30.99
**0107T**28.37*26.95*30.99
**0108T**28.37*26.95*30.99
**0109T**28.37*26.95*30.99
**0110T**28.37*26.95*30.99
**0164T**621.93*590.83*679.45
**0165T**636.95*605.10*695.87
**0184T**754.17*716.46*823.93
**0198T**75.30*71.54*82.27
#**0198T**29.48*28.01*32.21
**0200T**1517.00*1441.15*1657.32
#**0200T**373.97*355.27*408.56
**0201T**2275.50*2161.73*2485.99
#**0201T**560.95*532.90*612.84
**0207T**128.90*122.46*140.83
**0208T**34.56*32.83*37.75
**0209T**41.76*39.67*45.62
**0210T**26.20*24.89*28.62
**0211T**40.61*38.58*44.37
**0212T**33.48*31.81*36.58
#**0212T**29.44*27.97*32.17
**0213T**172.00*163.40*187.91
#**0213T**97.06*92.21*106.04
**0214T**88.21*83.80*96.37
#**0214T**55.06*52.31*60.16
**0215T**87.94*83.54*96.07
#**0215T**55.38*52.61*60.50
**0216T**158.28*150.37*172.93
#**0216T**83.64*79.46*91.38
**0217T**81.67*77.59*89.23
#**0217T**47.08*44.73*51.44
**0218T**80.85*76.81*88.33
#**0218T**47.42*45.05*51.81
**0219T**1198.05*1138.15*1308.87
**0220T**1180.25*1121.24*1289.43
**0221T**1450.47*1377.95*1584.64
**0222T**356.38*338.56*389.34
**0232T**799.27*759.31*873.21
#**0232T**83.94*79.74*91.70
**0234T**7074.92*6721.17*7729.35
#**0234T**536.36*509.54*585.97
**0235T**7074.92*6721.17*7729.35
#**0235T**536.36*509.54*585.97
**0236T**7232.49*6870.87*7901.50
#**0236T**623.61*592.43*681.29
**0237T**7232.49*6870.87*7901.50
#**0237T**623.61*592.43*681.29
**0238T**7232.49*6870.87*7901.50
#**0238T**623.61*592.43*681.29
**0266T**819.98*778.98*895.83
**0267T**145.77*138.48*159.25
**0268T**304.13*288.92*332.26
**0269T**774.92*736.17*846.60
**0270T**145.77*138.48*159.25
**0271T**304.13*288.92*332.26
**0272T**49.31*46.84*53.87
**0273T**63.64*60.46*69.53
**0274T**1012.59*961.96*1106.25
**0278T**13.54*12.86*14.79
**0308T**1266.36*1203.04*1383.50
**0329T**75.30*71.54*82.27
#**0329T**29.48*28.01*32.21
**0330T**39.25*37.29*42.88
**0331T**159.43*151.46*174.18
**0332T**269.24*255.78*294.15
**0347T**130.91*124.36*143.01
**0348T**29.19*27.73*31.89
**0349T**30.56*29.03*33.38
**0350T**31.42*29.85*34.33
**0351T**146.82*139.48*160.40
**0352T**39.92*37.92*43.61
**0353T**146.82*139.48*160.40
**0354T**39.92*37.92*43.61
**0358T**22.74*21.60*24.84
**0362T**83.59*79.41*91.32
#**0362T**61.11*58.05*66.76
**0378T**23.23*22.07*25.38
**0394T**220.23*209.22*240.60
**0395T**542.13*515.02*592.27
**0397T**43.17*41.01*47.16
**0408T**466.18*442.87*509.30
**0409T**321.31*305.24*351.03
**0410T**334.24*317.53*365.16
**0411T**334.24*317.53*365.16
**0412T**209.30*198.84*228.67
**0413T**435.93*414.13*476.25
**0414T**335.03*318.28*366.02
**0415T**279.96*265.96*305.85
**0416T**308.85*293.41*337.42
**0417T**74.08*70.38*80.94
**0418T**49.31*46.84*53.87
**0419T**406.65*386.32*444.27
#**0419T**330.85*314.31*361.46
**0420T**578.68*549.75*632.21
#**0420T**484.73*460.49*529.56
**0421T**1385.35*1316.08*1513.49
#**0421T**640.33*608.31*699.56
**0437T**196.16*186.35*214.30
**0439T**62.93*59.78*68.75
**0440T**221.17*210.11*241.63
#**0440T**110.78*105.24*121.03
**0441T**221.17*210.11*241.63
#**0441T**110.78*105.24*121.03
**0442T**221.17*210.11*241.63
#**0442T**110.78*105.24*121.03
**0449T**687.16*652.80*750.72
**0464T**58.25*55.34*63.64
**0472T**59.57*56.59*65.08
**0473T**49.31*46.84*53.87
**0479T**46.63*44.30*50.95
**0480T**62.37*59.25*68.14
#**0480T**23.32*22.15*25.47
**0483T**1089.55*1035.07*1190.33
**0484T**1415.32*1344.55*1546.23
**0485T**21.25*20.19*23.22
**0485T*TC*7.61*7.23*8.31
**0485T*26*13.90*13.21*15.19
**0486T**42.49*40.37*46.43
**0486T*TC*14.96*14.21*16.34
**0486T*26*27.53*26.15*30.07
**0488T**57.27*54.41*62.57
#**0488T**46.03*43.73*50.29
**0505T**9806.39*9316.07*10713.48
#**0505T**541.66*514.58*591.77
**0507T**20.01*19.01*21.86
**0507T*TC*17.27*16.41*18.87
**0507T*26*2.74*2.60*2.99
**0510T**537.76*510.87*587.50
#**0510T**387.32*367.95*423.14
**0512T**279.78*265.79*305.66
#**0512T**206.57*196.24*225.68
**0513T**83.93*79.73*91.69
#**0513T**61.97*58.87*67.70
**0515T**466.18*442.87*509.30
**0516T**429.75*408.26*469.50
**0517T**304.13*288.92*332.26
**0518T**209.30*198.84*228.67
**0519T**305.18*289.92*333.41
**0520T**429.75*408.26*469.50
**0521T**49.31*46.84*53.87
**0521T*TC*30.52*28.99*33.34
**0521T*26*18.78*17.84*20.52
**0522T**59.57*56.59*65.08
**0522T*TC*30.81*29.27*33.66
**0522T*26*28.76*27.32*31.42
**0523T**135.84*129.05*148.41
**0524T**1374.63*1305.90*1501.79
#**0524T**162.72*154.58*177.77
**0525T**431.43*409.86*471.34
**0526T**334.24*317.53*365.16
**0527T**292.02*277.42*319.03
**0528T**59.57*56.59*65.08
**0528T*TC*30.81*29.27*33.66
**0528T*26*28.76*27.32*31.42
**0529T**49.31*46.84*53.87
**0529T*TC*30.52*28.99*33.34
**0529T*26*18.78*17.84*20.52
**0530T**572.24*543.63*625.17
**0531T**435.93*414.13*476.25
**0532T**305.18*289.92*333.41
**0543T**1415.32*1344.55*1546.23
**0544T**1620.72*1539.68*1770.63
**0545T**1620.72*1539.68*1770.63
**0546T**64.56*61.33*70.53
**0552T**6.24*5.93*6.82
**0565T**555.20*527.44*606.56
#**0565T**470.47*446.95*513.99
**0566T**89.36*84.89*97.62
#**0566T**54.49*51.77*59.54
**0569T**1620.72*1539.68*1770.63
**0570T**381.08*362.03*416.33
**0571T**504.18*478.97*550.82
**0572T**410.61*390.08*448.59
**0573T**313.99*298.29*343.03
**0574T**362.18*344.07*395.68
**0575T**59.57*56.59*65.08
**0576T**49.31*46.84*53.87
**0577T**173.62*164.94*189.68
**0578T**27.09*25.74*29.60
**0579T**17.27*16.41*18.87
**0580T**193.43*183.76*211.32
**0581T**1895.80*1801.01*2071.16
#**0581T**192.50*182.88*210.31
**0582T**1401.07*1331.02*1530.67
#**0582T**352.28*334.67*384.87
**0583T**1314.94*1249.19*1436.57
#**0583T**121.13*115.07*132.33
**0587T**374.43*355.71*409.07
#**0587T**271.83*258.24*296.98
**0588T**303.35*288.18*331.41
#**0588T**211.99*201.39*231.60
**0589T**43.81*41.62*47.86
#**0589T**35.74*33.95*39.04
**0590T**51.64*49.06*56.42
#**0590T**36.65*34.82*40.04
**0596T**2235.23*2123.47*2441.99
#**0596T**122.81*116.67*134.17
**0597T**122.81*116.67*134.17
**0598T**129.55*123.07*141.53
**0599T**87.94*83.54*96.07
**0600T**3051.36*2898.79*3333.61
#**0600T**675.09*641.34*737.54
**0601T**1327.76*1261.37*1450.58
**0604T**17.53*16.65*19.15
**0605T**38.31*36.39*41.85
**0606T**53.64*50.96*58.60
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**172.15*163.54*188.07
**0611T**36.26*34.45*39.62
**0614T**334.81*318.07*365.78
**0615T**42.64*40.51*46.59
**0619T**572.41*543.79*625.36
#**0619T**438.68*416.75*479.26
**0620T**1414.22*1343.51*1545.04
**0627T**225.82*214.53*246.71
#**0627T**91.52*86.94*99.98
**0628T**67.75*64.36*74.01
#**0628T**27.45*26.08*29.99
**0629T**225.82*214.53*246.71
#**0629T**91.52*86.94*99.98
**0630T**67.75*64.36*74.01
#**0630T**27.45*26.08*29.99
**0631T**71.37*67.80*77.97
**0632T**521.67*495.59*569.93
**0633T**176.27*167.46*192.58
*C*0633T*TC*94.79*90.05*103.56
**0633T*26*54.98*52.23*60.06
**0634T**176.27*167.46*192.58
**0634T*TC*121.28*115.22*132.50
**0634T*26*54.98*52.23*60.06
**0635T**176.27*167.46*192.58
**0635T*TC*121.28*115.22*132.50
**0635T*26*54.98*52.23*60.06
**0636T**176.27*167.46*192.58
**0636T*TC*121.28*115.22*132.50
**0636T*26*54.98*52.23*60.06
**0637T**176.27*167.46*192.58
**0637T*TC*121.28*115.22*132.50
**0637T*26*54.98*52.23*60.06
**0638T**176.27*167.46*192.58
**0638T*TC*121.28*115.22*132.50
**0638T*26*54.98*52.23*60.06
**0639T**71.37*67.80*77.97
**0640T**20.01*19.01*21.86
**0640T*TC*17.27*16.41*18.87
**0640T*26*2.74*2.60*2.99
**0644T**990.07*940.57*1081.66
#**0644T**221.13*210.07*241.58
**0646T**1620.72*1539.68*1770.63
**0650T**52.48*49.86*57.34
**0652T**252.82*240.18*276.21
#**0652T**111.88*106.29*122.23
**0653T**325.88*309.59*356.03
#**0653T**125.86*119.57*137.51
**0654T**129.86*123.37*141.88
**0655T**1385.35*1316.08*1513.49
#**0655T**640.33*608.31*699.56
**0658T**81.54*77.46*89.08
**0659T**2258.46*2145.54*2467.37
#**0659T**397.22*377.36*433.96
**0660T**687.16*652.80*750.72
**0671T**922.97*876.82*1008.34
**0673T**2897.18*2752.32*3165.17
#**0673T**336.75*319.91*367.90
**0699T**101.90*96.81*111.33
#**0699T**83.74*79.55*91.48
**0707T**322.57*306.44*352.41
#**0707T**247.06*234.71*269.92
**0714T**1192.49*1132.87*1302.80
#**0714T**329.02*312.57*359.46
**0738T**65.53*62.25*71.59
**0739T**1385.35*1316.08*1513.49
#**0739T**640.33*608.31*699.56
**0740T**17.53*16.65*19.15
**0741T**38.31*36.39*41.85
**0742T**80.77*76.73*88.24
**0742T*TC*63.00*59.85*68.83
**0742T*26*17.77*16.88*19.41
**0743T**47.67*45.29*52.08
**0744T**810.67*770.14*885.66
**0745T**224.05*212.85*244.78
**0746T**210.97*200.42*230.48
**0747T**845.21*802.95*923.39
**0748T**167.44*159.07*182.93
**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**3.88*3.69*4.24
**0765T**7.49*7.12*8.19
**0771T**24.32*23.10*26.57
**0772T**24.32*23.10*26.57
**0773T**20.78*19.74*22.70
**0774T**20.78*19.74*22.70
**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**362.31*344.19*395.82
**0779T*TC*338.33*321.41*369.62
**0779T*26*23.97*22.77*26.19
**0780T**20.78*19.74*22.70
**0783T**12.37*11.75*13.51
**0784T**1790.04*1700.54*1955.62
#**0784T**301.45*286.38*329.34
**0785T**213.64*202.96*233.40
#**0785T**132.08*125.48*144.30
**0786T**634.42*602.70*693.11
#**0786T**279.34*265.37*305.18
**0787T**213.64*202.96*233.40
#**0787T**132.08*125.48*144.30
**0788T**17.30*16.44*18.91
#**0788T**17.01*16.16*18.58
**0789T**21.62*20.54*23.62
#**0789T**21.26*20.20*23.23
**0790T**1774.33*1685.61*1938.45
**0791T**8.26*7.85*9.03
**0793T**521.67*495.59*569.93
**0794T**130.35*123.83*142.40
**0795T**644.62*612.39*704.25
**0796T**429.75*408.26*469.50
**0797T**429.75*408.26*469.50
**0798T**682.98*648.83*746.15
**0799T**455.32*432.55*497.43
**0800T**454.12*431.41*496.12
**0801T**885.07*840.82*966.94
**0802T**442.53*420.40*483.46
**0803T**442.53*420.40*483.46
**0804T**69.50*66.03*75.93
**0804T*TC*35.71*33.92*39.01
**0804T*26*33.79*32.10*36.92
**0805T**2485.38*2361.11*2715.28
#**0805T**300.48*285.46*328.28
**0806T**3313.83*3148.14*3620.36
#**0806T**400.63*380.60*437.69
**0807T**38.14*36.23*41.66
**0807T*TC*24.18*22.97*26.42
**0807T*26*13.95*13.25*15.24
**0808T**38.14*36.23*41.66
**0808T*TC*24.18*22.97*26.42
**0808T*26*13.95*13.25*15.24
**0810T**1027.94*976.54*1123.02
**0811T**17.53*16.65*19.15
**0813T**2097.72*1992.83*2291.75
#**0813T**162.69*154.56*177.74
**0814T**378.19*359.28*413.17
#**0814T**283.80*269.61*310.05
**0820T**144.13*136.92*157.46
#**0820T**127.99*121.59*139.83
**0821T**144.13*136.92*157.46
#**0821T**127.99*121.59*139.83
**0822T**122.51*116.38*133.84
#**0822T**108.79*103.35*118.85
**0823T**644.62*612.39*704.25
**0824T**682.98*648.83*746.15
**0825T**885.07*840.82*966.94
**0826T**59.57*56.59*65.08
**0826T*TC*30.81*29.27*33.66
**0826T*26*28.76*27.32*31.42
**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**20.01*19.01*21.86
**0859T*TC*17.27*16.41*18.87
**0859T*26*2.74*2.60*2.99
**0864T**279.78*265.79*305.66
#**0864T**206.57*196.24*225.68
**0867T**1490.61*1416.08*1628.49
#**0867T**411.28*390.72*449.33
**0868T**362.31*344.19*395.82
**0868T*TC*338.33*321.41*369.62
**0868T*26*23.97*22.77*26.19
**0869T**322.57*306.44*352.41
#**0869T**247.06*234.71*269.92
**0876T**128.32*121.90*140.19
**0876T*TC*105.41*100.14*115.16
**0876T*26*24.85*23.61*27.15
**0884T**883.30*839.14*965.01
#**0884T**172.15*163.54*188.07
**0885T**588.17*558.76*642.57
#**0885T**277.49*263.62*303.16
**0886T**480.83*456.79*525.31
#**0886T**96.83*91.99*105.79
**0897T**51.82*49.23*56.61
**0897T*TC*46.06*43.76*50.32
**0897T*26*7.49*7.12*8.19
**0898T**61.73*58.64*67.44
**0898T*TC*52.98*50.33*57.88
**0898T*26*8.75*8.31*9.56
**0899T**115.20*109.44*125.86
**0899T*TC*74.42*70.70*81.31
**0899T*26*39.05*37.10*42.67
**0900T**113.47*107.80*123.97
**0900T*TC*74.42*70.70*81.31
**0900T*26*39.05*37.10*42.67
**10011**368.83*350.39*402.95
#**10011**99.93*94.93*109.17
**10012**208.19*197.78*227.45
#**10012**67.25*63.89*73.47
**15847**323.28*307.12*353.19
**21742**1060.23*1007.22*1158.30
**21743**1247.27*1184.91*1362.65
**32855**318.72*302.78*348.20
**32856**412.72*392.08*450.89
**33928**3032.57*2880.94*3313.08
**33929**1136.09*1079.29*1241.18
**33933**488.17*463.76*533.32
**33944**488.17*463.76*533.32
**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**442.49*420.37*483.43
**43648**477.31*453.44*521.46
#**43648**217.91*207.01*238.06
**43881**595.57*565.79*650.66
#**43881**546.88*519.54*597.47
**43882**629.04*597.59*687.23
#**43882**576.61*547.78*629.95
**47143**385.36*366.09*421.00
**47144**457.61*434.73*499.94
**47145**433.53*411.85*473.63
**48551**241.38*229.31*263.71
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**699.27*664.31*763.96
**53452**349.64*332.16*381.98
**53453**594.31*564.59*649.28
**53454**51.34*48.77*56.09
#**53454**32.60*30.97*35.62
**63043**516.83*490.99*564.64
**63044**459.74*436.75*502.26
**64596**1790.04*1700.54*1955.62
#**64596**301.45*286.38*329.34
**64597**537.21*510.35*586.90
#**64597**90.63*86.10*99.02
**64598**213.64*202.96*233.40
#**64598**132.08*125.48*144.30
**65757**112.99*107.34*123.44
**66983**602.14*572.03*657.83
**66987**701.82*666.73*766.74
**66988**581.51*552.43*635.29
*C*70170**228.67*217.24*249.83
*C*70170*TC*215.27*204.51*235.19
**70555**241.72*229.63*264.07
**70555*TC*131.36*124.79*143.51
*C*70557**628.08*596.68*686.18
*C*70557*TC*488.49*464.07*533.68
*C*70558**312.92*297.27*341.86
*C*70558*TC*158.49*150.57*173.16
*C*70559**305.10*289.85*333.33
*C*70559*TC*158.49*150.57*173.16
*C*74190**508.84*483.40*555.91
*C*74190*TC*488.49*464.07*533.68
**74235**132.11*125.50*144.33
**74235*TC*79.62*75.64*86.99
**74300**75.46*71.69*82.44
**74300*TC*63.32*60.15*69.17
**74301**23.20*22.04*25.35
**74301*TC*13.84*13.15*15.12
**74328**175.06*166.31*191.26
**74328*TC*153.86*146.17*168.10
**74329**126.86*120.52*138.60
**74329*TC*105.37*100.10*115.12
**74330**262.59*249.46*286.88
**74330*TC*237.61*225.73*259.59
**74340**86.58*82.25*94.59
**74340*TC*62.85*59.71*68.67
**74355**86.58*82.25*94.59
**74355*TC*52.87*50.23*57.76
**74360**86.58*82.25*94.59
**74360*TC*61.72*58.63*67.42
**74363**175.06*166.31*191.26
**74363*TC*138.10*131.20*150.88
*C*74445**144.54*137.31*157.91
*C*74445*TC*94.79*90.05*103.56
*C*74450**229.66*218.18*250.91
*C*74450*TC*215.27*204.51*235.19
*C*74470**511.93*486.33*559.28
*C*74470*TC*488.49*464.07*533.68
**74742**233.47*221.80*255.07
**74742*TC*206.61*196.28*225.72
*C*74775**242.74*230.60*265.19
*C*74775*TC*215.27*204.51*235.19
*C*75801**590.16*560.65*644.75
*C*75801*TC*550.74*523.20*601.68
*C*75803**1435.50*1363.73*1568.29
*C*75803*TC*1383.95*1314.75*1511.96
*C*75805**2840.42*2698.40*3103.16
*C*75805*TC*2804.52*2664.29*3063.93
*C*75807**2853.14*2710.48*3117.05
*C*75807*TC*2804.52*2664.29*3063.93
*C*75810**2849.79*2707.30*3113.40
*C*75810*TC*2804.52*2664.29*3063.93
**75894**797.42*757.55*871.18
**75894*TC*731.83*695.24*799.53
*C*75898**2887.53*2743.15*3154.62
*C*75898*TC*2804.52*2664.29*3063.93
**75970**389.94*370.44*426.01
**75970*TC*355.15*337.39*388.00
**76125**35.82*34.03*39.13
**76125*TC*23.39*22.22*25.55
**76390**184.61*175.38*201.69
**76390*TC*135.62*128.84*148.17
**76390*26*48.99*46.54*53.52
**76932**76.77*72.93*83.87
**76932*TC*44.35*42.13*48.45
**76940**144.77*137.53*158.16
**76940*TC*51.96*49.36*56.76
**76941**106.22*100.91*116.05
**76941*TC*47.10*44.75*51.46
**76945**75.92*72.12*82.94
**76945*TC*46.49*44.17*50.80
*C*76975**252.63*240.00*276.00
*C*76975*TC*215.27*204.51*235.19
**76998**175.06*166.31*191.26
**76998*TC*132.19*125.58*144.42
**77013**377.42*358.55*412.33
**77013*TC*207.77*197.38*226.99
**77022**426.54*405.21*465.99
**77022*TC*241.58*229.50*263.93
**77520**765.00*726.75*835.76
**77522**765.00*726.75*835.76
**77523**878.42*834.50*959.68
**77525**991.87*942.28*1083.62
*C*78282**372.21*353.60*406.64
*C*78282*TC*357.93*340.03*391.03
**78414**514.99*489.24*562.63
**78414*TC*495.56*470.78*541.40
*C*78429**1373.02*1304.37*1500.03
*C*78429*TC*1299.50*1234.53*1419.71
*C*78430**1368.98*1300.53*1495.61
*C*78430*TC*1299.50*1234.53*1419.71
*C*78431**2086.25*1981.94*2279.23
*C*78431*TC*2005.03*1904.78*2190.50
*C*78432**1738.07*1651.17*1898.85
*C*78432*TC*1648.81*1566.37*1801.33
*C*78433**1833.27*1741.61*2002.85
*C*78433*TC*1737.86*1650.97*1898.62
**78434**626.12*594.81*684.03
**78434*TC*599.16*569.20*654.58
*C*78459**1231.27*1169.71*1345.17
*C*78459*TC*1163.18*1105.02*1270.77
*C*78491**1366.26*1297.95*1492.64
*C*78491*TC*1299.50*1234.53*1419.71
*C*78492**1376.91*1308.06*1504.27
*C*78492*TC*1299.50*1234.53*1419.71
*C*78608**1363.46*1295.29*1489.58
*C*78608*TC*1299.50*1234.53*1419.71
*C*78811**1229.27*1167.81*1342.98
*C*78811*TC*1163.18*1105.02*1270.77
*C*78812**1382.48*1313.36*1510.36
*C*78812*TC*1299.50*1234.53*1419.71
*C*78813**1384.17*1314.96*1512.20
*C*78813*TC*1299.50*1234.53*1419.71
*C*78814**1393.76*1324.07*1522.68
*C*78814*TC*1299.50*1234.53*1419.71
*C*78815**1404.93*1334.68*1534.88
*C*78815*TC*1299.50*1234.53*1419.71
*C*78816**1405.77*1335.48*1535.80
*C*78816*TC*1299.50*1234.53*1419.71
**79300**237.04*225.19*258.97
**79300*TC*177.27*168.41*193.67
**79445**237.04*225.19*258.97
**79445*TC*135.03*128.28*147.52
**86485**17.28*16.42*18.88
**90867**265.68*252.40*290.26
#**90867**124.31*118.09*135.80
**90868**180.57*171.54*197.27
#**90868**103.22*98.06*112.77
**90869**215.73*204.94*235.68
#**90869**145.41*138.14*158.86
**92978**220.97*209.92*241.41
**92978*TC*135.65*128.87*148.20
**92979**135.36*128.59*147.88
**92979*TC*67.27*63.91*73.50
*C*93315**603.83*573.64*659.69
*C*93315*TC*488.49*464.07*533.68
**93317**193.65*183.97*211.57
**93317*TC*112.82*107.18*123.26
*C*93318**582.15*553.04*636.00
*C*93318*TC*488.49*464.07*533.68
**93571**220.10*209.10*240.47
**93571*TC*155.05*147.30*169.40
**93572**133.34*126.67*145.67
**93572*TC*86.17*81.86*94.14
**93600**3557.81*3379.92*3886.91
**93600*TC*3453.93*3281.23*3773.41
**93602**3557.81*3379.92*3886.91
**93602*TC*3455.06*3282.31*3774.66
**93603**3557.81*3379.92*3886.91
**93603*TC*3455.06*3282.31*3774.66
**93609**2134.69*2027.96*2332.15
**93609*TC*1890.58*1796.05*2065.46
**93610**3557.81*3379.92*3886.91
**93610*TC*3413.09*3242.44*3728.81
**93612**3557.81*3379.92*3886.91
**93612*TC*3414.43*3243.71*3730.27
**93615**45.03*42.78*49.20
**93615*TC*12.78*12.14*13.96
**93619**7115.62*6759.84*7773.82
**93619*TC*6771.77*6433.18*7398.16
**93620**7115.62*6759.84*7773.82
**93620*TC*6562.02*6233.92*7169.01
**93621**7115.62*6759.84*7773.82
**93621*TC*7042.16*6690.05*7693.56
**93622**7115.62*6759.84*7773.82
**93622*TC*6963.25*6615.09*7607.35
**93623**2134.69*2027.96*2332.15
**93623*TC*2085.58*1981.30*2278.50
**93624**3557.81*3379.92*3886.91
**93624*TC*3342.79*3175.65*3652.00
**93631**7115.62*6759.84*7773.82
**93631*TC*6762.43*6424.31*7387.96
**93640**1133.95*1077.25*1238.84
**93640*TC*975.86*927.07*1066.13
**93641**1133.95*1077.25*1238.84
**93641*TC*858.66*815.73*938.09
**93662**343.67*326.49*375.46
**93662*TC*280.95*266.90*306.94
**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**884.81*840.57*966.66
**95965*TC*518.41*492.49*566.36
**95966**528.68*502.25*577.59
**95966*TC*349.79*332.30*382.15
**95967**444.52*422.29*485.63
**95967*TC*290.07*275.57*316.91
**96020**376.79*357.95*411.64
**97151**48.07*45.67*52.52
#**97151**41.69*39.61*45.55
**97152**39.60*37.62*43.26
#**97152**35.44*33.67*38.72
**97153**33.01*31.36*36.06
#**97153**29.27*27.81*31.98
**97154**4.27*4.06*4.67
#**97154**3.90*3.71*4.27
**97155**31.59*30.01*34.51
#**97155**27.99*26.59*30.58
**97156**33.36*31.69*36.44
#**97156**29.61*28.13*32.35
**97157**9.68*9.20*10.58
#**97157**8.82*8.38*9.64
**97158**4.97*4.72*5.43
#**97158**4.54*4.31*4.96
**98978**38.31*36.39*41.85
# - 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.