TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
FORT WORTH
******
**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**499.78*474.79*546.01
#**G0186**428.43*407.01*468.06
**G0339**2771.30*2632.74*3027.65
**G0340**2084.19*1979.98*2276.98
**G0398**124.49*118.27*136.01
**G0398*TC*87.10*82.75*95.16
**G0398*26*37.39*35.52*40.85
**G0399**93.21*88.55*101.83
**G0399*TC*51.27*48.71*56.02
**G0399*26*41.94*39.84*45.82
**G0400**94.47*89.75*103.21
**G0400*TC*55.46*52.69*60.59
**G0400*26*39.00*37.05*42.61
**G0460**771.98*733.38*843.39
#**G0460**116.33*110.51*127.09
**G0498**142.56*135.43*155.74
**G0552**128.87*122.43*140.79
**G6017**76.98*73.13*84.10
**0042T**221.40*210.33*241.88
**0054T**222.42*211.30*243.00
**0055T**222.42*211.30*243.00
**0071T**546.27*518.96*596.80
**0072T**546.27*518.96*596.80
**0075T*26*929.86*883.37*1015.88
**0076T**1041.16*989.10*1137.47
**0095T**605.10*574.85*661.08
**0098T**677.28*643.42*739.93
**0101T**301.12*286.06*328.97
#**0101T**219.13*208.17*239.40
**0102T**301.12*286.06*328.97
#**0102T**219.13*208.17*239.40
**0106T**31.60*30.02*34.52
**0107T**31.60*30.02*34.52
**0108T**31.60*30.02*34.52
**0109T**31.60*30.02*34.52
**0110T**31.60*30.02*34.52
**0164T**661.91*628.81*723.13
**0165T**677.77*643.88*740.46
**0184T**801.34*761.27*875.46
**0198T**82.19*78.08*89.79
#**0198T**30.86*29.32*33.72
**0200T**1673.02*1589.37*1827.78
#**0200T**392.72*373.08*429.04
**0201T**2509.53*2384.05*2741.66
#**0201T**589.08*559.63*643.57
**0207T**128.90*122.46*140.83
**0208T**38.71*36.77*42.29
**0209T**46.78*44.44*51.11
**0210T**29.35*27.88*32.06
**0211T**45.49*43.22*49.70
**0212T**35.38*33.61*38.65
#**0212T**30.86*29.32*33.72
**0213T**186.18*176.87*203.40
#**0213T**102.25*97.14*111.71
**0214T**94.67*89.94*103.43
#**0214T**57.55*54.67*62.87
**0215T**94.38*89.66*103.11
#**0215T**57.90*55.01*63.26
**0216T**171.88*163.29*187.78
#**0216T**88.27*83.86*96.44
**0217T**87.92*83.52*96.05
#**0217T**49.18*46.72*53.73
**0218T**87.01*82.66*95.06
#**0218T**49.56*47.08*54.14
**0219T**1278.83*1214.89*1397.12
**0220T**1259.41*1196.44*1375.91
**0221T**1539.77*1462.78*1682.20
**0222T**375.91*357.11*410.68
**0232T**888.76*844.32*970.97
#**0232T**87.53*83.15*95.62
**0234T**7882.39*7488.27*8611.51
#**0234T**558.62*530.69*610.29
**0235T**7882.39*7488.27*8611.51
#**0235T**558.62*530.69*610.29
**0236T**8051.57*7648.99*8796.34
#**0236T**649.03*616.58*709.07
**0237T**8051.57*7648.99*8796.34
#**0237T**649.03*616.58*709.07
**0238T**8051.57*7648.99*8796.34
#**0238T**649.03*616.58*709.07
**0266T**864.87*821.63*944.87
**0267T**152.34*144.72*166.43
**0268T**321.70*305.62*351.46
**0269T**818.63*777.70*894.36
**0270T**152.34*144.72*166.43
**0271T**321.70*305.62*351.46
**0272T**53.71*51.02*58.67
**0273T**68.63*65.20*74.98
**0274T**1080.21*1026.20*1180.13
**0278T**14.28*13.57*15.61
**0308T**1348.35*1280.93*1473.07
**0329T**82.19*78.08*89.79
#**0329T**30.86*29.32*33.72
**0330T**39.25*37.29*42.88
**0331T**175.73*166.94*191.98
**0332T**296.68*281.85*324.13
**0347T**137.66*130.78*150.40
**0348T**31.98*30.38*34.94
**0349T**33.59*31.91*36.70
**0350T**34.56*32.83*37.75
**0351T**161.62*153.54*176.57
**0352T**41.89*39.80*45.77
**0353T**161.62*153.54*176.57
**0354T**41.89*39.80*45.77
**0358T**25.47*24.20*27.83
**0362T**89.01*84.56*97.24
#**0362T**63.83*60.64*69.74
**0378T**24.32*23.10*26.57
**0394T**242.95*230.80*265.42
**0395T**593.75*564.06*648.67
**0397T**45.13*42.87*49.30
**0408T**491.56*466.98*537.03
**0409T**339.96*322.96*371.40
**0410T**354.20*336.49*386.96
**0411T**354.20*336.49*386.96
**0412T**223.15*211.99*243.79
**0413T**460.77*437.73*503.39
**0414T**354.47*336.75*387.26
**0415T**295.91*281.11*323.28
**0416T**328.51*312.08*358.89
**0417T**79.97*75.97*87.37
**0418T**53.71*51.02*58.67
**0419T**438.43*416.51*478.99
#**0419T**353.53*335.85*386.23
**0420T**621.47*590.40*678.96
#**0420T**516.23*490.42*563.98
**0421T**1508.43*1433.01*1647.96
#**0421T**673.94*640.24*736.28
**0437T**206.64*196.31*225.76
**0439T**68.60*65.17*74.95
**0440T**240.68*228.65*262.95
#**0440T**117.04*111.19*127.87
**0441T**240.68*228.65*262.95
#**0441T**117.04*111.19*127.87
**0442T**240.68*228.65*262.95
#**0442T**117.04*111.19*127.87
**0449T**735.04*698.29*803.03
**0464T**64.00*60.80*69.92
**0472T**64.42*61.20*70.38
**0473T**53.71*51.02*58.67
**0479T**49.29*46.83*53.85
**0480T**68.39*64.97*74.72
#**0480T**24.65*23.42*26.93
**0483T**1139.66*1082.68*1245.08
**0484T**1479.83*1405.84*1616.72
**0485T**22.84*21.70*24.96
**0485T*TC*8.52*8.09*9.30
**0485T*26*14.61*13.88*15.96
**0486T**45.68*43.40*49.91
**0486T*TC*16.76*15.92*18.31
**0486T*26*28.93*27.48*31.60
**0488T**60.60*57.57*66.21
#**0488T**48.01*45.61*52.45
**0505T**10790.31*10250.79*11788.41
#**0505T**537.75*510.86*587.49
**0507T**22.23*21.12*24.29
**0507T*TC*19.34*18.37*21.13
**0507T*26*2.90*2.76*3.17
**0510T**581.03*551.98*634.78
#**0510T**412.51*391.88*450.66
**0512T**301.12*286.06*328.97
#**0512T**219.13*208.17*239.40
**0513T**90.34*85.82*98.69
#**0513T**65.74*62.45*71.82
**0515T**491.56*466.98*537.03
**0516T**453.34*430.67*495.27
**0517T**321.70*305.62*351.46
**0518T**223.15*211.99*243.79
**0519T**322.98*306.83*352.85
**0520T**453.34*430.67*495.27
**0521T**53.71*51.02*58.67
**0521T*TC*34.19*32.48*37.35
**0521T*26*19.52*18.54*21.32
**0522T**64.42*61.20*70.38
**0522T*TC*34.51*32.78*37.70
**0522T*26*29.91*28.41*32.67
**0523T**147.00*139.65*160.60
**0524T**1527.16*1450.80*1668.42
#**0524T**169.71*161.22*185.40
**0525T**455.22*432.46*497.33
**0526T**354.20*336.49*386.96
**0527T**309.09*293.64*337.69
**0528T**64.42*61.20*70.38
**0528T*TC*34.51*32.78*37.70
**0528T*26*29.91*28.41*32.67
**0529T**53.71*51.02*58.67
**0529T*TC*34.19*32.48*37.35
**0529T*26*19.52*18.54*21.32
**0530T**605.40*575.13*661.40
**0531T**460.77*437.73*503.39
**0532T**322.98*306.83*352.85
**0543T**1479.83*1405.84*1616.72
**0544T**1699.51*1614.53*1856.71
**0545T**1699.51*1614.53*1856.71
**0546T**69.66*66.18*76.11
**0552T**6.77*6.43*7.39
**0565T**597.78*567.89*653.07
#**0565T**502.87*477.73*549.39
**0566T**96.17*91.36*105.06
#**0566T**57.10*54.25*62.39
**0569T**1699.51*1614.53*1856.71
**0570T**398.36*378.44*435.21
**0571T**532.05*505.45*581.27
**0572T**432.97*411.32*473.02
**0573T**332.22*315.61*362.95
**0574T**382.32*363.20*417.68
**0575T**64.42*61.20*70.38
**0576T**53.71*51.02*58.67
**0577T**183.71*174.52*200.70
**0578T**28.21*26.80*30.82
**0579T**19.34*18.37*21.13
**0580T**205.74*195.45*224.77
**0581T**2110.19*2004.68*2305.38
#**0581T**202.33*192.21*221.04
**0582T**1548.20*1470.79*1691.41
#**0582T**373.47*354.80*408.02
**0583T**1467.25*1393.89*1602.97
#**0583T**130.07*123.57*142.11
**0587T**401.20*381.14*438.31
#**0587T**286.28*271.97*312.77
**0588T**326.25*309.94*356.43
#**0588T**223.92*212.72*244.63
**0589T**46.30*43.99*50.59
#**0589T**37.27*35.41*40.72
**0590T**55.00*52.25*60.09
#**0590T**38.21*36.30*41.75
**0596T**2235.23*2123.47*2441.99
#**0596T**126.64*120.31*138.36
**0597T**126.64*120.31*138.36
**0598T**144.16*136.95*157.49
**0599T**97.60*92.72*106.63
**0600T**3364.54*3196.31*3675.76
#**0600T**702.90*667.76*767.92
**0601T**1398.91*1328.96*1528.30
**0604T**19.63*18.65*21.45
**0605T**42.90*40.76*46.87
**0606T**58.23*55.32*63.62
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**187.58*178.20*204.93
**0611T**40.61*38.58*44.37
**0614T**354.15*336.44*386.91
**0615T**45.38*43.11*49.58
**0619T**614.28*583.57*671.11
#**0619T**464.50*441.28*507.47
**0620T**1414.22*1343.51*1545.04
**0627T**246.54*234.21*269.34
#**0627T**96.11*91.30*105.00
**0628T**73.96*70.26*80.80
#**0628T**28.83*27.39*31.50
**0629T**246.54*234.21*269.34
#**0629T**96.11*91.30*105.00
**0630T**73.96*70.26*80.80
#**0630T**28.83*27.39*31.50
**0631T**79.04*75.09*86.35
**0632T**547.54*520.16*598.18
**0633T**193.00*183.35*210.85
*C*0633T*TC*106.18*100.87*116.00
**0633T*26*57.16*54.30*62.45
**0634T**193.00*183.35*210.85
**0634T*TC*135.84*129.05*148.41
**0634T*26*57.16*54.30*62.45
**0635T**193.00*183.35*210.85
**0635T*TC*135.84*129.05*148.41
**0635T*26*57.16*54.30*62.45
**0636T**193.00*183.35*210.85
**0636T*TC*135.84*129.05*148.41
**0636T*26*57.16*54.30*62.45
**0637T**193.00*183.35*210.85
**0637T*TC*135.84*129.05*148.41
**0637T*26*57.16*54.30*62.45
**0638T**193.00*183.35*210.85
**0638T*TC*135.84*129.05*148.41
**0638T*26*57.16*54.30*62.45
**0639T**79.04*75.09*86.35
**0640T**22.23*21.12*24.29
**0640T*TC*19.34*18.37*21.13
**0640T*26*2.90*2.76*3.17
**0644T**1091.32*1036.75*1192.26
#**0644T**230.04*218.54*251.32
**0646T**1699.51*1614.53*1856.71
**0650T**56.94*54.09*62.20
**0652T**275.73*261.94*301.23
#**0652T**117.87*111.98*128.78
**0653T**356.50*338.68*389.48
#**0653T**132.46*125.84*144.72
**0654T**136.57*129.74*149.20
**0655T**1508.43*1433.01*1647.96
#**0655T**673.94*640.24*736.28
**0658T**91.33*86.76*99.77
**0659T**2498.27*2373.36*2729.36
#**0659T**413.51*392.83*451.75
**0660T**735.04*698.29*803.03
**0671T**986.95*937.60*1078.24
**0673T**3220.03*3059.03*3517.88
#**0673T**352.12*334.51*384.69
**0699T**109.02*103.57*119.11
#**0699T**88.69*84.26*96.90
**0707T**351.09*333.54*383.57
#**0707T**266.51*253.18*291.16
**0714T**1316.39*1250.57*1438.16
#**0714T**349.23*331.77*381.54
**0738T**68.80*65.36*75.16
**0739T**1508.43*1433.01*1647.96
#**0739T**673.94*640.24*736.28
**0740T**19.63*18.65*21.45
**0741T**42.90*40.76*46.87
**0742T**89.00*84.55*97.23
**0742T*TC*70.56*67.03*77.08
**0742T*26*18.44*17.52*20.15
**0743T**52.33*49.71*57.17
**0744T**847.41*805.04*925.80
**0745T**250.94*238.39*274.15
**0746T**221.12*210.06*241.57
**0747T**946.63*899.30*1034.20
**0748T**177.21*168.35*193.60
**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**25.36*24.09*27.70
**0772T**25.36*24.09*27.70
**0773T**22.64*21.51*24.74
**0774T**22.64*21.51*24.74
**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**403.97*383.77*441.34
**0779T*TC*378.96*360.01*414.01
**0779T*26*25.01*23.76*27.32
**0780T**22.64*21.51*24.74
**0783T**13.85*13.16*15.13
**0784T**1984.51*1885.28*2168.07
#**0784T**317.15*301.29*346.48
**0785T**231.77*220.18*253.21
#**0785T**140.41*133.39*153.40
**0786T**691.21*656.65*755.15
#**0786T**293.49*278.82*320.64
**0787T**231.77*220.18*253.21
#**0787T**140.41*133.39*153.40
**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**1859.36*1766.39*2031.35
**0791T**8.77*8.33*9.58
**0793T**547.54*520.16*598.18
**0794T**130.35*123.83*142.40
**0795T**680.01*646.01*742.91
**0796T**453.34*430.67*495.27
**0797T**453.34*430.67*495.27
**0798T**718.71*682.77*785.19
**0799T**479.14*455.18*523.46
**0800T**477.79*453.90*521.99
**0801T**932.48*885.86*1018.74
**0802T**466.24*442.93*509.37
**0803T**466.24*442.93*509.37
**0804T**75.12*71.36*82.06
**0804T*TC*40.00*38.00*43.70
**0804T*26*35.13*33.37*38.38
**0805T**2759.97*2621.97*3015.27
#**0805T**312.69*297.06*341.62
**0806T**3679.96*3495.96*4020.35
#**0806T**416.92*396.07*455.48
**0807T**41.65*39.57*45.51
**0807T*TC*27.09*25.74*29.60
**0807T*26*14.56*13.83*15.90
**0808T**41.65*39.57*45.51
**0808T*TC*27.09*25.74*29.60
**0808T*26*14.56*13.83*15.90
**0810T**1093.40*1038.73*1194.54
**0811T**19.63*18.65*21.45
**0813T**2338.51*2221.58*2554.82
#**0813T**171.11*162.55*186.93
**0814T**411.31*390.74*449.35
#**0814T**305.59*290.31*333.86
**0820T**149.31*141.84*163.12
#**0820T**131.23*124.67*143.37
**0821T**149.31*141.84*163.12
#**0821T**131.23*124.67*143.37
**0822T**126.91*120.56*138.64
#**0822T**111.54*105.96*121.85
**0823T**680.01*646.01*742.91
**0824T**718.71*682.77*785.19
**0825T**932.48*885.86*1018.74
**0826T**64.42*61.20*70.38
**0826T*TC*34.51*32.78*37.70
**0826T*26*29.91*28.41*32.67
**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**22.23*21.12*24.29
**0859T*TC*19.34*18.37*21.13
**0859T*26*2.90*2.76*3.17
**0864T**301.12*286.06*328.97
#**0864T**219.13*208.17*239.40
**0867T**1645.49*1563.22*1797.70
#**0867T**436.53*414.70*476.91
**0868T**403.97*383.77*441.34
**0868T*TC*378.96*360.01*414.01
**0868T*26*25.01*23.76*27.32
**0869T**351.09*333.54*383.57
#**0869T**266.51*253.18*291.16
**0876T**141.94*134.84*155.07
**0876T*TC*118.06*112.16*128.98
**0876T*26*25.84*24.55*28.23
**0884T**977.54*928.66*1067.96
#**0884T**180.99*171.94*197.73
**0885T**639.55*607.57*698.71
#**0885T**291.56*276.98*318.53
**0886T**532.45*505.83*581.70
#**0886T**102.50*97.38*111.99
**0897T**57.44*54.57*62.76
**0897T*TC*51.59*49.01*56.36
**0897T*26*7.79*7.40*8.51
**0898T**68.43*65.01*74.76
**0898T*TC*59.34*56.37*64.83
**0898T*26*9.09*8.64*9.94
**0899T**125.85*119.56*137.49
**0899T*TC*83.36*79.19*91.07
**0899T*26*40.55*38.52*44.30
**0900T**123.91*117.71*135.37
**0900T*TC*83.36*79.19*91.07
**0900T*26*40.55*38.52*44.30
**10011**405.08*384.83*442.55
#**10011**103.89*98.70*113.51
**10012**227.31*215.94*248.33
#**10012**69.45*65.98*75.88
**15847**343.71*326.52*375.50
**21742**1115.05*1059.30*1218.20
**21743**1313.75*1248.06*1435.27
**32855**343.94*326.74*375.75
**32856**431.89*410.30*471.85
**33928**3161.95*3003.85*3454.43
**33929**1184.48*1125.26*1294.05
**33933**526.57*500.24*575.28
**33944**526.57*500.24*575.28
**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**523.86*497.67*572.32
#**43648**236.68*224.85*258.58
**43881**660.57*627.54*721.67
#**43881**604.86*574.62*660.81
**43882**701.13*666.07*765.98
#**43882**641.15*609.09*700.45
**47143**411.70*391.12*449.79
**47144**488.91*464.46*534.13
**47145**463.17*440.01*506.01
**48551**263.06*249.91*287.40
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**736.94*700.09*805.10
**53452**368.47*350.05*402.56
**53453**626.42*595.10*684.37
**53454**55.02*52.27*60.11
#**53454**34.03*32.33*37.18
**63043**552.02*524.42*603.08
**63044**503.26*478.10*549.82
**64596**1984.51*1885.28*2168.07
#**64596**317.15*301.29*346.48
**64597**595.55*565.77*650.64
#**64597**95.34*90.57*104.16
**64598**231.77*220.18*253.21
#**64598**140.41*133.39*153.40
**65757**120.56*114.53*131.71
**66983**640.42*608.40*699.66
**66987**739.72*702.73*808.14
**66988**615.32*584.55*672.23
*C*70170**255.06*242.31*278.66
*C*70170*TC*241.11*229.05*263.41
**70555**241.72*229.63*264.07
**70555*TC*127.10*120.75*138.86
*C*70557**693.23*658.57*757.36
*C*70557*TC*547.15*519.79*597.76
*C*70558**339.16*322.20*370.53
*C*70558*TC*177.52*168.64*193.94
*C*70559**330.37*313.85*360.93
*C*70559*TC*177.52*168.64*193.94
*C*74190**568.24*539.83*620.80
*C*74190*TC*547.15*519.79*597.76
**74235**143.74*136.55*157.03
**74235*TC*89.16*84.70*97.41
**74300**83.39*79.22*91.10
**74300*TC*70.75*67.21*77.29
**74301**25.64*24.36*28.01
**74301*TC*15.90*15.11*17.38
**74328**175.06*166.31*191.26
**74328*TC*152.97*145.32*167.12
**74329**139.58*132.60*152.49
**74329*TC*117.17*111.31*128.01
**74330**262.59*249.46*286.88
**74330*TC*236.59*224.76*258.47
**74340**86.58*82.25*94.59
**74340*TC*61.91*58.81*67.63
**74355**86.58*82.25*94.59
**74355*TC*51.52*48.94*56.28
**74360**86.58*82.25*94.59
**74360*TC*60.65*57.62*66.26
**74363**175.06*166.31*191.26
**74363*TC*136.78*129.94*149.43
*C*74445**157.86*149.97*172.47
*C*74445*TC*106.18*100.87*116.00
*C*74450**256.07*243.27*279.76
*C*74450*TC*241.11*229.05*263.41
*C*74470**571.49*542.92*624.36
*C*74470*TC*547.15*519.79*597.76
**74742**233.47*221.80*255.07
**74742*TC*205.54*195.26*224.55
*C*74775**269.69*256.21*294.64
*C*74775*TC*241.11*229.05*263.41
*C*75801**658.13*625.22*719.00
*C*75801*TC*616.87*586.03*673.93
*C*75803**1603.74*1523.55*1752.08
*C*75803*TC*1550.14*1472.63*1693.52
*C*75805**3178.65*3019.72*3472.68
*C*75805*TC*3141.31*2984.24*3431.88
*C*75807**3191.62*3032.04*3486.85
*C*75807*TC*3141.31*2984.24*3431.88
*C*75810**3187.97*3028.57*3482.86
*C*75810*TC*3141.31*2984.24*3431.88
**75894**888.20*843.79*970.36
**75894*TC*819.44*778.47*895.24
*C*75898**3228.37*3066.95*3526.99
*C*75898*TC*3141.31*2984.24*3431.88
**75970**433.68*412.00*473.80
**75970*TC*397.65*377.77*434.44
**76125**39.16*37.20*42.78
**76125*TC*26.20*24.89*28.62
**76390**202.90*192.76*221.67
**76390*TC*151.90*144.31*165.96
**76390*26*51.00*48.45*55.72
**76932**83.61*79.43*91.34
**76932*TC*49.68*47.20*54.28
**76940**154.97*147.22*169.30
**76940*TC*58.15*55.24*63.53
**76941**114.24*108.53*124.81
**76941*TC*52.76*50.12*57.64
**76945**82.66*78.53*90.31
**76945*TC*52.06*49.46*56.88
*C*76975**280.10*266.10*306.02
*C*76975*TC*241.11*229.05*263.41
**76998**175.06*166.31*191.26
**76998*TC*130.30*123.79*142.36
**77013**417.47*396.60*456.09
**77013*TC*241.60*229.52*263.95
**77022**467.22*443.86*510.44
**77022*TC*275.07*261.32*300.52
**77520**874.92*831.17*955.85
**77522**874.92*831.17*955.85
**77523**1004.63*954.40*1097.56
**77525**1134.33*1077.61*1239.25
*C*78282**415.56*394.78*454.00
*C*78282*TC*400.91*380.86*437.99
**78414**514.99*489.24*562.63
**78414*TC*494.82*470.08*540.59
*C*78429**1531.68*1455.10*1673.37
*C*78429*TC*1455.56*1382.78*1590.20
*C*78430**1527.48*1451.11*1668.78
*C*78430*TC*1455.56*1382.78*1590.20
*C*78431**2330.07*2213.57*2545.61
*C*78431*TC*2245.81*2133.52*2453.55
*C*78432**1939.47*1842.50*2118.88
*C*78432*TC*1846.81*1754.47*2017.64
*C*78433**2045.43*1943.16*2234.63
*C*78433*TC*1946.56*1849.23*2126.61
**78434**699.27*664.31*763.96
**78434*TC*671.30*637.74*733.40
*C*78459**1373.44*1304.77*1500.49
*C*78459*TC*1302.86*1237.72*1423.38
*C*78491**1524.82*1448.58*1665.87
*C*78491*TC*1455.56*1382.78*1590.20
*C*78492**1535.89*1459.10*1677.97
*C*78492*TC*1455.56*1382.78*1590.20
*C*78608**1521.89*1445.80*1662.67
*C*78608*TC*1455.56*1382.78*1590.20
*C*78811**1371.44*1302.87*1498.30
*C*78811*TC*1302.86*1237.72*1423.38
*C*78812**1541.67*1464.59*1684.28
*C*78812*TC*1455.56*1382.78*1590.20
*C*78813**1543.31*1466.14*1686.06
*C*78813*TC*1455.56*1382.78*1590.20
*C*78814**1553.34*1475.67*1697.02
*C*78814*TC*1455.56*1382.78*1590.20
*C*78815**1565.00*1486.75*1709.76
*C*78815*TC*1455.56*1382.78*1590.20
*C*78816**1565.73*1487.44*1710.56
*C*78816*TC*1455.56*1382.78*1590.20
**79300**237.04*225.19*258.97
**79300*TC*175.74*166.95*191.99
**79445**237.04*225.19*258.97
**79445*TC*131.29*124.73*143.44
**86485**17.28*16.42*18.88
**90867**290.04*275.54*316.87
#**90867**131.70*125.12*143.89
**90868**194.74*185.00*212.75
#**90868**108.09*102.69*118.09
**90869**234.12*222.41*255.77
#**90869**155.36*147.59*169.73
**92978**241.11*229.05*263.41
**92978*TC*151.99*144.39*166.05
**92979**146.51*139.18*160.06
**92979*TC*75.40*71.63*82.37
*C*93315**666.83*633.49*728.51
*C*93315*TC*547.15*519.79*597.76
**93317**210.41*199.89*229.87
**93317*TC*126.40*120.08*138.09
*C*93318**644.43*612.21*704.04
*C*93318*TC*547.15*519.79*597.76
**93571**240.13*228.12*262.34
**93571*TC*172.21*163.60*188.14
**93572**144.25*137.04*157.60
**93572*TC*95.00*90.25*103.79
**93600**3557.81*3379.92*3886.91
**93600*TC*3449.05*3276.60*3768.09
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.31*3277.79*3769.46
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.31*3277.79*3769.46
**93609**2134.69*2027.96*2332.15
**93609*TC*1879.13*1785.17*2052.95
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.52*3236.19*3721.62
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.01*3237.61*3723.25
**93615**49.27*46.81*53.83
**93615*TC*14.83*14.09*16.20
**93619**7115.62*6759.84*7773.82
**93619*TC*6755.75*6417.96*7380.65
**93620**7115.62*6759.84*7773.82
**93620*TC*6536.08*6209.28*7140.67
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.71*6686.77*7689.79
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.06*6608.26*7599.50
**93623**2134.69*2027.96*2332.15
**93623*TC*2083.19*1979.03*2275.88
**93624**3557.81*3379.92*3886.91
**93624*TC*3333.27*3166.61*3641.60
**93631**7115.62*6759.84*7773.82
**93631*TC*6747.23*6409.87*7371.35
**93640**1133.95*1077.25*1238.84
**93640*TC*968.54*920.11*1058.13
**93641**1133.95*1077.25*1238.84
**93641*TC*845.90*803.61*924.15
**93662**379.49*360.52*414.60
**93662*TC*312.51*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**925.58*879.30*1011.20
**95965*TC*533.34*506.67*582.67
**95966**536.37*509.55*585.98
**95966*TC*345.10*327.85*377.03
**95967**451.10*428.55*492.83
**95967*TC*286.06*271.76*312.52
**96020**376.62*357.79*411.46
**97151**49.78*47.29*54.38
#**97151**42.80*40.66*46.76
**97152**41.05*39.00*44.85
#**97152**36.38*34.56*39.74
**97153**34.17*32.46*37.33
#**97153**29.97*28.47*32.74
**97154**4.45*4.23*4.86
#**97154**4.04*3.84*4.42
**97155**32.70*31.07*35.73
#**97155**28.67*27.24*31.33
**97156**34.50*32.78*37.70
#**97156**30.30*28.79*33.11
**97157**10.07*9.57*11.01
#**97157**9.10*8.65*9.95
**97158**5.18*4.92*5.66
#**97158**4.70*4.47*5.14
**98978**42.90*40.76*46.87
# - 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.