TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
BRAZORIA
******
**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**501.79*476.70*548.21
#**G0186**429.87*408.38*469.64
**G0339**2794.17*2654.46*3052.63
**G0340**2101.45*1996.38*2295.84
**G0398**125.16*118.90*136.74
**G0398*TC*87.72*83.33*95.83
**G0398*26*37.44*35.57*40.91
**G0399**93.62*88.94*102.28
**G0399*TC*51.60*49.02*56.37
**G0399*26*42.01*39.91*45.90
**G0400**94.90*90.16*103.68
**G0400*TC*55.83*53.04*61.00
**G0400*26*39.06*37.11*42.68
**G0460**776.43*737.61*848.25
#**G0460**115.53*109.75*126.21
**G0498**143.41*136.24*156.68
**G0552**128.87*122.43*140.79
**G6017**77.24*73.38*84.39
**0042T**222.60*211.47*243.19
**0054T**218.63*207.70*238.86
**0055T**218.63*207.70*238.86
**0071T**543.63*516.45*593.92
**0072T**543.63*516.45*593.92
**0075T*26*917.61*871.73*1002.49
**0076T**1055.04*1002.29*1152.63
**0095T**595.10*565.35*650.15
**0098T**665.83*632.54*727.42
**0101T**301.93*286.83*329.85
#**0101T**219.28*208.32*239.57
**0102T**301.93*286.83*329.85
#**0102T**219.28*208.32*239.57
**0106T**31.77*30.18*34.71
**0107T**31.77*30.18*34.71
**0108T**31.77*30.18*34.71
**0109T**31.77*30.18*34.71
**0110T**31.77*30.18*34.71
**0164T**651.17*618.61*711.40
**0165T**666.73*633.39*728.40
**0184T**797.89*758.00*871.70
**0198T**82.67*78.54*90.32
#**0198T**30.93*29.38*33.79
**0200T**1681.38*1597.31*1836.91
#**0200T**390.82*371.28*426.97
**0201T**2522.07*2395.97*2755.37
#**0201T**586.23*556.92*640.46
**0207T**128.90*122.46*140.83
**0208T**38.98*37.03*42.58
**0209T**47.12*44.76*51.47
**0210T**29.54*28.06*32.27
**0211T**45.81*43.52*50.05
**0212T**35.49*33.72*38.78
#**0212T**30.93*29.38*33.79
**0213T**186.74*177.40*204.01
#**0213T**102.14*97.03*111.58
**0214T**94.76*90.02*103.52
#**0214T**57.34*54.47*62.64
**0215T**94.50*89.78*103.25
#**0215T**57.73*54.84*63.07
**0216T**172.42*163.80*188.37
#**0216T**88.14*83.73*96.29
**0217T**88.09*83.69*96.24
#**0217T**49.04*46.59*53.58
**0218T**87.25*82.89*95.32
#**0218T**49.50*47.03*54.08
**0219T**1263.86*1200.67*1380.77
**0220T**1245.44*1183.17*1360.65
**0221T**1523.69*1447.51*1664.64
**0222T**370.21*351.70*404.46
**0232T**895.10*850.35*977.90
#**0232T**87.45*83.08*95.54
**0234T**7934.48*7537.76*8668.42
#**0234T**551.99*524.39*603.05
**0235T**7934.48*7537.76*8668.42
#**0235T**551.99*524.39*603.05
**0236T**8103.68*7698.50*8853.28
#**0236T**641.80*609.71*701.17
**0237T**8103.68*7698.50*8853.28
#**0237T**641.80*609.71*701.17
**0238T**8103.68*7698.50*8853.28
#**0238T**641.80*609.71*701.17
**0266T**856.92*814.07*936.18
**0267T**150.73*143.19*164.67
**0268T**319.04*303.09*348.55
**0269T**811.40*770.83*886.45
**0270T**150.73*143.19*164.67
**0271T**319.04*303.09*348.55
**0272T**53.99*51.29*58.98
**0273T**68.91*65.46*75.28
**0274T**1068.27*1014.86*1167.09
**0278T**14.31*13.59*15.63
**0308T**1350.17*1282.66*1475.06
**0329T**82.67*78.54*90.32
#**0329T**30.93*29.38*33.79
**0330T**39.25*37.29*42.88
**0331T**176.75*167.91*193.10
**0332T**298.53*283.60*326.14
**0347T**136.51*129.68*149.13
**0348T**32.13*30.52*35.10
**0349T**33.75*32.06*36.87
**0350T**34.73*32.99*37.94
**0351T**162.64*154.51*177.69
**0352T**41.98*39.88*45.86
**0353T**162.64*154.51*177.69
**0354T**41.98*39.88*45.86
**0358T**25.64*24.36*28.01
**0362T**89.14*84.68*97.38
#**0362T**63.76*60.57*69.66
**0378T**24.32*23.10*26.57
**0394T**244.43*232.21*267.04
**0395T**596.84*567.00*652.05
**0397T**45.19*42.93*49.37
**0408T**487.04*462.69*532.09
**0409T**337.12*320.26*368.30
**0410T**351.45*333.88*383.96
**0411T**351.45*333.88*383.96
**0412T**221.80*210.71*242.32
**0413T**456.81*433.97*499.07
**0414T**351.55*333.97*384.07
**0415T**293.33*278.66*320.46
**0416T**326.24*309.93*356.42
**0417T**80.32*76.30*87.75
**0418T**53.99*51.29*58.98
**0419T**439.20*417.24*479.83
#**0419T**353.62*335.94*386.33
**0420T**621.52*590.44*679.01
#**0420T**515.44*489.67*563.12
**0421T**1513.08*1437.43*1653.04
#**0421T**671.91*638.31*734.06
**0437T**205.15*194.89*224.12
**0439T**68.74*65.30*75.10
**0440T**241.51*229.43*263.84
#**0440T**116.88*111.04*127.70
**0441T**241.51*229.43*263.84
#**0441T**116.88*111.04*127.70
**0442T**241.51*229.43*263.84
#**0442T**116.88*111.04*127.70
**0449T**736.52*699.69*804.64
**0464T**64.38*61.16*70.33
**0472T**64.72*61.48*70.70
**0473T**53.99*51.29*58.98
**0479T**49.40*46.93*53.97
**0480T**68.79*65.35*75.15
#**0480T**24.70*23.47*26.99
**0483T**1125.91*1069.61*1230.05
**0484T**1461.84*1388.75*1597.06
**0485T**22.94*21.79*25.06
**0485T*TC*8.56*8.13*9.35
**0485T*26*14.64*13.91*16.00
**0486T**45.89*43.60*50.14
**0486T*TC*16.85*16.01*18.41
**0486T*26*29.03*27.58*31.72
**0488T**60.70*57.67*66.32
#**0488T**48.01*45.61*52.45
**0505T**10917.98*10372.08*11927.89
#**0505T**551.05*523.50*602.03
**0507T**22.33*21.21*24.39
**0507T*TC*19.46*18.49*21.26
**0507T*26*2.87*2.73*3.14
**0510T**580.89*551.85*634.63
#**0510T**411.03*390.48*449.05
**0512T**301.93*286.83*329.85
#**0512T**219.28*208.32*239.57
**0513T**90.58*86.05*98.96
#**0513T**65.78*62.49*71.86
**0515T**487.04*462.69*532.09
**0516T**449.22*426.76*490.77
**0517T**319.04*303.09*348.55
**0518T**221.80*210.71*242.32
**0519T**320.34*304.32*349.97
**0520T**449.22*426.76*490.77
**0521T**53.99*51.29*58.98
**0521T*TC*34.42*32.70*37.61
**0521T*26*19.57*18.59*21.38
**0522T**64.72*61.48*70.70
**0522T*TC*34.75*33.01*37.96
**0522T*26*29.97*28.47*32.74
**0523T**146.98*139.63*160.57
**0524T**1536.21*1459.40*1678.31
#**0524T**167.87*159.48*183.40
**0525T**451.04*428.49*492.76
**0526T**351.45*333.88*383.96
**0527T**306.49*291.17*334.85
**0528T**64.72*61.48*70.70
**0528T*TC*34.75*33.01*37.96
**0528T*26*29.97*28.47*32.74
**0529T**53.99*51.29*58.98
**0529T*TC*34.42*32.70*37.61
**0529T*26*19.57*18.59*21.38
**0530T**600.34*570.32*655.87
**0531T**456.81*433.97*499.07
**0532T**320.34*304.32*349.97
**0543T**1461.84*1388.75*1597.06
**0544T**1680.76*1596.72*1836.23
**0545T**1680.76*1596.72*1836.23
**0546T**70.02*66.52*76.50
**0552T**6.78*6.44*7.41
**0565T**596.84*567.00*652.05
#**0565T**501.17*476.11*547.53
**0566T**96.16*91.35*105.05
#**0566T**56.79*53.95*62.04
**0569T**1680.76*1596.72*1836.23
**0570T**393.60*373.92*430.01
**0571T**527.24*500.88*576.01
**0572T**428.85*407.41*468.52
**0573T**329.41*312.94*359.88
**0574T**378.88*359.94*413.93
**0575T**64.72*61.48*70.70
**0576T**53.99*51.29*58.98
**0577T**184.35*175.13*201.40
**0578T**28.19*26.78*30.80
**0579T**19.46*18.49*21.26
**0580T**204.34*194.12*223.24
**0581T**2123.02*2016.87*2319.40
#**0581T**199.87*189.88*218.36
**0582T**1557.01*1479.16*1701.03
#**0582T**372.86*354.22*407.35
**0583T**1477.94*1404.04*1614.65
#**0583T**130.04*123.54*142.07
**0587T**400.95*380.90*438.04
#**0587T**285.11*270.85*311.48
**0588T**326.21*309.90*356.39
#**0588T**223.06*211.91*243.70
**0589T**46.33*44.01*50.61
#**0589T**37.21*35.35*40.65
**0590T**55.05*52.30*60.15
#**0590T**38.13*36.22*41.65
**0596T**2235.23*2123.47*2441.99
#**0596T**126.48*120.16*138.18
**0597T**126.48*120.16*138.18
**0598T**145.12*137.86*158.54
**0599T**98.23*93.32*107.32
**0600T**3383.24*3214.08*3696.19
#**0600T**700.27*665.26*765.05
**0601T**1384.34*1315.12*1512.39
**0604T**19.71*18.72*21.53
**0605T**43.21*41.05*47.21
**0606T**58.50*55.58*63.92
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**188.50*179.08*205.94
**0611T**40.86*38.82*44.64
**0614T**351.23*333.67*383.72
**0615T**45.53*43.25*49.74
**0619T**614.53*583.80*671.37
#**0619T**463.54*440.36*506.41
**0620T**1414.22*1343.51*1545.04
**0627T**247.59*235.21*270.49
#**0627T**95.95*91.15*104.82
**0628T**74.28*70.57*81.16
#**0628T**28.79*27.35*31.45
**0629T**247.59*235.21*270.49
#**0629T**95.95*91.15*104.82
**0630T**74.28*70.57*81.16
#**0630T**28.79*27.35*31.45
**0631T**79.45*75.48*86.80
**0632T**541.70*514.62*591.81
**0633T**194.04*184.34*211.99
*C*0633T*TC*106.99*101.64*116.89
**0633T*26*57.19*54.33*62.48
**0634T**194.04*184.34*211.99
**0634T*TC*136.86*130.02*149.52
**0634T*26*57.19*54.33*62.48
**0635T**194.04*184.34*211.99
**0635T*TC*136.86*130.02*149.52
**0635T*26*57.19*54.33*62.48
**0636T**194.04*184.34*211.99
**0636T*TC*136.86*130.02*149.52
**0636T*26*57.19*54.33*62.48
**0637T**194.04*184.34*211.99
**0637T*TC*136.86*130.02*149.52
**0637T*26*57.19*54.33*62.48
**0638T**194.04*184.34*211.99
**0638T*TC*136.86*130.02*149.52
**0638T*26*57.19*54.33*62.48
**0639T**79.45*75.48*86.80
**0640T**22.33*21.21*24.39
**0640T*TC*19.46*18.49*21.26
**0640T*26*2.87*2.73*3.14
**0644T**1095.48*1040.71*1196.82
#**0644T**227.30*215.94*248.33
**0646T**1680.76*1596.72*1836.23
**0650T**57.20*54.34*62.49
**0652T**276.59*262.76*302.17
#**0652T**117.47*111.60*128.34
**0653T**357.89*340.00*391.00
#**0653T**132.06*125.46*144.28
**0654T**136.04*129.24*148.63
**0655T**1513.08*1437.43*1653.04
#**0655T**671.91*638.31*734.06
**0658T**92.02*87.42*100.53
**0659T**2509.75*2384.26*2741.90
#**0659T**408.28*387.87*446.05
**0660T**736.52*699.69*804.64
**0671T**988.87*939.43*1080.34
**0673T**3240.69*3078.66*3540.46
#**0673T**349.79*332.30*382.15
**0699T**109.22*103.76*119.32
#**0699T**88.71*84.27*96.91
**0707T**352.21*334.60*384.79
#**0707T**266.95*253.60*291.64
**0714T**1323.65*1257.47*1446.09
#**0714T**348.73*331.29*380.98
**0738T**68.91*65.46*75.28
**0739T**1513.08*1437.43*1653.04
#**0739T**671.91*638.31*734.06
**0740T**19.71*18.72*21.53
**0741T**43.21*41.05*47.21
**0742T**89.56*85.08*97.84
**0742T*TC*71.08*67.53*77.66
**0742T*26*18.48*17.56*20.19
**0743T**52.59*49.96*57.45
**0744T**836.08*794.28*913.42
**0745T**252.69*240.06*276.07
**0746T**221.55*210.47*242.04
**0747T**953.22*905.56*1041.39
**0748T**176.31*167.49*192.61
**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**4.17*3.96*4.55
**0765T**7.79*7.40*8.51
**0771T**25.24*23.98*27.58
**0772T**25.24*23.98*27.58
**0773T**22.76*21.62*24.86
**0774T**22.76*21.62*24.86
**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**407.01*386.66*444.66
**0779T*TC*381.96*362.86*417.29
**0779T*26*25.05*23.80*27.37
**0780T**22.76*21.62*24.86
**0783T**13.92*13.22*15.20
**0784T**1997.13*1897.27*2181.86
#**0784T**316.41*300.59*345.68
**0785T**232.21*220.60*253.69
#**0785T**140.12*133.11*153.08
**0786T**693.19*658.53*757.31
#**0786T**292.29*277.68*319.33
**0787T**232.21*220.60*253.69
#**0787T**140.12*133.11*153.08
**0788T**18.11*17.20*19.78
#**0788T**17.78*16.89*19.42
**0789T**22.64*21.51*24.74
#**0789T**22.23*21.12*24.29
**0790T**1854.84*1762.10*2026.42
**0791T**8.79*8.35*9.60
**0793T**541.70*514.62*591.81
**0794T**130.35*123.83*142.40
**0795T**673.83*640.14*736.16
**0796T**449.22*426.76*490.77
**0797T**449.22*426.76*490.77
**0798T**711.42*675.85*777.23
**0799T**474.28*450.57*518.16
**0800T**472.84*449.20*516.58
**0801T**923.50*877.33*1008.93
**0802T**461.75*438.66*504.46
**0803T**461.75*438.66*504.46
**0804T**75.49*71.72*82.48
**0804T*TC*40.28*38.27*44.01
**0804T*26*35.21*33.45*38.47
**0805T**2777.50*2638.63*3034.42
#**0805T**310.60*295.07*339.33
**0806T**3703.33*3518.16*4045.88
#**0806T**414.13*393.42*452.43
**0807T**41.78*39.69*45.64
**0807T*TC*27.27*25.91*29.80
**0807T*26*14.52*13.79*15.86
**0808T**41.78*39.69*45.64
**0808T*TC*27.27*25.91*29.80
**0808T*26*14.52*13.79*15.86
**0810T**1094.78*1040.04*1196.05
**0811T**19.71*18.72*21.53
**0813T**2354.82*2237.08*2572.64
#**0813T**170.05*161.55*185.78
**0814T**412.55*391.92*450.71
#**0814T**305.98*290.68*334.28
**0820T**149.57*142.09*163.40
#**0820T**131.34*124.77*143.49
**0821T**149.57*142.09*163.40
#**0821T**131.34*124.77*143.49
**0822T**127.13*120.77*138.89
#**0822T**111.64*106.06*121.97
**0823T**673.83*640.14*736.16
**0824T**711.42*675.85*777.23
**0825T**923.50*877.33*1008.93
**0826T**64.72*61.48*70.70
**0826T*TC*34.75*33.01*37.96
**0826T*26*29.97*28.47*32.74
**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**22.33*21.21*24.39
**0859T*TC*19.46*18.49*21.26
**0859T*26*2.87*2.73*3.14
**0864T**301.93*286.83*329.85
#**0864T**219.28*208.32*239.57
**0867T**1654.56*1571.83*1807.60
#**0867T**435.91*414.11*476.23
**0868T**407.01*386.66*444.66
**0868T*TC*381.96*362.86*417.29
**0868T*26*25.05*23.80*27.37
**0869T**352.21*334.60*384.79
#**0869T**266.95*253.60*291.64
**0876T**142.63*135.50*155.83
**0876T*TC*118.89*112.95*129.89
**0876T*26*25.70*24.42*28.08
**0884T**983.04*933.89*1073.97
#**0884T**180.10*171.10*196.77
**0885T**641.15*609.09*700.45
#**0885T**290.36*275.84*317.22
**0886T**533.45*506.78*582.80
#**0886T**102.21*97.10*111.67
**0897T**57.76*54.87*63.10
**0897T*TC*51.93*49.33*56.73
**0897T*26*7.79*7.40*8.51
**0898T**68.83*65.39*75.20
**0898T*TC*59.74*56.75*65.26
**0898T*26*9.09*8.64*9.94
**0899T**126.54*120.21*138.24
**0899T*TC*83.99*79.79*91.76
**0899T*26*40.60*38.57*44.36
**0900T**124.59*118.36*136.11
**0900T*TC*83.99*79.79*91.76
**0900T*26*40.60*38.57*44.36
**10011**407.14*386.78*444.80
#**10011**103.54*98.36*113.11
**10012**228.08*216.68*249.18
#**10012**68.96*65.51*75.34
**15847**341.90*324.81*373.53
**21742**1104.73*1049.49*1206.91
**21743**1295.35*1230.58*1415.17
**32855**351.74*334.15*384.27
**32856**426.29*404.98*465.73
**33928**3119.94*2963.94*3408.53
**33929**1168.90*1110.46*1277.03
**33933**538.99*512.04*588.85
**33944**538.99*512.04*588.85
**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**532.30*505.69*581.54
#**43648**240.44*228.42*262.68
**43881**675.69*641.91*738.20
#**43881**619.52*588.54*676.82
**43882**716.29*680.48*782.55
#**43882**655.82*623.03*716.48
**47143**422.20*401.09*461.25
**47144**501.36*476.29*547.73
**47145**474.95*451.20*518.88
**48551**268.04*254.64*292.84
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**734.90*698.16*802.88
**53452**367.45*349.08*401.44
**53453**624.67*593.44*682.46
**53454**55.16*52.40*60.26
#**53454**34.01*32.31*37.16
**63043**542.33*515.21*592.49
**63044**515.91*490.11*563.63
**64596**1997.13*1897.27*2181.86
#**64596**316.41*300.59*345.68
**64597**599.34*569.37*654.78
#**64597**95.12*90.36*103.91
**64598**232.21*220.60*253.69
#**64598**140.12*133.11*153.08
**65757**120.76*114.72*131.93
**66983**641.78*609.69*701.14
**66987**739.42*702.45*807.82
**66988**616.21*585.40*673.21
*C*70170**256.94*244.09*280.70
*C*70170*TC*243.01*230.86*265.49
**70555**241.72*229.63*264.07
**70555*TC*114.64*108.91*125.25
*C*70557**697.79*662.90*762.34
*C*70557*TC*551.49*523.92*602.51
*C*70558**340.76*323.72*372.28
*C*70558*TC*178.90*169.96*195.45
*C*70559**331.41*314.84*362.07
*C*70559*TC*178.90*169.96*195.45
*C*74190**572.57*543.94*625.53
*C*74190*TC*551.49*523.92*602.51
**74235**144.22*137.01*157.56
**74235*TC*89.59*85.11*97.88
**74300**83.97*79.77*91.74
**74300*TC*71.35*67.78*77.95
**74301**25.74*24.45*28.12
**74301*TC*15.99*15.19*17.47
**74328**175.06*166.31*191.26
**74328*TC*152.95*145.30*167.10
**74329**139.99*132.99*152.94
**74329*TC*117.55*111.67*128.42
**74330**262.59*249.46*286.88
**74330*TC*236.55*224.72*258.43
**74340**86.58*82.25*94.59
**74340*TC*61.91*58.81*67.63
**74355**86.58*82.25*94.59
**74355*TC*51.51*48.93*56.27
**74360**86.58*82.25*94.59
**74360*TC*60.68*57.65*66.30
**74363**175.06*166.31*191.26
**74363*TC*136.84*130.00*149.50
*C*74445**158.75*150.81*173.43
*C*74445*TC*106.99*101.64*116.89
*C*74450**258.00*245.10*281.87
*C*74450*TC*243.01*230.86*265.49
*C*74470**575.83*547.04*629.10
*C*74470*TC*551.49*523.92*602.51
**74742**233.47*221.80*255.07
**74742*TC*205.53*195.25*224.54
*C*74775**271.60*258.02*296.72
*C*74775*TC*243.01*230.86*265.49
*C*75801**662.76*629.62*724.06
*C*75801*TC*621.78*590.69*679.29
*C*75803**1616.18*1535.37*1765.68
*C*75803*TC*1562.53*1484.40*1707.06
*C*75805**3203.81*3043.62*3500.16
*C*75805*TC*3166.46*3008.14*3459.36
*C*75807**3216.72*3055.88*3514.26
*C*75807*TC*3166.46*3008.14*3459.36
*C*75810**3212.93*3052.28*3510.12
*C*75810*TC*3166.46*3008.14*3459.36
**75894**890.35*845.83*972.70
**75894*TC*822.29*781.18*898.36
*C*75898**3252.61*3089.98*3553.48
*C*75898*TC*3166.46*3008.14*3459.36
**75970**434.81*413.07*475.03
**75970*TC*398.82*378.88*435.71
**76125**39.26*37.30*42.90
**76125*TC*26.31*24.99*28.74
**76390**204.29*194.08*223.19
**76390*TC*153.03*145.38*167.19
**76390*26*51.26*48.70*56.01
**76932**83.87*79.68*91.63
**76932*TC*50.08*47.58*54.72
**76940**154.09*146.39*168.35
**76940*TC*57.86*54.97*63.22
**76941**114.67*108.94*125.28
**76941*TC*53.03*50.38*57.94
**76945**82.95*78.80*90.62
**76945*TC*52.26*49.65*57.10
*C*76975**282.06*267.96*308.15
*C*76975*TC*243.01*230.86*265.49
**76998**175.06*166.31*191.26
**76998*TC*130.69*124.16*142.78
**77013**420.61*399.58*459.52
**77013*TC*244.91*232.66*267.56
**77022**470.85*447.31*514.41
**77022*TC*278.75*264.81*304.53
**77520**882.21*838.10*963.82
**77522**882.21*838.10*963.82
**77523**1013.00*962.35*1106.70
**77525**1143.78*1086.59*1249.58
*C*78282**418.76*397.82*457.49
*C*78282*TC*404.09*383.89*441.47
**78414**514.99*489.24*562.63
**78414*TC*494.77*470.03*540.53
*C*78429**1543.45*1466.28*1686.22
*C*78429*TC*1467.19*1393.83*1602.90
*C*78430**1539.26*1462.30*1681.65
*C*78430*TC*1467.19*1393.83*1602.90
*C*78431**2348.21*2230.80*2565.42
*C*78431*TC*2263.78*2150.59*2473.18
*C*78432**1954.38*1856.66*2135.16
*C*78432*TC*1861.58*1768.50*2033.78
*C*78433**2061.16*1958.10*2251.82
*C*78433*TC*1962.13*1864.02*2143.62
**78434**704.70*669.47*769.89
**78434*TC*676.69*642.86*739.29
*C*78459**1383.96*1314.76*1511.97
*C*78459*TC*1313.27*1247.61*1434.75
*C*78491**1536.56*1459.73*1678.69
*C*78491*TC*1467.19*1393.83*1602.90
*C*78492**1547.69*1470.31*1690.86
*C*78492*TC*1467.19*1393.83*1602.90
*C*78608**1533.62*1456.94*1675.48
*C*78608*TC*1467.19*1393.83*1602.90
*C*78811**1381.92*1312.82*1509.74
*C*78811*TC*1313.27*1247.61*1434.75
*C*78812**1553.37*1475.70*1697.06
*C*78812*TC*1467.19*1393.83*1602.90
*C*78813**1555.02*1477.27*1698.86
*C*78813*TC*1467.19*1393.83*1602.90
*C*78814**1565.02*1486.77*1709.79
*C*78814*TC*1467.19*1393.83*1602.90
*C*78815**1576.66*1497.83*1722.50
*C*78815*TC*1467.19*1393.83*1602.90
*C*78816**1577.46*1498.59*1723.38
*C*78816*TC*1467.19*1393.83*1602.90
**79300**237.04*225.19*258.97
**79300*TC*175.59*166.81*191.83
**79445**237.04*225.19*258.97
**79445*TC*131.43*124.86*143.59
**86485**17.28*16.42*18.88
**90867**290.77*276.23*317.66
#**90867**131.15*124.59*143.28
**90868**194.99*185.24*213.03
#**90868**107.65*102.27*117.61
**90869**234.69*222.96*256.40
#**90869**155.29*147.53*169.66
**92978**242.03*229.93*264.42
**92978*TC*153.75*146.06*167.97
**92979**147.06*139.71*160.67
**92979*TC*76.62*72.79*83.71
*C*93315**671.39*637.82*733.49
*C*93315*TC*551.49*523.92*602.51
**93317**211.08*200.53*230.61
**93317*TC*127.14*120.78*138.90
*C*93318**648.65*616.22*708.65
*C*93318*TC*551.49*523.92*602.51
**93571**241.04*228.99*263.34
**93571*TC*173.73*165.04*189.80
**93572**144.83*137.59*158.23
**93572*TC*96.01*91.21*104.89
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.00*3277.50*3769.13
**93602**3557.81*3379.92*3886.91
**93602*TC*3451.24*3278.68*3770.48
**93603**3557.81*3379.92*3886.91
**93603*TC*3451.24*3278.68*3770.48
**93609**2134.69*2027.96*2332.15
**93609*TC*1881.31*1787.24*2055.33
**93610**3557.81*3379.92*3886.91
**93610*TC*3407.84*3237.45*3723.07
**93612**3557.81*3379.92*3886.91
**93612*TC*3409.20*3238.74*3724.55
**93615**49.35*46.88*53.91
**93615*TC*14.87*14.13*16.25
**93619**7115.62*6759.84*7773.82
**93619*TC*6758.79*6420.85*7383.98
**93620**7115.62*6759.84*7773.82
**93620*TC*6541.17*6214.11*7146.23
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.37*6687.40*7690.51
**93622**7115.62*6759.84*7773.82
**93622*TC*6957.51*6609.63*7601.07
**93623**2134.69*2027.96*2332.15
**93623*TC*2083.60*1979.42*2276.33
**93624**3557.81*3379.92*3886.91
**93624*TC*3335.44*3168.67*3643.97
**93631**7115.62*6759.84*7773.82
**93631*TC*6751.18*6413.62*7375.66
**93640**1133.95*1077.25*1238.84
**93640*TC*970.01*921.51*1059.74
**93641**1133.95*1077.25*1238.84
**93641*TC*848.41*805.99*926.89
**93662**380.45*361.43*415.64
**93662*TC*313.32*297.65*342.30
**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**931.44*884.87*1017.60
**95965*TC*538.67*511.74*588.50
**95966**536.26*509.45*585.87
**95966*TC*345.15*327.89*377.07
**95967**450.95*428.40*492.66
**95967*TC*286.05*271.75*312.51
**96020**373.48*354.81*408.03
**97151**49.88*47.39*54.50
#**97151**42.84*40.70*46.81
**97152**41.11*39.05*44.91
#**97152**36.41*34.59*39.78
**97153**34.24*32.53*37.41
#**97153**30.01*28.51*32.79
**97154**4.43*4.21*4.84
#**97154**4.02*3.82*4.39
**97155**32.76*31.12*35.79
#**97155**28.70*27.27*31.36
**97156**34.57*32.84*37.77
#**97156**30.34*28.82*33.14
**97157**10.08*9.58*11.02
#**97157**9.10*8.65*9.95
**97158**5.17*4.91*5.65
#**97158**4.68*4.45*5.12
**98978**43.21*41.05*47.21
# - 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.