TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
DALLAS
******
**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**502.66*477.53*549.16
#**G0186**430.67*409.14*470.51
**G0339**2878.81*2734.87*3145.10
**G0340**2165.02*2056.77*2365.29
**G0398**125.31*119.04*136.90
**G0398*TC*87.86*83.47*95.99
**G0398*26*37.44*35.57*40.91
**G0399**93.72*89.03*102.38
**G0399*TC*51.71*49.12*56.49
**G0399*26*42.01*39.91*45.90
**G0400**95.01*90.26*103.80
**G0400*TC*55.94*53.14*61.11
**G0400*26*39.07*37.12*42.69
**G0460**777.88*738.99*849.84
#**G0460**116.32*110.50*127.08
**G0498**143.71*136.52*157.00
**G0552**128.87*122.43*140.79
**G6017**77.37*73.50*84.53
**0042T**222.75*211.61*243.35
**0054T**221.88*210.79*242.41
**0055T**221.88*210.79*242.41
**0071T**546.96*519.61*597.55
**0072T**546.96*519.61*597.55
**0075T*26*928.15*881.74*1014.00
**0076T**1060.79*1007.75*1158.91
**0095T**604.07*573.87*659.95
**0098T**676.02*642.22*738.55
**0101T**302.52*287.39*330.50
#**0101T**219.79*208.80*240.12
**0102T**302.52*287.39*330.50
#**0102T**219.79*208.80*240.12
**0106T**31.84*30.25*34.79
**0107T**31.84*30.25*34.79
**0108T**31.84*30.25*34.79
**0109T**31.84*30.25*34.79
**0110T**31.84*30.25*34.79
**0164T**660.87*627.83*722.00
**0165T**676.69*642.86*739.29
**0184T**802.70*762.57*876.96
**0198T**82.73*78.59*90.38
#**0198T**30.94*29.39*33.80
**0200T**1684.83*1600.59*1840.68
#**0200T**392.99*373.34*429.34
**0201T**2527.24*2400.88*2761.01
#**0201T**589.48*560.01*644.01
**0207T**128.90*122.46*140.83
**0208T**39.05*37.10*42.67
**0209T**47.19*44.83*51.55
**0210T**29.60*28.12*32.34
**0211T**45.89*43.60*50.14
**0212T**35.50*33.73*38.79
#**0212T**30.94*29.39*33.80
**0213T**187.14*177.78*204.45
#**0213T**102.45*97.33*111.93
**0214T**95.04*90.29*103.83
#**0214T**57.58*54.70*62.91
**0215T**94.76*90.02*103.52
#**0215T**57.95*55.05*63.31
**0216T**172.81*164.17*188.80
#**0216T**88.45*84.03*96.63
**0217T**88.31*83.89*96.47
#**0217T**49.22*46.76*53.77
**0218T**87.41*83.04*95.50
#**0218T**49.63*47.15*54.22
**0219T**1278.75*1214.81*1397.03
**0220T**1259.52*1196.54*1376.02
**0221T**1539.60*1462.62*1682.01
**0222T**375.19*356.43*409.89
**0232T**896.10*851.30*979.00
#**0232T**87.64*83.26*95.75
**0234T**7947.35*7549.98*8682.48
#**0234T**557.53*529.65*609.10
**0235T**7947.35*7549.98*8682.48
#**0235T**557.53*529.65*609.10
**0236T**8117.17*7711.31*8868.01
#**0236T**647.87*615.48*707.80
**0237T**8117.17*7711.31*8868.01
#**0237T**647.87*615.48*707.80
**0238T**8117.17*7711.31*8868.01
#**0238T**647.87*615.48*707.80
**0266T**864.66*821.43*944.64
**0267T**152.14*144.53*166.21
**0268T**321.78*305.69*351.54
**0269T**818.62*777.69*894.34
**0270T**152.14*144.53*166.21
**0271T**321.78*305.69*351.54
**0272T**54.04*51.34*59.04
**0273T**68.98*65.53*75.36
**0274T**1080.29*1026.28*1180.22
**0278T**14.32*13.60*15.64
**0308T**1353.02*1285.37*1478.18
**0329T**82.73*78.59*90.38
#**0329T**30.94*29.39*33.80
**0330T**39.25*37.29*42.88
**0331T**177.01*168.16*193.38
**0332T**298.86*283.92*326.51
**0347T**137.63*130.75*150.36
**0348T**32.19*30.58*35.17
**0349T**33.82*32.13*36.95
**0350T**34.79*33.05*38.01
**0351T**162.80*154.66*177.86
**0352T**42.00*39.90*45.89
**0353T**162.80*154.66*177.86
**0354T**42.00*39.90*45.89
**0358T**25.69*24.41*28.07
**0362T**89.32*84.85*97.58
#**0362T**63.92*60.72*69.83
**0378T**24.37*23.15*26.62
**0394T**244.75*232.51*267.39
**0395T**597.68*567.80*652.97
**0397T**45.23*42.97*49.42
**0408T**491.44*466.87*536.90
**0409T**340.04*323.04*371.50
**0410T**354.38*336.66*387.16
**0411T**354.38*336.66*387.16
**0412T**223.48*212.31*244.16
**0413T**460.81*437.77*503.44
**0414T**354.56*336.83*387.35
**0415T**295.92*281.12*323.29
**0416T**328.86*312.42*359.28
**0417T**80.40*76.38*87.84
**0418T**54.04*51.34*59.04
**0419T**440.41*418.39*481.15
#**0419T**354.74*337.00*387.55
**0420T**623.79*592.60*681.49
#**0420T**517.61*491.73*565.49
**0421T**1516.87*1441.03*1657.18
#**0421T**674.86*641.12*737.29
**0437T**206.69*196.36*225.81
**0439T**68.97*65.52*75.35
**0440T**242.04*229.94*264.43
#**0440T**117.29*111.43*128.14
**0441T**242.04*229.94*264.43
#**0441T**117.29*111.43*128.14
**0442T**242.04*229.94*264.43
#**0442T**117.29*111.43*128.14
**0449T**737.98*701.08*806.24
**0464T**64.46*61.24*70.43
**0472T**64.78*61.54*70.77
**0473T**54.04*51.34*59.04
**0479T**49.45*46.98*54.03
**0480T**68.86*65.42*75.23
#**0480T**24.73*23.49*27.01
**0483T**1137.75*1080.86*1242.99
**0484T**1477.27*1403.41*1613.92
**0485T**22.96*21.81*25.08
**0485T*TC*8.59*8.16*9.38
**0485T*26*14.65*13.92*16.01
**0486T**45.91*43.61*50.15
**0486T*TC*16.90*16.06*18.47
**0486T*26*29.02*27.57*31.71
**0488T**60.79*57.75*66.41
#**0488T**48.09*45.69*52.54
**0505T**11087.91*10533.51*12113.54
#**0505T**544.21*517.00*594.55
**0507T**22.40*21.28*24.47
**0507T*TC*19.50*18.53*21.31
**0507T*26*2.90*2.76*3.17
**0510T**583.40*554.23*637.36
#**0510T**413.37*392.70*451.61
**0512T**302.52*287.39*330.50
#**0512T**219.79*208.80*240.12
**0513T**90.76*86.22*99.15
#**0513T**65.94*62.64*72.04
**0515T**491.44*466.87*536.90
**0516T**453.25*430.59*495.18
**0517T**321.78*305.69*351.54
**0518T**223.48*212.31*244.16
**0519T**323.08*306.93*352.97
**0520T**453.25*430.59*495.18
**0521T**54.04*51.34*59.04
**0521T*TC*34.49*32.77*37.69
**0521T*26*19.56*18.58*21.37
**0522T**64.78*61.54*70.77
**0522T*TC*34.81*33.07*38.03
**0522T*26*29.97*28.47*32.74
**0523T**147.63*140.25*161.29
**0524T**1539.14*1462.18*1681.51
#**0524T**169.45*160.98*185.13
**0525T**455.12*432.36*497.21
**0526T**354.38*336.66*387.16
**0527T**309.16*293.70*337.76
**0528T**64.78*61.54*70.77
**0528T*TC*34.81*33.07*38.03
**0528T*26*29.97*28.47*32.74
**0529T**54.04*51.34*59.04
**0529T*TC*34.49*32.77*37.69
**0529T*26*19.56*18.58*21.37
**0530T**605.54*575.26*661.55
**0531T**460.81*437.77*503.44
**0532T**323.08*306.93*352.97
**0543T**1477.27*1403.41*1613.92
**0544T**1697.48*1612.61*1854.50
**0545T**1697.48*1612.61*1854.50
**0546T**70.04*66.54*76.52
**0552T**6.81*6.47*7.44
**0565T**599.84*569.85*655.33
#**0565T**504.08*478.88*550.71
**0566T**96.54*91.71*105.47
#**0566T**57.12*54.26*62.40
**0569T**1697.48*1612.61*1854.50
**0570T**397.69*377.81*434.48
**0571T**531.96*505.36*581.16
**0572T**432.82*411.18*472.86
**0573T**332.29*315.68*363.03
**0574T**382.28*363.17*417.65
**0575T**64.78*61.54*70.77
**0576T**54.04*51.34*59.04
**0577T**184.38*175.16*201.43
**0578T**28.25*26.84*30.87
**0579T**19.50*18.53*21.31
**0580T**205.96*195.66*225.01
**0581T**2127.12*2020.76*2323.87
#**0581T**202.06*191.96*220.75
**0582T**1559.65*1481.67*1703.92
#**0582T**374.32*355.60*408.94
**0583T**1479.78*1405.79*1616.66
#**0583T**130.55*124.02*142.62
**0587T**402.56*382.43*439.79
#**0587T**286.60*272.27*313.11
**0588T**327.49*311.12*357.79
#**0588T**224.23*213.02*244.97
**0589T**46.43*44.11*50.73
#**0589T**37.31*35.44*40.76
**0590T**55.18*52.42*60.28
#**0590T**38.25*36.34*41.79
**0596T**2235.23*2123.47*2441.99
#**0596T**126.68*120.35*138.40
**0597T**126.68*120.35*138.40
**0598T**145.34*138.07*158.78
**0599T**98.37*93.45*107.47
**0600T**3388.78*3219.34*3702.24
#**0600T**703.14*667.98*768.18
**0601T**1397.98*1328.08*1527.29
**0604T**19.79*18.80*21.62
**0605T**43.28*41.12*47.29
**0606T**58.57*55.64*63.99
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**188.74*179.30*206.20
**0611T**40.96*38.91*44.75
**0614T**354.24*336.53*387.01
**0615T**45.56*43.28*49.77
**0619T**616.60*585.77*673.64
#**0619T**465.46*442.19*508.52
**0620T**1414.22*1343.51*1545.04
**0627T**248.05*235.65*271.00
#**0627T**96.26*91.45*105.17
**0628T**74.41*70.69*81.29
#**0628T**28.88*27.44*31.56
**0629T**248.05*235.65*271.00
#**0629T**96.26*91.45*105.17
**0630T**74.41*70.69*81.29
#**0630T**28.88*27.44*31.56
**0631T**79.63*75.65*87.00
**0632T**546.98*519.63*597.57
**0633T**194.29*184.58*212.27
*C*0633T*TC*107.12*101.76*117.02
**0633T*26*57.24*54.38*62.54
**0634T**194.29*184.58*212.27
**0634T*TC*137.05*130.20*149.73
**0634T*26*57.24*54.38*62.54
**0635T**194.29*184.58*212.27
**0635T*TC*137.05*130.20*149.73
**0635T*26*57.24*54.38*62.54
**0636T**194.29*184.58*212.27
**0636T*TC*137.05*130.20*149.73
**0636T*26*57.24*54.38*62.54
**0637T**194.29*184.58*212.27
**0637T*TC*137.05*130.20*149.73
**0637T*26*57.24*54.38*62.54
**0638T**194.29*184.58*212.27
**0638T*TC*137.05*130.20*149.73
**0638T*26*57.24*54.38*62.54
**0639T**79.63*75.65*87.00
**0640T**22.40*21.28*24.47
**0640T*TC*19.50*18.53*21.31
**0640T*26*2.90*2.76*3.17
**0644T**1098.62*1043.69*1200.24
#**0644T**229.57*218.09*250.80
**0646T**1697.48*1612.61*1854.50
**0650T**57.27*54.41*62.57
**0652T**277.31*263.44*302.96
#**0652T**118.03*112.13*128.95
**0653T**358.69*340.76*391.87
#**0653T**132.64*126.01*144.91
**0654T**136.72*129.88*149.36
**0655T**1516.87*1441.03*1657.18
#**0655T**674.86*641.12*737.29
**0658T**92.14*87.53*100.66
**0659T**2516.16*2390.35*2748.90
#**0659T**412.60*391.97*450.77
**0660T**737.98*701.08*806.24
**0671T**990.85*941.31*1082.51
**0673T**3245.84*3083.55*3546.08
#**0673T**352.06*334.46*384.63
**0699T**109.45*103.98*119.58
#**0699T**88.93*84.48*97.15
**0707T**353.05*335.40*385.71
#**0707T**267.71*254.32*292.47
**0714T**1325.97*1259.67*1448.62
#**0714T**350.08*332.58*382.47
**0738T**68.97*65.52*75.35
**0739T**1516.87*1441.03*1657.18
#**0739T**674.86*641.12*737.29
**0740T**19.79*18.80*21.62
**0741T**43.28*41.12*47.29
**0742T**89.66*85.18*97.96
**0742T*TC*71.19*67.63*77.77
**0742T*26*18.47*17.55*20.18
**0743T**52.68*50.05*57.56
**0744T**845.63*803.35*923.85
**0745T**253.12*240.46*276.53
**0746T**221.66*210.58*242.17
**0747T**954.88*907.14*1043.21
**0748T**177.42*168.55*193.83
**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**4.18*3.97*4.57
**0765T**7.80*7.41*8.52
**0771T**25.36*24.09*27.70
**0772T**25.36*24.09*27.70
**0773T**22.78*21.64*24.89
**0774T**22.78*21.64*24.89
**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**407.43*387.06*445.12
**0779T*TC*382.36*363.24*417.73
**0779T*26*25.06*23.81*27.38
**0780T**22.78*21.64*24.89
**0783T**13.96*13.26*15.25
**0784T**2000.03*1900.03*2185.03
#**0784T**317.64*301.76*347.02
**0785T**232.93*221.28*254.47
#**0785T**140.75*133.71*153.77
**0786T**695.06*660.31*759.36
#**0786T**293.76*279.07*320.93
**0787T**232.93*221.28*254.47
#**0787T**140.75*133.71*153.77
**0788T**18.16*17.25*19.84
#**0788T**17.83*16.94*19.48
**0789T**22.70*21.57*24.81
#**0789T**22.29*21.18*24.36
**0790T**1861.60*1768.52*2033.80
**0791T**8.80*8.36*9.61
**0793T**546.98*519.63*597.57
**0794T**130.35*123.83*142.40
**0795T**679.88*645.89*742.77
**0796T**453.25*430.59*495.18
**0797T**453.25*430.59*495.18
**0798T**718.22*682.31*784.66
**0799T**478.82*454.88*523.11
**0800T**477.43*453.56*521.59
**0801T**932.07*885.47*1018.29
**0802T**466.03*442.73*509.14
**0803T**466.03*442.73*509.14
**0804T**75.54*71.76*82.52
**0804T*TC*40.35*38.33*44.08
**0804T*26*35.19*33.43*38.44
**0805T**2781.88*2642.79*3039.21
#**0805T**312.52*296.89*341.42
**0806T**3709.17*3523.71*4052.27
#**0806T**416.70*395.87*455.25
**0807T**41.89*39.80*45.77
**0807T*TC*27.32*25.95*29.84
**0807T*26*14.57*13.84*15.92
**0808T**41.89*39.80*45.77
**0808T*TC*27.32*25.95*29.84
**0808T*26*14.57*13.84*15.92
**0810T**1097.09*1042.24*1198.58
**0811T**19.79*18.80*21.62
**0813T**2358.12*2240.21*2576.24
#**0813T**171.18*162.62*187.01
**0814T**413.57*392.89*451.82
#**0814T**306.89*291.55*335.28
**0820T**149.53*142.05*163.36
#**0820T**131.29*124.73*143.44
**0821T**149.53*142.05*163.36
#**0821T**131.29*124.73*143.44
**0822T**127.10*120.75*138.86
#**0822T**111.60*106.02*121.92
**0823T**679.88*645.89*742.77
**0824T**718.22*682.31*784.66
**0825T**932.07*885.47*1018.29
**0826T**64.78*61.54*70.77
**0826T*TC*34.81*33.07*38.03
**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**22.40*21.28*24.47
**0859T*TC*19.50*18.53*21.31
**0859T*26*2.90*2.76*3.17
**0864T**302.52*287.39*330.50
#**0864T**219.79*208.80*240.12
**0867T**1657.46*1574.59*1810.78
#**0867T**437.60*415.72*478.08
**0868T**407.43*387.06*445.12
**0868T*TC*382.36*363.24*417.73
**0868T*26*25.06*23.81*27.38
**0869T**353.05*335.40*385.71
#**0869T**267.71*254.32*292.47
**0876T**142.97*135.82*156.19
**0876T*TC*119.09*113.14*130.11
**0876T*26*25.84*24.55*28.23
**0884T**984.86*935.62*1075.96
#**0884T**181.12*172.06*197.87
**0885T**642.96*610.81*702.43
#**0885T**291.83*277.24*318.83
**0886T**535.89*509.10*585.47
#**0886T**102.69*97.56*112.19
**0897T**57.88*54.99*63.24
**0897T*TC*52.03*49.43*56.84
**0897T*26*7.80*7.41*8.52
**0898T**68.95*65.50*75.33
**0898T*TC*59.85*56.86*65.39
**0898T*26*9.10*8.65*9.95
**0899T**126.67*120.34*138.39
**0899T*TC*84.10*79.90*91.89
**0899T*26*40.62*38.59*44.38
**0900T**124.71*118.47*136.24
**0900T*TC*84.10*79.90*91.89
**0900T*26*40.62*38.59*44.38
**10011**407.83*387.44*445.56
#**10011**103.93*98.73*113.54
**10012**228.64*217.21*249.79
#**10012**69.36*65.89*75.77
**15847**344.22*327.01*376.06
**21742**1114.53*1058.80*1217.62
**21743**1311.51*1245.93*1432.82
**32855**349.86*332.37*382.23
**32856**431.07*409.52*470.95
**33928**3154.79*2997.05*3446.61
**33929**1181.84*1122.75*1291.16
**33933**535.43*508.66*584.96
**33944**535.43*508.66*584.96
**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**536.48*509.66*586.11
#**43648**241.61*229.53*263.96
**43881**677.72*643.83*740.40
#**43881**619.85*588.86*677.19
**43882**720.61*684.58*787.27
#**43882**658.32*625.40*719.21
**47143**418.01*397.11*456.68
**47144**496.38*471.56*542.29
**47145**470.26*446.75*513.76
**48551**268.65*255.22*293.50
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**738.07*701.17*806.35
**53452**369.03*350.58*403.17
**53453**627.38*596.01*685.41
**53454**55.25*52.49*60.36
#**53454**34.08*32.38*37.24
**63043**551.09*523.54*602.07
**63044**513.97*488.27*561.51
**64596**2000.03*1900.03*2185.03
#**64596**317.64*301.76*347.02
**64597**600.20*570.19*655.72
#**64597**95.49*90.72*104.33
**64598**232.93*221.28*254.47
#**64598**140.75*133.71*153.77
**65757**121.01*114.96*132.20
**66983**642.73*610.59*702.18
**66987**741.36*704.29*809.93
**66988**617.18*586.32*674.27
*C*70170**257.24*244.38*281.04
*C*70170*TC*243.28*231.12*265.79
**70555**241.72*229.63*264.07
**70555*TC*126.96*120.61*138.70
*C*70557**698.48*663.56*763.09
*C*70557*TC*552.07*524.47*603.14
*C*70558**341.11*324.05*372.66
*C*70558*TC*179.11*170.15*195.67
*C*70559**332.09*315.49*362.81
*C*70559*TC*179.11*170.15*195.67
*C*74190**573.18*544.52*626.20
*C*74190*TC*552.07*524.47*603.14
**74235**144.62*137.39*158.00
**74235*TC*89.95*85.45*98.27
**74300**84.06*79.86*91.84
**74300*TC*71.41*67.84*78.02
**74301**25.82*24.53*28.21
**74301*TC*16.06*15.26*17.55
**74328**175.06*166.31*191.26
**74328*TC*152.93*145.28*167.07
**74329**140.50*133.48*153.50
**74329*TC*118.05*112.15*128.97
**74330**262.59*249.46*286.88
**74330*TC*236.54*224.71*258.42
**74340**86.58*82.25*94.59
**74340*TC*61.88*58.79*67.61
**74355**86.58*82.25*94.59
**74355*TC*51.47*48.90*56.24
**74360**86.58*82.25*94.59
**74360*TC*60.62*57.59*66.23
**74363**175.06*166.31*191.26
**74363*TC*136.76*129.92*149.41
*C*74445**158.89*150.95*173.59
*C*74445*TC*107.12*101.76*117.02
*C*74450**258.26*245.35*282.15
*C*74450*TC*243.28*231.12*265.79
*C*74470**576.44*547.62*629.76
*C*74470*TC*552.07*524.47*603.14
**74742**233.47*221.80*255.07
**74742*TC*205.50*195.23*224.51
*C*74775**271.90*258.31*297.06
*C*74775*TC*243.28*231.12*265.79
*C*75801**663.68*630.50*725.08
*C*75801*TC*622.43*591.31*680.01
*C*75803**1617.80*1536.91*1767.45
*C*75803*TC*1564.11*1485.90*1708.79
*C*75805**3207.02*3046.67*3503.67
*C*75805*TC*3169.63*3011.15*3462.82
*C*75807**3219.97*3058.97*3517.82
*C*75807*TC*3169.63*3011.15*3462.82
*C*75810**3216.26*3055.45*3513.77
*C*75810*TC*3169.63*3011.15*3462.82
**75894**894.53*849.80*977.27
**75894*TC*825.83*784.54*902.22
*C*75898**3256.60*3093.77*3557.84
*C*75898*TC*3169.63*3011.15*3462.82
**75970**436.75*414.91*477.15
**75970*TC*400.70*380.67*437.77
**76125**39.40*37.43*43.04
**76125*TC*26.42*25.10*28.87
**76390**204.45*194.23*223.36
**76390*TC*153.24*145.58*167.42
**76390*26*51.21*48.65*55.95
**76932**84.12*79.91*91.90
**76932*TC*50.17*47.66*54.81
**76940**155.38*147.61*169.75
**76940*TC*58.58*55.65*64.00
**76941**114.88*109.14*125.51
**76941*TC*53.27*50.61*58.20
**76945**83.17*79.01*90.86
**76945*TC*52.51*49.88*57.36
*C*76975**282.34*268.22*308.45
*C*76975*TC*243.28*231.12*265.79
**76998**175.06*166.31*191.26
**76998*TC*130.34*123.82*142.39
**77013**420.89*399.85*459.83
**77013*TC*244.88*232.64*267.54
**77022**470.84*447.30*514.40
**77022*TC*278.47*264.55*304.23
**77520**908.83*863.39*992.90
**77522**908.83*863.39*992.90
**77523**1043.59*991.41*1140.12
**77525**1178.33*1119.41*1287.32
*C*78282**419.18*398.22*457.95
*C*78282*TC*404.51*384.28*441.92
**78414**514.99*489.24*562.63
**78414*TC*494.78*470.04*540.55
*C*78429**1544.91*1467.66*1687.81
*C*78429*TC*1468.67*1395.24*1604.53
*C*78430**1540.71*1463.67*1683.22
*C*78430*TC*1468.67*1395.24*1604.53
*C*78431**2350.46*2232.94*2567.88
*C*78431*TC*2266.06*2152.76*2475.67
*C*78432**1956.26*1858.45*2137.22
*C*78432*TC*1863.46*1770.29*2035.83
*C*78433**2063.13*1959.97*2253.97
*C*78433*TC*1964.11*1865.90*2145.79
**78434**705.38*670.11*770.63
**78434*TC*677.37*643.50*740.03
*C*78459**1385.28*1316.02*1513.42
*C*78459*TC*1314.60*1248.87*1436.20
*C*78491**1538.04*1461.14*1680.31
*C*78491*TC*1468.67*1395.24*1604.53
*C*78492**1549.15*1471.69*1692.44
*C*78492*TC*1468.67*1395.24*1604.53
*C*78608**1535.10*1458.35*1677.10
*C*78608*TC*1468.67*1395.24*1604.53
*C*78811**1383.28*1314.12*1511.24
*C*78811*TC*1314.60*1248.87*1436.20
*C*78812**1554.90*1477.16*1698.73
*C*78812*TC*1468.67*1395.24*1604.53
*C*78813**1556.54*1478.71*1700.52
*C*78813*TC*1468.67*1395.24*1604.53
*C*78814**1566.58*1488.25*1711.49
*C*78814*TC*1468.67*1395.24*1604.53
*C*78815**1578.25*1499.34*1724.24
*C*78815*TC*1468.67*1395.24*1604.53
*C*78816**1579.00*1500.05*1725.06
*C*78816*TC*1468.67*1395.24*1604.53
**79300**237.04*225.19*258.97
**79300*TC*175.68*166.90*191.94
**79445**237.04*225.19*258.97
**79445*TC*131.21*124.65*143.35
**86485**17.28*16.42*18.88
**90867**291.67*277.09*318.65
#**90867**131.90*125.31*144.11
**90868**195.59*185.81*213.68
#**90868**108.17*102.76*118.17
**90869**235.33*223.56*257.09
#**90869**155.86*148.07*170.28
**92978**242.66*230.53*265.11
**92978*TC*153.63*145.95*167.84
**92979**147.38*140.01*161.01
**92979*TC*76.34*72.52*83.40
*C*93315**671.95*638.35*734.10
*C*93315*TC*552.07*524.47*603.14
**93317**211.67*201.09*231.25
**93317*TC*127.57*121.19*139.37
*C*93318**649.44*616.97*709.52
*C*93318*TC*552.07*524.47*603.14
**93571**241.67*229.59*264.03
**93571*TC*173.81*165.12*189.89
**93572**145.12*137.86*158.54
**93572*TC*95.91*91.11*104.78
**93600**3557.81*3379.92*3886.91
**93600*TC*3449.12*3276.66*3768.16
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.38*3277.86*3769.54
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.38*3277.86*3769.54
**93609**2134.69*2027.96*2332.15
**93609*TC*1879.28*1785.32*2053.12
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.64*3236.31*3721.76
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.10*3237.70*3723.36
**93615**49.34*46.87*53.90
**93615*TC*14.84*14.10*16.22
**93619**7115.62*6759.84*7773.82
**93619*TC*6755.97*6418.17*7380.90
**93620**7115.62*6759.84*7773.82
**93620*TC*6536.47*6209.65*7141.10
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.75*6686.81*7689.83
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.18*6608.37*7599.63
**93623**2134.69*2027.96*2332.15
**93623*TC*2083.20*1979.04*2275.90
**93624**3557.81*3379.92*3886.91
**93624*TC*3333.52*3166.84*3641.87
**93631**7115.62*6759.84*7773.82
**93631*TC*6747.79*6410.40*7371.96
**93640**1133.95*1077.25*1238.84
**93640*TC*968.67*920.24*1058.28
**93641**1133.95*1077.25*1238.84
**93641*TC*846.10*803.80*924.37
**93662**381.73*362.64*417.04
**93662*TC*314.61*298.88*343.71
**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**931.72*885.13*1017.90
**95965*TC*538.68*511.75*588.51
**95966**536.62*509.79*586.26
**95966*TC*344.74*327.50*376.63
**95967**451.29*428.73*493.04
**95967*TC*286.05*271.75*312.51
**96020**374.11*355.40*408.71
**97151**49.86*47.37*54.48
#**97151**42.83*40.69*46.79
**97152**41.11*39.05*44.91
#**97152**36.40*34.58*39.77
**97153**34.22*32.51*37.39
#**97153**29.99*28.49*32.76
**97154**4.45*4.23*4.86
#**97154**4.03*3.83*4.40
**97155**32.75*31.11*35.78
#**97155**28.68*27.25*31.34
**97156**34.55*32.82*37.74
#**97156**30.31*28.79*33.11
**97157**10.08*9.58*11.02
#**97157**9.11*8.65*9.95
**97158**5.18*4.92*5.66
#**97158**4.70*4.47*5.14
**98978**43.28*41.12*47.29
# - 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.