TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
HOUSTON
******
**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**507.69*482.31*554.66
#**G0186**435.99*414.19*476.32
**G0339**2836.59*2694.76*3098.97
**G0340**2133.34*2026.67*2330.67
**G0398**125.87*119.58*137.52
**G0398*TC*87.86*83.47*95.99
**G0398*26*38.01*36.11*41.53
**G0399**94.42*89.70*103.16
**G0399*TC*51.85*49.26*56.65
**G0399*26*42.58*40.45*46.52
**G0400**95.69*90.91*104.55
**G0400*TC*56.07*53.27*61.26
**G0400*26*39.63*37.65*43.30
**G0460**781.71*742.62*854.01
#**G0460**122.78*116.64*134.14
**G0498**144.39*137.17*157.75
**G0552**128.87*122.43*140.79
**G6017**78.28*74.37*85.53
**0042T**223.52*212.34*244.19
**0054T**245.06*232.81*267.73
**0055T**245.06*232.81*267.73
**0071T**572.79*544.15*625.77
**0072T**572.79*544.15*625.77
**0075T*26*1007.13*956.77*1100.29
**0076T**1059.96*1006.96*1158.00
**0095T**666.44*633.12*728.09
**0098T**746.95*709.60*816.04
**0101T**306.95*291.60*335.34
#**0101T**224.55*213.32*245.32
**0102T**306.95*291.60*335.34
#**0102T**224.55*213.32*245.32
**0106T**32.08*30.48*35.05
**0107T**32.08*30.48*35.05
**0108T**32.08*30.48*35.05
**0109T**32.08*30.48*35.05
**0110T**32.08*30.48*35.05
**0164T**728.27*691.86*795.64
**0165T**745.90*708.61*814.90
**0184T**839.16*797.20*916.78
**0198T**82.89*78.75*90.56
#**0198T**31.30*29.74*34.20
**0200T**1697.81*1612.92*1854.86
#**0200T**411.10*390.55*449.13
**0201T**2546.72*2419.38*2782.29
#**0201T**616.66*585.83*673.70
**0207T**128.90*122.46*140.83
**0208T**39.06*37.11*42.68
**0209T**47.17*44.81*51.53
**0210T**29.65*28.17*32.40
**0211T**45.88*43.59*50.13
**0212T**35.84*34.05*39.16
#**0212T**31.30*29.74*34.20
**0213T**189.75*180.26*207.30
#**0213T**105.40*100.13*115.15
**0214T**97.18*92.32*106.17
#**0214T**59.87*56.88*65.41
**0215T**96.72*91.88*105.66
#**0215T**60.06*57.06*65.62
**0216T**175.24*166.48*191.45
#**0216T**91.21*86.65*99.65
**0217T**89.92*85.42*98.23
#**0217T**50.98*48.43*55.69
**0218T**88.68*84.25*96.89
#**0218T**51.05*48.50*55.78
**0219T**1382.41*1313.29*1510.28
**0220T**1357.86*1289.97*1483.47
**0221T**1653.84*1571.15*1806.82
**0222T**411.01*390.46*449.03
**0232T**895.20*850.44*978.01
#**0232T**89.96*85.46*98.28
**0234T**7961.41*7563.34*8697.84
#**0234T**600.94*570.89*656.52
**0235T**7961.41*7563.34*8697.84
#**0235T**600.94*570.89*656.52
**0236T**8135.69*7728.91*8888.25
#**0236T**696.06*661.26*760.45
**0237T**8135.69*7728.91*8888.25
#**0237T**696.06*661.26*760.45
**0238T**8135.69*7728.91*8888.25
#**0238T**696.06*661.26*760.45
**0266T**922.81*876.67*1008.17
**0267T**163.14*154.98*178.23
**0268T**342.14*325.03*373.78
**0269T**872.52*828.89*953.22
**0270T**163.14*154.98*178.23
**0271T**342.14*325.03*373.78
**0272T**54.27*51.56*59.29
**0273T**69.57*66.09*76.00
**0274T**1164.43*1106.21*1272.14
**0278T**14.50*13.78*15.85
**0308T**1378.98*1310.03*1506.53
**0329T**82.89*78.75*90.56
#**0329T**31.30*29.74*34.20
**0330T**39.25*37.29*42.88
**0331T**177.70*168.82*194.14
**0332T**299.37*284.40*327.06
**0347T**146.31*138.99*159.84
**0348T**32.45*30.83*35.45
**0349T**34.07*32.37*37.23
**0350T**35.04*33.29*38.28
**0351T**163.03*154.88*178.11
**0352T**42.53*40.40*46.46
**0353T**163.03*154.88*178.11
**0354T**42.53*40.40*46.46
**0358T**25.76*24.47*28.14
**0362T**91.00*86.45*99.42
#**0362T**65.69*62.41*71.77
**0378T**24.90*23.66*27.21
**0394T**245.40*233.13*268.10
**0395T**601.02*570.97*656.62
**0397T**45.95*43.65*50.20
**0408T**524.50*498.28*573.02
**0409T**361.77*343.68*395.23
**0410T**376.07*357.27*410.86
**0411T**376.07*357.27*410.86
**0412T**235.60*223.82*257.39
**0413T**490.69*466.16*536.08
**0414T**376.98*358.13*411.85
**0415T**315.26*299.50*344.43
**0416T**347.88*330.49*380.06
**0417T**80.96*76.91*88.45
**0418T**54.27*51.56*59.29
**0419T**448.92*426.47*490.44
#**0419T**363.60*345.42*397.23
**0420T**640.34*608.32*699.57
#**0420T**534.57*507.84*584.02
**0421T**1539.07*1462.12*1681.44
#**0421T**700.40*665.38*765.19
**0437T**218.65*207.72*238.88
**0439T**70.38*66.86*76.89
**0440T**245.17*232.91*267.85
#**0440T**120.91*114.86*132.09
**0441T**245.17*232.91*267.85
#**0441T**120.91*114.86*132.09
**0442T**245.17*232.91*267.85
#**0442T**120.91*114.86*132.09
**0449T**750.36*712.84*819.77
**0464T**64.63*61.40*70.61
**0472T**65.19*61.93*71.22
**0473T**54.27*51.56*59.29
**0479T**50.13*47.62*54.76
**0480T**69.03*65.58*75.42
#**0480T**25.07*23.82*27.39
**0483T**1228.22*1166.81*1341.83
**0484T**1595.32*1515.55*1742.88
**0485T**23.10*21.95*25.24
**0485T*TC*8.73*8.29*9.53
**0485T*26*14.83*14.09*16.20
**0486T**46.20*43.89*50.47
**0486T*TC*17.00*16.15*18.57
**0486T*26*29.20*27.74*31.90
**0488T**61.81*58.72*67.53
#**0488T**49.16*46.70*53.71
**0505T**11083.22*10529.06*12108.42
#**0505T**560.31*532.29*612.13
**0507T**22.67*21.54*24.77
**0507T*TC*19.60*18.62*21.41
**0507T*26*3.07*2.92*3.36
**0510T**600.28*570.27*655.81
#**0510T**430.92*409.37*470.78
**0512T**306.95*291.60*335.34
#**0512T**224.55*213.32*245.32
**0513T**92.09*87.49*100.61
#**0513T**67.36*63.99*73.59
**0515T**524.50*498.28*573.02
**0516T**483.54*459.36*528.26
**0517T**342.14*325.03*373.78
**0518T**235.60*223.82*257.39
**0519T**343.42*326.25*375.19
**0520T**483.54*459.36*528.26
**0521T**54.27*51.56*59.29
**0521T*TC*34.52*32.79*37.71
**0521T*26*19.75*18.76*21.57
**0522T**65.19*61.93*71.22
**0522T*TC*34.85*33.11*38.08
**0522T*26*30.34*28.82*33.14
**0523T**151.87*144.28*165.92
**0524T**1546.12*1468.81*1689.13
#**0524T**181.87*172.78*198.70
**0525T**485.75*461.46*530.68
**0526T**376.07*357.27*410.86
**0527T**328.99*312.54*359.42
**0528T**65.19*61.93*71.22
**0528T*TC*34.85*33.11*38.08
**0528T*26*30.34*28.82*33.14
**0529T**54.27*51.56*59.29
**0529T*TC*34.52*32.79*37.71
**0529T*26*19.75*18.76*21.57
**0530T**644.18*611.97*703.77
**0531T**490.69*466.16*536.08
**0532T**343.42*326.25*375.19
**0543T**1595.32*1515.55*1742.88
**0544T**1824.84*1733.60*1993.64
**0545T**1824.84*1733.60*1993.64
**0546T**70.28*66.77*76.79
**0552T**6.97*6.62*7.61
**0565T**620.64*589.61*678.05
#**0565T**525.25*498.99*573.84
**0566T**99.17*94.21*108.34
#**0566T**59.92*56.92*65.46
**0569T**1824.84*1733.60*1993.64
**0570T**429.08*407.63*468.77
**0571T**567.42*539.05*619.91
**0572T**462.60*439.47*505.39
**0573T**353.68*336.00*386.40
**0574T**407.70*387.32*445.42
**0575T**65.19*61.93*71.22
**0576T**54.27*51.56*59.29
**0577T**185.89*176.60*203.09
**0578T**28.96*27.51*31.64
**0579T**19.60*18.62*21.41
**0580T**217.78*206.89*237.92
**0581T**2135.79*2029.00*2333.35
#**0581T**218.38*207.46*238.58
**0582T**1567.10*1488.75*1712.06
#**0582T**386.48*367.16*422.23
**0583T**1478.07*1404.17*1614.80
#**0583T**134.20*127.49*146.61
**0587T**414.41*393.69*452.74
#**0587T**298.91*283.96*326.55
**0588T**336.58*319.75*367.71
#**0588T**233.73*222.04*255.35
**0589T**47.46*45.09*51.85
#**0589T**38.38*36.46*41.93
**0590T**56.36*53.54*61.57
#**0590T**39.49*37.52*43.15
**0596T**2235.23*2123.47*2441.99
#**0596T**129.99*123.49*142.01
**0597T**129.99*123.49*142.01
**0598T**145.51*138.23*158.96
**0599T**98.56*93.63*107.67
**0600T**3405.91*3235.61*3720.95
#**0600T**730.94*694.39*798.55
**0601T**1499.85*1424.86*1638.59
**0604T**20.05*19.05*21.91
**0605T**43.28*41.12*47.29
**0606T**58.98*56.03*64.43
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**189.88*180.39*207.45
**0611T**41.14*39.08*44.94
**0614T**376.67*357.84*411.52
**0615T**46.05*43.75*50.31
**0619T**631.97*600.37*690.43
#**0619T**481.43*457.36*525.96
**0620T**1414.22*1343.51*1545.04
**0627T**250.42*237.90*273.59
#**0627T**99.23*94.27*108.41
**0628T**75.13*71.37*82.08
#**0628T**29.77*28.28*32.52
**0629T**250.42*237.90*273.59
#**0629T**99.23*94.27*108.41
**0630T**75.13*71.37*82.08
#**0630T**29.77*28.28*32.52
**0631T**80.23*76.22*87.65
**0632T**587.14*557.78*641.45
**0633T**195.18*185.42*213.23
*C*0633T*TC*106.87*101.53*116.76
**0633T*26*58.33*55.41*63.72
**0634T**195.18*185.42*213.23
**0634T*TC*136.85*130.01*149.51
**0634T*26*58.33*55.41*63.72
**0635T**195.18*185.42*213.23
**0635T*TC*136.85*130.01*149.51
**0635T*26*58.33*55.41*63.72
**0636T**195.18*185.42*213.23
**0636T*TC*136.85*130.01*149.51
**0636T*26*58.33*55.41*63.72
**0637T**195.18*185.42*213.23
**0637T*TC*136.85*130.01*149.51
**0637T*26*58.33*55.41*63.72
**0638T**195.18*185.42*213.23
**0638T*TC*136.85*130.01*149.51
**0638T*26*58.33*55.41*63.72
**0639T**80.23*76.22*87.65
**0640T**22.67*21.54*24.77
**0640T*TC*19.60*18.62*21.41
**0640T*26*3.07*2.92*3.36
**0644T**1113.04*1057.39*1216.00
#**0644T**247.44*235.07*270.33
**0646T**1824.84*1733.60*1993.64
**0650T**57.68*54.80*63.02
**0652T**281.36*267.29*307.38
#**0652T**122.71*116.57*134.06
**0653T**362.84*344.70*396.41
#**0653T**137.68*130.80*150.42
**0654T**142.46*135.34*155.64
**0655T**1539.07*1462.12*1681.44
#**0655T**700.40*665.38*765.19
**0658T**91.95*87.35*100.45
**0659T**2541.40*2414.33*2776.48
#**0659T**446.20*423.89*487.47
**0660T**750.36*712.84*819.77
**0671T**1007.75*957.36*1100.96
**0673T**3253.25*3090.59*3554.18
#**0673T**370.96*352.41*405.27
**0699T**111.42*105.85*121.73
#**0699T**90.98*86.43*99.39
**0707T**358.02*340.12*391.14
#**0707T**273.01*259.36*298.26
**0714T**1333.19*1266.53*1456.51
#**0714T**361.18*343.12*394.59
**0738T**70.03*66.53*76.51
**0739T**1539.07*1462.12*1681.44
#**0739T**700.40*665.38*765.19
**0740T**20.05*19.05*21.91
**0741T**43.28*41.12*47.29
**0742T**89.81*85.32*98.12
**0742T*TC*71.11*67.55*77.68
**0742T*26*18.70*17.77*20.44
**0743T**53.06*50.41*57.97
**0744T**917.98*872.08*1002.89
**0745T**253.33*240.66*276.76
**0746T**224.70*213.47*245.49
**0747T**955.76*907.97*1044.17
**0748T**186.03*176.73*203.24
**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**4.28*4.07*4.68
**0765T**7.98*7.58*8.72
**0771T**26.51*25.18*28.96
**0772T**26.51*25.18*28.96
**0773T**22.91*21.76*25.02
**0774T**22.91*21.76*25.02
**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**406.45*386.13*444.05
**0779T*TC*381.02*361.97*416.27
**0779T*26*25.43*24.16*27.78
**0780T**22.91*21.76*25.02
**0783T**14.08*13.38*15.39
**0784T**2004.30*1904.09*2189.70
#**0784T**328.59*312.16*358.98
**0785T**237.50*225.63*259.47
#**0785T**145.69*138.41*159.17
**0786T**706.01*670.71*771.32
#**0786T**306.30*290.99*334.64
**0787T**237.50*225.63*259.47
#**0787T**145.69*138.41*159.17
**0788T**18.69*17.76*20.42
#**0788T**18.36*17.44*20.06
**0789T**23.36*22.19*25.52
#**0789T**22.95*21.80*25.07
**0790T**1925.60*1829.32*2103.72
**0791T**8.97*8.52*9.80
**0793T**587.14*557.78*641.45
**0794T**130.35*123.83*142.40
**0795T**725.30*689.04*792.40
**0796T**483.54*459.36*528.26
**0797T**483.54*459.36*528.26
**0798T**769.48*731.01*840.66
**0799T**512.99*487.34*560.44
**0800T**511.95*486.35*559.30
**0801T**996.52*946.69*1088.69
**0802T**498.26*473.35*544.35
**0803T**498.26*473.35*544.35
**0804T**75.94*72.14*82.96
**0804T*TC*40.36*38.34*44.09
**0804T*26*35.58*33.80*38.87
**0805T**2788.71*2649.27*3046.66
#**0805T**329.17*312.71*359.62
**0806T**3718.28*3532.37*4062.23
#**0806T**438.89*416.95*479.49
**0807T**42.48*40.36*46.41
**0807T*TC*27.38*26.01*29.91
**0807T*26*15.10*14.35*16.50
**0808T**42.48*40.36*46.41
**0808T*TC*27.38*26.01*29.91
**0808T*26*15.10*14.35*16.50
**0810T**1118.43*1062.51*1221.89
**0811T**20.05*19.05*21.91
**0813T**2358.47*2240.55*2576.63
#**0813T**180.21*171.20*196.88
**0814T**419.68*398.70*458.51
#**0814T**313.43*297.76*342.42
**0820T**151.45*143.88*165.46
#**0820T**133.28*126.62*145.61
**0821T**151.45*143.88*165.46
#**0821T**133.28*126.62*145.61
**0822T**128.73*122.29*140.63
#**0822T**113.29*107.63*123.77
**0823T**725.30*689.04*792.40
**0824T**769.48*731.01*840.66
**0825T**996.52*946.69*1088.69
**0826T**65.19*61.93*71.22
**0826T*TC*34.85*33.11*38.08
**0826T*26*30.34*28.82*33.14
**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**22.67*21.54*24.77
**0859T*TC*19.60*18.62*21.41
**0859T*26*3.07*2.92*3.36
**0864T**306.95*291.60*335.34
#**0864T**224.55*213.32*245.32
**0867T**1666.48*1583.16*1820.63
#**0867T**451.47*428.90*493.24
**0868T**406.45*386.13*444.05
**0868T*TC*381.02*361.97*416.27
**0868T*26*25.43*24.16*27.78
**0869T**358.02*340.12*391.14
#**0869T**273.01*259.36*298.26
**0876T**144.24*137.03*157.58
**0876T*TC*119.14*113.18*130.16
**0876T*26*27.07*25.72*29.58
**0884T**990.10*940.60*1081.69
#**0884T**189.56*180.08*207.09
**0885T**654.02*621.32*714.52
#**0885T**304.28*289.07*332.43
**0886T**548.17*520.76*598.87
#**0886T**106.56*101.23*116.41
**0897T**58.20*55.29*63.58
**0897T*TC*52.17*49.56*56.99
**0897T*26*7.98*7.58*8.72
**0898T**69.25*65.79*75.66
**0898T*TC*59.96*56.96*65.50
**0898T*26*9.29*8.83*10.15
**0899T**127.15*120.79*138.91
**0899T*TC*83.92*79.72*91.68
**0899T*26*41.28*39.22*45.10
**0900T**125.20*118.94*136.78
**0900T*TC*83.92*79.72*91.68
**0900T*26*41.28*39.22*45.10
**10011**410.54*390.01*448.51
#**10011**107.84*102.45*117.82
**10012**231.75*220.16*253.18
#**10012**73.10*69.45*79.87
**15847**361.42*343.35*394.85
**21742**1189.34*1129.87*1299.35
**21743**1429.32*1357.85*1561.53
**32855**353.05*335.40*385.71
**32856**467.18*443.82*510.39
**33928**3422.27*3251.16*3738.83
**33929**1281.26*1217.20*1399.78
**33933**540.91*513.86*590.94
**33944**540.91*513.86*590.94
**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**536.22*509.41*585.82
#**43648**241.80*229.71*264.17
**43881**681.31*647.24*744.33
#**43881**624.29*593.08*682.04
**43882**722.94*686.79*789.81
#**43882**661.57*628.49*722.76
**47143**423.96*402.76*463.17
**47144**503.44*478.27*550.01
**47145**476.95*453.10*521.07
**48551**269.63*256.15*294.57
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**765.28*727.02*836.07
**53452**382.64*363.51*418.04
**53453**650.60*618.07*710.78
**53454**56.06*53.26*61.25
#**53454**34.97*33.22*38.20
**63043**611.02*580.47*667.54
**63044**518.94*492.99*566.94
**64596**2004.30*1904.09*2189.70
#**64596**328.59*312.16*358.98
**64597**601.49*571.42*657.13
#**64597**98.78*93.84*107.92
**64598**237.50*225.63*259.47
#**64598**145.69*138.41*159.17
**65757**123.16*117.00*134.55
**66983**652.57*619.94*712.93
**66987**760.43*722.41*830.77
**66988**628.12*596.71*686.22
*C*70170**256.80*243.96*280.55
*C*70170*TC*242.48*230.36*264.91
**70555**241.72*229.63*264.07
**70555*TC*124.06*117.86*135.54
*C*70557**698.78*663.84*763.42
*C*70557*TC*550.05*522.55*600.93
*C*70558**343.25*326.09*375.00
*C*70558*TC*178.57*169.64*195.09
*C*70559**336.52*319.69*367.64
*C*70559*TC*178.57*169.64*195.09
*C*74190**571.70*543.12*624.59
*C*74190*TC*550.05*522.55*600.93
**74235**147.94*140.54*161.62
**74235*TC*92.35*87.73*100.89
**74300**84.36*80.14*92.16
**74300*TC*71.35*67.78*77.95
**74301**26.28*24.97*28.72
**74301*TC*16.34*15.52*17.85
**74328**175.06*166.31*191.26
**74328*TC*152.57*144.94*166.68
**74329**143.68*136.50*156.98
**74329*TC*120.86*114.82*132.04
**74330**262.59*249.46*286.88
**74330*TC*236.17*224.36*258.01
**74340**86.58*82.25*94.59
**74340*TC*61.34*58.27*67.01
**74355**86.58*82.25*94.59
**74355*TC*50.75*48.21*55.44
**74360**86.58*82.25*94.59
**74360*TC*59.91*56.91*65.45
**74363**175.06*166.31*191.26
**74363*TC*135.68*128.90*148.24
*C*74445**159.39*151.42*174.13
*C*74445*TC*106.87*101.53*116.76
*C*74450**257.66*244.78*281.50
*C*74450*TC*242.48*230.36*264.91
*C*74470**574.97*546.22*628.15
*C*74470*TC*550.05*522.55*600.93
**74742**233.47*221.80*255.07
**74742*TC*204.96*194.71*223.92
*C*74775**271.65*258.07*296.78
*C*74775*TC*242.48*230.36*264.91
*C*75801**663.65*630.47*725.04
*C*75801*TC*620.13*589.12*677.49
*C*75803**1612.67*1532.04*1761.85
*C*75803*TC*1558.07*1480.17*1702.20
*C*75805**3195.34*3035.57*3490.91
*C*75805*TC*3157.21*2999.35*3449.25
*C*75807**3208.84*3048.40*3505.66
*C*75807*TC*3157.21*2999.35*3449.25
*C*75810**3205.65*3045.37*3502.18
*C*75810*TC*3157.21*2999.35*3449.25
**75894**915.07*869.32*999.72
**75894*TC*841.50*799.43*919.34
*C*75898**3250.45*3087.93*3551.12
*C*75898*TC*3157.21*2999.35*3449.25
**75970**446.51*424.18*487.81
**75970*TC*409.55*389.07*447.43
**76125**40.39*38.37*44.13
**76125*TC*27.05*25.70*29.56
**76390**205.41*195.14*224.41
**76390*TC*152.99*145.34*167.14
**76390*26*52.42*49.80*57.27
**76932**86.11*81.80*94.07
**76932*TC*50.76*48.22*55.45
**76940**165.94*157.64*181.29
**76940*TC*64.22*61.01*70.16
**76941**117.49*111.62*128.36
**76941*TC*55.30*52.54*60.42
**76945**84.99*80.74*92.85
**76945*TC*54.12*51.41*59.12
*C*76975**282.10*268.00*308.20
*C*76975*TC*242.48*230.36*264.91
**76998**175.06*166.31*191.26
**76998*TC*127.54*121.16*139.33
**77013**421.12*400.06*460.07
**77013*TC*240.57*228.54*262.82
**77022**471.36*447.79*514.96
**77022*TC*274.63*260.90*300.04
**77520**895.59*850.81*978.43
**77522**895.59*850.81*978.43
**77523**1028.37*976.95*1123.49
**77525**1161.13*1103.07*1268.53
*C*78282**417.95*397.05*456.61
*C*78282*TC*403.08*382.93*440.37
**78414**514.99*489.24*562.63
**78414*TC*494.58*469.85*540.33
*C*78429**1540.21*1463.20*1682.68
*C*78429*TC*1463.01*1389.86*1598.34
*C*78430**1535.83*1459.04*1677.90
*C*78430*TC*1463.01*1389.86*1598.34
*C*78431**2342.59*2225.46*2559.28
*C*78431*TC*2257.23*2144.37*2466.03
*C*78432**1950.35*1852.83*2130.75
*C*78432*TC*1856.23*1763.42*2027.93
*C*78433**2056.83*1953.99*2247.09
*C*78433*TC*1956.48*1858.66*2137.46
**78434**703.08*667.93*768.12
**78434*TC*674.69*640.96*737.10
*C*78459**1381.18*1312.12*1508.94
*C*78459*TC*1309.55*1244.07*1430.68
*C*78491**1533.33*1456.66*1675.16
*C*78491*TC*1463.01*1389.86*1598.34
*C*78492**1544.44*1467.22*1687.30
*C*78492*TC*1463.01*1389.86*1598.34
*C*78608**1530.39*1453.87*1671.95
*C*78608*TC*1463.01*1389.86*1598.34
*C*78811**1379.34*1310.37*1506.93
*C*78811*TC*1309.55*1244.07*1430.68
*C*78812**1550.72*1473.18*1694.16
*C*78812*TC*1463.01*1389.86*1598.34
*C*78813**1552.37*1474.75*1695.96
*C*78813*TC*1463.01*1389.86*1598.34
*C*78814**1562.76*1484.62*1707.31
*C*78814*TC*1463.01*1389.86*1598.34
*C*78815**1574.79*1496.05*1720.46
*C*78815*TC*1463.01*1389.86*1598.34
*C*78816**1575.20*1496.44*1720.91
*C*78816*TC*1463.01*1389.86*1598.34
**79300**237.04*225.19*258.97
**79300*TC*175.21*166.45*191.42
**79445**237.04*225.19*258.97
**79445*TC*128.32*121.90*140.19
**86485**17.28*16.42*18.88
**90867**296.88*282.04*324.35
#**90867**137.75*130.86*150.49
**90868**199.80*189.81*218.28
#**90868**112.72*107.08*123.14
**90869**239.38*227.41*261.52
#**90869**160.22*152.21*175.04
**92978**247.54*235.16*270.43
**92978*TC*152.57*144.94*166.68
**92979**150.60*143.07*164.53
**92979*TC*74.84*71.10*81.77
*C*93315**671.45*637.88*733.56
*C*93315*TC*550.05*522.55*600.93
**93317**216.69*205.86*236.74
**93317*TC*130.43*123.91*142.50
*C*93318**650.11*617.60*710.24
*C*93318*TC*550.05*522.55*600.93
**93571**246.56*234.23*269.36
**93571*TC*174.33*165.61*190.45
**93572**148.17*140.76*161.87
**93572*TC*95.81*91.02*104.67
**93600**3557.81*3379.92*3886.91
**93600*TC*3442.14*3270.03*3760.53
**93602**3557.81*3379.92*3886.91
**93602*TC*3443.57*3271.39*3762.10
**93603**3557.81*3379.92*3886.91
**93603*TC*3443.57*3271.39*3762.10
**93609**2134.69*2027.96*2332.15
**93609*TC*1863.23*1770.07*2035.58
**93610**3557.81*3379.92*3886.91
**93610*TC*3397.03*3227.18*3711.26
**93612**3557.81*3379.92*3886.91
**93612*TC*3399.18*3229.22*3713.60
**93615**49.73*47.24*54.33
**93615*TC*14.68*13.95*16.04
**93619**7115.62*6759.84*7773.82
**93619*TC*6733.45*6396.78*7356.30
**93620**7115.62*6759.84*7773.82
**93620*TC*6499.31*6174.34*7100.49
**93621**7115.62*6759.84*7773.82
**93621*TC*7033.87*6682.18*7684.51
**93622**7115.62*6759.84*7773.82
**93622*TC*6945.72*6598.43*7588.19
**93623**2134.69*2027.96*2332.15
**93623*TC*2080.07*1976.07*2272.48
**93624**3557.81*3379.92*3886.91
**93624*TC*3318.31*3152.39*3625.25
**93631**7115.62*6759.84*7773.82
**93631*TC*6721.02*6384.97*7342.72
**93640**1133.95*1077.25*1238.84
**93640*TC*958.02*910.12*1046.64
**93641**1133.95*1077.25*1238.84
**93641*TC*827.77*786.38*904.34
**93662**388.69*369.26*424.65
**93662*TC*320.82*304.78*350.50
**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**938.11*891.20*1024.88
**95965*TC*538.75*511.81*588.58
**95966**541.34*514.27*591.41
**95966*TC*344.83*327.59*376.73
**95967**455.64*432.86*497.79
**95967*TC*286.11*271.80*312.57
**96020**375.58*356.80*410.32
**97151**50.44*47.92*55.11
#**97151**43.51*41.33*47.53
**97152**41.68*39.60*45.54
#**97152**36.99*35.14*40.41
**97153**34.61*32.88*37.81
#**97153**30.39*28.87*33.20
**97154**4.63*4.40*5.06
#**97154**4.21*4.00*4.60
**97155**33.14*31.48*36.20
#**97155**29.08*27.63*31.77
**97156**34.94*33.19*38.17
#**97156**30.72*29.18*33.56
**97157**10.27*9.76*11.22
#**97157**9.29*8.83*10.15
**97158**5.36*5.09*5.85
#**97158**4.87*4.63*5.32
**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.