TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
GALVESTON
******
**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**500.36*475.34*546.64
#**G0186**428.87*407.43*468.54
**G0339**2819.77*2678.78*3080.60
**G0340**2120.74*2014.70*2316.91
**G0398**124.68*118.45*136.22
**G0398*TC*87.24*82.88*95.31
**G0398*26*37.44*35.57*40.91
**G0399**93.34*88.67*101.97
**G0399*TC*51.34*48.77*56.09
**G0399*26*42.01*39.91*45.90
**G0400**94.60*89.87*103.35
**G0400*TC*55.54*52.76*60.67
**G0400*26*39.06*37.11*42.68
**G0460**773.01*734.36*844.51
#**G0460**116.05*110.25*126.79
**G0498**142.74*135.60*155.94
**G0552**128.87*122.43*140.79
**G6017**77.06*73.21*84.19
**0042T**221.79*210.70*242.31
**0054T**220.87*209.83*241.30
**0055T**220.87*209.83*241.30
**0071T**545.27*518.01*595.71
**0072T**545.27*518.01*595.71
**0075T*26*925.12*878.86*1010.69
**0076T**1060.82*1007.78*1158.95
**0095T**600.87*570.83*656.45
**0098T**672.45*638.83*734.65
**0101T**301.39*286.32*329.27
#**0101T**219.23*208.27*239.51
**0102T**301.39*286.32*329.27
#**0102T**219.23*208.27*239.51
**0106T**31.63*30.05*34.56
**0107T**31.63*30.05*34.56
**0108T**31.63*30.05*34.56
**0109T**31.63*30.05*34.56
**0110T**31.63*30.05*34.56
**0164T**657.35*624.48*718.15
**0165T**673.09*639.44*735.36
**0184T**799.96*759.96*873.95
**0198T**82.34*78.22*89.95
#**0198T**30.91*29.36*33.76
**0200T**1674.96*1591.21*1829.89
#**0200T**392.10*372.50*428.38
**0201T**2512.44*2386.82*2744.84
#**0201T**588.15*558.74*642.55
**0207T**128.90*122.46*140.83
**0208T**38.77*36.83*42.35
**0209T**46.86*44.52*51.20
**0210T**29.39*27.92*32.11
**0211T**45.56*43.28*49.77
**0212T**35.44*33.67*38.72
#**0212T**30.91*29.36*33.76
**0213T**186.34*177.02*203.57
#**0213T**102.24*97.13*111.70
**0214T**94.69*89.96*103.45
#**0214T**57.49*54.62*62.81
**0215T**94.41*89.69*103.14
#**0215T**57.86*54.97*63.22
**0216T**172.02*163.42*187.93
#**0216T**88.24*83.83*96.40
**0217T**87.97*83.57*96.11
#**0217T**49.15*46.69*53.69
**0218T**87.09*82.74*95.15
#**0218T**49.57*47.09*54.15
**0219T**1272.39*1208.77*1390.09
**0220T**1253.41*1190.74*1369.35
**0221T**1533.11*1456.45*1674.92
**0222T**373.60*354.92*408.16
**0232T**890.39*845.87*972.75
#**0232T**87.55*83.17*95.65
**0234T**7894.65*7499.92*8624.91
#**0234T**556.19*528.38*607.64
**0235T**7894.65*7499.92*8624.91
#**0235T**556.19*528.38*607.64
**0236T**8063.80*7660.61*8809.70
#**0236T**646.43*614.11*706.23
**0237T**8063.80*7660.61*8809.70
#**0237T**646.43*614.11*706.23
**0238T**8063.80*7660.61*8809.70
#**0238T**646.43*614.11*706.23
**0266T**861.77*818.68*941.48
**0267T**151.75*144.16*165.78
**0268T**320.65*304.62*350.31
**0269T**815.78*774.99*891.24
**0270T**151.75*144.16*165.78
**0271T**320.65*304.62*350.31
**0272T**53.80*51.11*58.78
**0273T**68.73*65.29*75.08
**0274T**1075.09*1021.34*1174.54
**0278T**14.30*13.59*15.63
**0308T**1349.22*1281.76*1474.02
**0329T**82.34*78.22*89.95
#**0329T**30.91*29.36*33.76
**0330T**39.25*37.29*42.88
**0331T**176.00*167.20*192.28
**0332T**297.19*282.33*324.68
**0347T**137.23*130.37*149.93
**0348T**32.02*30.42*34.98
**0349T**33.63*31.95*36.74
**0350T**34.60*32.87*37.80
**0351T**161.91*153.81*176.88
**0352T**41.95*39.85*45.83
**0353T**161.91*153.81*176.88
**0354T**41.95*39.85*45.83
**0358T**25.51*24.23*27.86
**0362T**89.07*84.62*97.31
#**0362T**63.84*60.65*69.75
**0378T**24.34*23.12*26.59
**0394T**243.35*231.18*265.86
**0395T**594.61*564.88*649.61
**0397T**45.19*42.93*49.37
**0408T**489.80*465.31*535.11
**0409T**338.83*321.89*370.17
**0410T**353.09*335.44*385.76
**0411T**353.09*335.44*385.76
**0412T**222.58*211.45*243.17
**0413T**459.20*436.24*501.68
**0414T**353.31*335.64*385.99
**0415T**294.89*280.15*322.17
**0416T**327.57*311.19*357.87
**0417T**80.09*76.09*87.50
**0418T**53.80*51.11*58.78
**0419T**438.63*416.70*479.21
#**0419T**353.55*335.87*386.25
**0420T**621.37*590.30*678.85
#**0420T**515.92*490.12*563.64
**0421T**1509.51*1434.03*1649.13
#**0421T**673.36*639.69*735.64
**0437T**206.08*195.78*225.15
**0439T**68.62*65.19*74.97
**0440T**240.89*228.85*263.18
#**0440T**117.01*111.16*127.83
**0441T**240.89*228.85*263.18
#**0441T**117.01*111.16*127.83
**0442T**240.89*228.85*263.18
#**0442T**117.01*111.16*127.83
**0449T**735.62*698.84*803.67
**0464T**64.11*60.90*70.04
**0472T**64.52*61.29*70.48
**0473T**53.80*51.11*58.78
**0479T**49.35*46.88*53.91
**0480T**68.51*65.08*74.84
#**0480T**24.68*23.45*26.97
**0483T**1134.46*1077.74*1239.40
**0484T**1473.04*1399.39*1609.30
**0485T**22.88*21.74*25.00
**0485T*TC*8.52*8.09*9.30
**0485T*26*14.63*13.90*15.99
**0486T**45.76*43.47*49.99
**0486T*TC*16.77*15.93*18.32
**0486T*26*28.99*27.54*31.67
**0488T**60.66*57.63*66.27
#**0488T**48.04*45.64*52.49
**0505T**11065.01*10511.76*12088.52
#**0505T**552.51*524.88*603.61
**0507T**22.25*21.14*24.31
**0507T*TC*19.36*18.39*21.15
**0507T*26*2.89*2.75*3.16
**0510T**580.75*551.71*634.47
#**0510T**411.90*391.31*450.01
**0512T**301.39*286.32*329.27
#**0512T**219.23*208.27*239.51
**0513T**90.42*85.90*98.79
#**0513T**65.77*62.48*71.85
**0515T**489.80*465.31*535.11
**0516T**451.73*429.14*493.51
**0517T**320.65*304.62*350.31
**0518T**222.58*211.45*243.17
**0519T**321.93*305.83*351.70
**0520T**451.73*429.14*493.51
**0521T**53.80*51.11*58.78
**0521T*TC*34.24*32.53*37.41
**0521T*26*19.56*18.58*21.37
**0522T**64.52*61.29*70.48
**0522T*TC*34.56*32.83*37.75
**0522T*26*29.96*28.46*32.73
**0523T**146.93*139.58*160.52
**0524T**1529.21*1452.75*1670.66
#**0524T**169.04*160.59*184.68
**0525T**453.58*430.90*495.54
**0526T**353.09*335.44*385.76
**0527T**308.05*292.65*336.55
**0528T**64.52*61.29*70.48
**0528T*TC*34.56*32.83*37.75
**0528T*26*29.96*28.46*32.73
**0529T**53.80*51.11*58.78
**0529T*TC*34.24*32.53*37.41
**0529T*26*19.56*18.58*21.37
**0530T**603.39*573.22*659.20
**0531T**459.20*436.24*501.68
**0532T**321.93*305.83*351.70
**0543T**1473.04*1399.39*1609.30
**0544T**1692.37*1607.75*1848.91
**0545T**1692.37*1607.75*1848.91
**0546T**69.79*66.30*76.25
**0552T**6.77*6.43*7.39
**0565T**597.21*567.35*652.45
#**0565T**502.11*477.00*548.55
**0566T**96.14*91.33*105.03
#**0566T**57.00*54.15*62.27
**0569T**1692.37*1607.75*1848.91
**0570T**396.57*376.74*433.25
**0571T**530.16*503.65*579.20
**0572T**431.36*409.79*471.26
**0573T**331.10*314.55*361.73
**0574T**380.97*361.92*416.21
**0575T**64.52*61.29*70.48
**0576T**53.80*51.11*58.78
**0577T**184.04*174.84*201.07
**0578T**28.23*26.82*30.84
**0579T**19.36*18.39*21.15
**0580T**205.16*194.90*224.14
**0581T**2113.05*2007.40*2308.51
#**0581T**201.37*191.30*220.00
**0582T**1550.37*1472.85*1693.78
#**0582T**373.28*354.62*407.81
**0583T**1469.89*1396.40*1605.86
#**0583T**130.04*123.54*142.07
**0587T**401.05*381.00*438.15
#**0587T**285.89*271.60*312.34
**0588T**326.16*309.85*356.33
#**0588T**223.62*212.44*244.31
**0589T**46.33*44.01*50.61
#**0589T**37.27*35.41*40.72
**0590T**55.02*52.27*60.11
#**0590T**38.20*36.29*41.73
**0596T**2235.23*2123.47*2441.99
#**0596T**126.70*120.37*138.43
**0597T**126.70*120.37*138.43
**0598T**144.39*137.17*157.75
**0599T**97.76*92.87*106.80
**0600T**3369.27*3200.81*3680.93
#**0600T**702.30*667.19*767.27
**0601T**1393.20*1323.54*1522.07
**0604T**19.64*18.66*21.46
**0605T**42.97*40.82*46.94
**0606T**58.32*55.40*63.71
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**187.86*178.47*205.24
**0611T**40.66*38.63*44.42
**0614T**352.99*335.34*385.64
**0615T**45.45*43.18*49.66
**0619T**614.28*583.57*671.11
#**0619T**464.20*440.99*507.14
**0620T**1414.22*1343.51*1545.04
**0627T**246.82*234.48*269.65
#**0627T**96.09*91.29*104.98
**0628T**74.05*70.35*80.90
#**0628T**28.83*27.39*31.50
**0629T**246.82*234.48*269.65
#**0629T**96.09*91.29*104.98
**0630T**74.05*70.35*80.90
#**0630T**28.83*27.39*31.50
**0631T**79.13*75.17*86.45
**0632T**545.31*518.04*595.75
**0633T**193.30*183.64*211.19
*C*0633T*TC*106.37*101.05*116.21
**0633T*26*57.21*54.35*62.50
**0634T**193.30*183.64*211.19
**0634T*TC*136.08*129.28*148.67
**0634T*26*57.21*54.35*62.50
**0635T**193.30*183.64*211.19
**0635T*TC*136.08*129.28*148.67
**0635T*26*57.21*54.35*62.50
**0636T**193.30*183.64*211.19
**0636T*TC*136.08*129.28*148.67
**0636T*26*57.21*54.35*62.50
**0637T**193.30*183.64*211.19
**0637T*TC*136.08*129.28*148.67
**0637T*26*57.21*54.35*62.50
**0638T**193.30*183.64*211.19
**0638T*TC*136.08*129.28*148.67
**0638T*26*57.21*54.35*62.50
**0639T**79.13*75.17*86.45
**0640T**22.25*21.14*24.31
**0640T*TC*19.36*18.39*21.15
**0640T*26*2.89*2.75*3.16
**0644T**1092.05*1037.45*1193.07
#**0644T**229.04*217.59*250.23
**0646T**1692.37*1607.75*1848.91
**0650T**57.02*54.17*62.30
**0652T**275.92*262.12*301.44
#**0652T**117.74*111.85*128.63
**0653T**356.83*338.99*389.84
#**0653T**132.34*125.72*144.58
**0654T**136.41*129.59*149.03
**0655T**1509.51*1434.03*1649.13
#**0655T**673.36*639.69*735.64
**0658T**91.49*86.92*99.96
**0659T**2500.52*2375.49*2731.81
#**0659T**411.58*391.00*449.65
**0660T**735.62*698.84*803.67
**0671T**987.71*938.32*1079.07
**0673T**3225.00*3063.75*3523.31
#**0673T**351.34*333.77*383.84
**0699T**109.10*103.65*119.20
#**0699T**88.72*84.28*96.92
**0707T**351.36*333.79*383.86
#**0707T**266.61*253.28*291.27
**0714T**1318.17*1252.26*1440.10
#**0714T**349.07*331.62*381.36
**0738T**68.88*65.44*75.26
**0739T**1509.51*1434.03*1649.13
#**0739T**673.36*639.69*735.64
**0740T**19.64*18.66*21.46
**0741T**42.97*40.82*46.94
**0742T**89.16*84.70*97.41
**0742T*TC*70.69*67.16*77.23
**0742T*26*18.47*17.55*20.18
**0743T**52.40*49.78*57.25
**0744T**843.08*800.93*921.07
**0745T**251.33*238.76*274.57
**0746T**221.43*210.36*241.91
**0747T**948.10*900.70*1035.81
**0748T**176.87*168.03*193.23
**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**25.33*24.06*27.67
**0772T**25.33*24.06*27.67
**0773T**22.68*21.55*24.78
**0774T**22.68*21.55*24.78
**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**404.75*384.51*442.19
**0779T*TC*379.70*360.72*414.83
**0779T*26*25.05*23.80*27.37
**0780T**22.68*21.55*24.78
**0783T**13.86*13.17*15.15
**0784T**1987.67*1888.29*2171.53
#**0784T**316.97*301.12*346.29
**0785T**231.84*220.25*253.29
#**0785T**140.30*133.29*153.28
**0786T**691.63*657.05*755.61
#**0786T**293.12*278.46*320.23
**0787T**231.84*220.25*253.29
#**0787T**140.30*133.29*153.28
**0788T**18.13*17.22*19.80
#**0788T**17.81*16.92*19.46
**0789T**22.66*21.53*24.76
#**0789T**22.26*21.15*24.32
**0790T**1858.46*1765.54*2030.37
**0791T**8.78*8.34*9.59
**0793T**545.31*518.04*595.75
**0794T**130.35*123.83*142.40
**0795T**677.60*643.72*740.28
**0796T**451.73*429.14*493.51
**0797T**451.73*429.14*493.51
**0798T**715.89*680.10*782.12
**0799T**477.26*453.40*521.41
**0800T**475.87*452.08*519.89
**0801T**928.99*882.54*1014.92
**0802T**464.50*441.28*507.47
**0803T**464.50*441.28*507.47
**0804T**75.25*71.49*82.21
**0804T*TC*40.06*38.06*43.77
**0804T*26*35.19*33.43*38.44
**0805T**2764.22*2626.01*3019.91
#**0805T**312.03*296.43*340.89
**0806T**3685.63*3501.35*4026.55
#**0806T**416.05*395.25*454.54
**0807T**41.68*39.60*45.54
**0807T*TC*27.12*25.76*29.62
**0807T*26*14.55*13.82*15.89
**0808T**41.68*39.60*45.54
**0808T*TC*27.12*25.76*29.62
**0808T*26*14.55*13.82*15.89
**0810T**1094.10*1039.40*1195.31
**0811T**19.64*18.66*21.46
**0813T**2342.47*2225.35*2559.15
#**0813T**170.73*162.19*186.52
**0814T**411.61*391.03*449.68
#**0814T**305.67*290.39*333.95
**0820T**149.55*142.07*163.38
#**0820T**131.44*124.87*143.60
**0821T**149.55*142.07*163.38
#**0821T**131.44*124.87*143.60
**0822T**127.12*120.76*138.87
#**0822T**111.72*106.13*122.05
**0823T**677.60*643.72*740.28
**0824T**715.89*680.10*782.12
**0825T**928.99*882.54*1014.92
**0826T**64.52*61.29*70.48
**0826T*TC*34.56*32.83*37.75
**0826T*26*29.96*28.46*32.73
**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**22.25*21.14*24.31
**0859T*TC*19.36*18.39*21.15
**0859T*26*2.89*2.75*3.16
**0864T**301.39*286.32*329.27
#**0864T**219.23*208.27*239.51
**0867T**1647.72*1565.33*1800.13
#**0867T**436.34*414.52*476.70
**0868T**404.75*384.51*442.19
**0868T*TC*379.70*360.72*414.83
**0868T*26*25.05*23.80*27.37
**0869T**351.36*333.79*383.86
#**0869T**266.61*253.28*291.27
**0876T**142.08*134.98*155.23
**0876T*TC*118.25*112.34*129.19
**0876T*26*25.80*24.51*28.19
**0884T**978.84*929.90*1069.39
#**0884T**180.69*171.66*197.41
**0885T**639.88*607.89*699.07
#**0885T**291.18*276.62*318.11
**0886T**532.29*505.68*581.53
#**0886T**102.40*97.28*111.87
**0897T**57.51*54.63*62.82
**0897T*TC*51.66*49.08*56.44
**0897T*26*7.79*7.40*8.51
**0898T**68.52*65.09*74.85
**0898T*TC*59.42*56.45*64.92
**0898T*26*9.10*8.65*9.95
**0899T**126.06*119.76*137.72
**0899T*TC*83.51*79.33*91.23
**0899T*26*40.61*38.58*44.37
**0900T**124.12*117.91*135.60
**0900T*TC*83.51*79.33*91.23
**0900T*26*40.61*38.58*44.37
**10011**405.62*385.34*443.14
#**10011**103.82*98.63*113.42
**10012**227.48*216.11*248.53
#**10012**69.31*65.84*75.72
**15847**342.97*325.82*374.69
**21742**1111.12*1055.56*1213.89
**21743**1306.38*1241.06*1427.22
**32855**355.66*337.88*388.56
**32856**429.75*408.26*469.50
**33928**3146.17*2988.86*3437.19
**33929**1178.64*1119.71*1287.67
**33933**545.30*518.04*595.75
**33944**545.30*518.04*595.75
**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**537.21*510.35*586.90
#**43648**242.33*230.21*264.74
**43881**685.47*651.20*748.88
#**43881**628.80*597.36*686.96
**43882**726.52*690.19*793.72
#**43882**665.51*632.23*727.06
**47143**425.67*404.39*465.05
**47144**505.48*480.21*552.24
**47145**478.87*454.93*523.17
**48551**270.77*257.23*295.81
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**736.35*699.53*804.46
**53452**368.17*349.76*402.22
**53453**625.90*594.61*683.80
**53454**55.07*52.32*60.17
#**53454**34.05*32.35*37.20
**63043**547.84*520.45*598.52
**63044**523.31*497.14*571.71
**64596**1987.67*1888.29*2171.53
#**64596**316.97*301.12*346.29
**64597**596.50*566.68*651.68
#**64597**95.29*90.53*104.11
**64598**231.84*220.25*253.29
#**64598**140.30*133.29*153.28
**65757**120.65*114.62*131.81
**66983**641.07*609.02*700.37
**66987**739.87*702.88*808.31
**66988**615.86*585.07*672.83
*C*70170**255.53*242.75*279.16
*C*70170*TC*241.58*229.50*263.93
**70555**241.72*229.63*264.07
**70555*TC*127.00*120.65*138.75
*C*70557**694.49*659.77*758.74
*C*70557*TC*548.23*520.82*598.94
*C*70558**339.69*322.71*371.12
*C*70558*TC*177.86*168.97*194.32
*C*70559**330.67*314.14*361.26
*C*70559*TC*177.86*168.97*194.32
*C*74190**569.33*540.86*621.99
*C*74190*TC*548.23*520.82*598.94
**74235**144.02*136.82*157.34
**74235*TC*89.37*84.90*97.64
**74300**83.60*79.42*91.33
**74300*TC*70.96*67.41*77.52
**74301**25.67*24.39*28.05
**74301*TC*15.92*15.12*17.39
**74328**175.06*166.31*191.26
**74328*TC*152.95*145.30*167.10
**74329**139.72*132.73*152.64
**74329*TC*117.28*111.42*128.13
**74330**262.59*249.46*286.88
**74330*TC*236.55*224.72*258.43
**74340**86.58*82.25*94.59
**74340*TC*61.89*58.80*67.62
**74355**86.58*82.25*94.59
**74355*TC*51.49*48.92*56.26
**74360**86.58*82.25*94.59
**74360*TC*60.65*57.62*66.26
**74363**175.06*166.31*191.26
**74363*TC*136.77*129.93*149.42
*C*74445**158.13*150.22*172.75
*C*74445*TC*106.37*101.05*116.21
*C*74450**256.56*243.73*280.29
*C*74450*TC*241.58*229.50*263.93
*C*74470**572.59*543.96*625.55
*C*74470*TC*548.23*520.82*598.94
**74742**233.47*221.80*255.07
**74742*TC*205.52*195.24*224.53
*C*74775**270.19*256.68*295.18
*C*74775*TC*241.58*229.50*263.93
*C*75801**659.26*626.30*720.25
*C*75801*TC*618.09*587.19*675.27
*C*75803**1606.90*1526.56*1755.54
*C*75803*TC*1553.23*1475.57*1696.91
*C*75805**3184.97*3025.72*3479.58
*C*75805*TC*3147.59*2990.21*3438.74
*C*75807**3197.93*3038.03*3493.73
*C*75807*TC*3147.59*2990.21*3438.74
*C*75810**3194.22*3034.51*3489.69
*C*75810*TC*3147.59*2990.21*3438.74
**75894**888.17*843.76*970.32
**75894*TC*819.67*778.69*895.49
*C*75898**3234.31*3072.59*3533.48
*C*75898*TC*3147.59*2990.21*3438.74
**75970**433.74*412.05*473.86
**75970*TC*397.69*377.81*434.48
**76125**39.21*37.25*42.84
**76125*TC*26.24*24.93*28.67
**76390**203.46*193.29*222.28
**76390*TC*152.16*144.55*166.23
**76390*26*51.30*48.74*56.05
**76932**83.76*79.57*91.51
**76932*TC*49.87*47.38*54.49
**76940**154.85*147.11*169.18
**76940*TC*58.22*55.31*63.61
**76941**114.57*108.84*125.17
**76941*TC*52.97*50.32*57.87
**76945**82.83*78.69*90.49
**76945*TC*52.17*49.56*56.99
*C*76975**280.62*266.59*306.58
*C*76975*TC*241.58*229.50*263.93
**76998**175.06*166.31*191.26
**76998*TC*130.44*123.92*142.51
**77013**418.57*397.64*457.29
**77013*TC*242.62*230.49*265.06
**77022**468.81*445.37*512.18
**77022*TC*276.52*262.69*302.09
**77520**890.35*845.83*972.70
**77522**890.35*845.83*972.70
**77523**1022.34*971.22*1116.90
**77525**1154.30*1096.59*1261.08
*C*78282**416.38*395.56*454.89
*C*78282*TC*401.70*381.62*438.86
**78414**514.99*489.24*562.63
**78414*TC*494.78*470.04*540.55
*C*78429**1534.71*1457.97*1676.67
*C*78429*TC*1458.46*1385.54*1593.37
*C*78430**1530.51*1453.98*1672.08
*C*78430*TC*1458.46*1385.54*1593.37
*C*78431**2334.70*2217.97*2550.67
*C*78431*TC*2250.30*2137.79*2458.46
*C*78432**1943.29*1846.13*2123.05
*C*78432*TC*1850.50*1757.98*2021.68
*C*78433**2049.48*1947.01*2239.06
*C*78433*TC*1950.45*1852.93*2130.87
**78434**700.66*665.63*765.47
**78434*TC*672.65*639.02*734.87
*C*78459**1376.14*1307.33*1503.43
*C*78459*TC*1305.46*1240.19*1426.22
*C*78491**1527.83*1451.44*1669.16
*C*78491*TC*1458.46*1385.54*1593.37
*C*78492**1538.93*1461.98*1681.28
*C*78492*TC*1458.46*1385.54*1593.37
*C*78608**1524.89*1448.65*1665.95
*C*78608*TC*1458.46*1385.54*1593.37
*C*78811**1374.12*1305.41*1501.22
*C*78811*TC*1305.46*1240.19*1426.22
*C*78812**1544.67*1467.44*1687.56
*C*78812*TC*1458.46*1385.54*1593.37
*C*78813**1546.32*1469.00*1689.35
*C*78813*TC*1458.46*1385.54*1593.37
*C*78814**1556.35*1478.53*1700.31
*C*78814*TC*1458.46*1385.54*1593.37
*C*78815**1568.01*1489.61*1713.05
*C*78815*TC*1458.46*1385.54*1593.37
*C*78816**1568.77*1490.33*1713.88
*C*78816*TC*1458.46*1385.54*1593.37
**79300**237.04*225.19*258.97
**79300*TC*175.60*166.82*191.84
**79445**237.04*225.19*258.97
**79445*TC*131.25*124.69*143.39
**86485**17.28*16.42*18.88
**90867**290.16*275.65*317.00
#**90867**131.50*124.93*143.67
**90868**194.79*185.05*212.81
#**90868**107.97*102.57*117.96
**90869**234.25*222.54*255.92
#**90869**155.32*147.55*169.68
**92978**241.58*229.50*263.93
**92978*TC*152.76*145.12*166.89
**92979**146.88*139.54*160.47
**92979*TC*76.01*72.21*83.04
*C*93315**668.10*634.70*729.91
*C*93315*TC*548.23*520.82*598.94
**93317**210.83*200.29*230.33
**93317*TC*126.78*120.44*138.51
*C*93318**645.54*613.26*705.25
*C*93318*TC*548.23*520.82*598.94
**93571**240.60*228.57*262.86
**93571*TC*172.90*164.26*188.90
**93572**144.63*137.40*158.01
**93572*TC*95.53*90.75*104.36
**93600**3557.81*3379.92*3886.91
**93600*TC*3449.39*3276.92*3768.46
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.64*3278.11*3769.83
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.64*3278.11*3769.83
**93609**2134.69*2027.96*2332.15
**93609*TC*1879.91*1785.91*2053.80
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.99*3236.64*3722.14
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.42*3238.00*3723.70
**93615**49.34*46.87*53.90
**93615*TC*14.86*14.12*16.24
**93619**7115.62*6759.84*7773.82
**93619*TC*6756.84*6419.00*7381.85
**93620**7115.62*6759.84*7773.82
**93620*TC*6537.92*6211.02*7142.67
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.95*6687.00*7690.05
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.59*6608.76*7600.07
**93623**2134.69*2027.96*2332.15
**93623*TC*2083.34*1979.17*2276.05
**93624**3557.81*3379.92*3886.91
**93624*TC*3334.05*3167.35*3642.45
**93631**7115.62*6759.84*7773.82
**93631*TC*6748.67*6411.24*7372.93
**93640**1133.95*1077.25*1238.84
**93640*TC*969.07*920.62*1058.71
**93641**1133.95*1077.25*1238.84
**93641*TC*846.81*804.47*925.14
**93662**379.60*360.62*414.71
**93662*TC*312.50*296.88*341.41
**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**931.39*884.82*1017.54
**95965*TC*538.67*511.74*588.50
**95966**536.47*509.65*586.10
**95966*TC*345.13*327.87*377.05
**95967**451.16*428.60*492.89
**95967*TC*286.06*271.76*312.52
**96020**372.54*353.91*407.00
**97151**49.87*47.38*54.49
#**97151**42.87*40.73*46.84
**97152**41.11*39.05*44.91
#**97152**36.44*34.62*39.81
**97153**34.23*32.52*37.40
#**97153**30.02*28.52*32.80
**97154**4.44*4.22*4.85
#**97154**4.03*3.83*4.40
**97155**32.76*31.12*35.79
#**97155**28.72*27.28*31.37
**97156**34.56*32.83*37.75
#**97156**30.36*28.84*33.17
**97157**10.08*9.58*11.02
#**97157**9.11*8.65*9.95
**97158**5.18*4.92*5.66
#**97158**4.69*4.46*5.13
**98978**42.97*40.82*46.94
# - 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.