TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
AUSTIN
******
**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**515.26*489.50*562.93
#**G0186**440.49*418.47*481.24
**G0339**2855.95*2713.15*3120.12
**G0340**2147.81*2040.42*2346.48
**G0398**128.78*122.34*140.69
**G0398*TC*91.27*86.71*99.72
**G0398*26*37.52*35.64*40.99
**G0399**95.85*91.06*104.72
**G0399*TC*53.71*51.02*58.67
**G0399*26*42.13*40.02*46.02
**G0400**97.32*92.45*106.32
**G0400*TC*58.11*55.20*63.48
**G0400*26*39.21*37.25*42.84
**G0460**804.39*764.17*878.80
#**G0460**117.21*111.35*128.05
**G0498**148.94*141.49*162.71
**G0552**128.87*122.43*140.79
**G6017**79.09*75.14*86.41
**0042T**228.27*216.86*249.39
**0054T**224.52*213.29*245.28
**0055T**224.52*213.29*245.28
**0071T**553.83*526.14*605.06
**0072T**553.83*526.14*605.06
**0075T*26*935.74*888.95*1022.29
**0076T**1037.29*985.43*1133.24
**0095T**613.51*582.83*670.25
**0098T**686.37*652.05*749.86
**0101T**308.67*293.24*337.23
#**0101T**222.73*211.59*243.33
**0102T**308.67*293.24*337.23
#**0102T**222.73*211.59*243.33
**0106T**33.00*31.35*36.05
**0107T**33.00*31.35*36.05
**0108T**33.00*31.35*36.05
**0109T**33.00*31.35*36.05
**0110T**33.00*31.35*36.05
**0164T**671.40*637.83*733.50
**0165T**687.41*653.04*751.00
**0184T**814.32*773.60*889.64
**0198T**84.95*80.70*92.81
#**0198T**31.15*29.59*34.03
**0200T**1738.29*1651.38*1899.09
#**0200T**396.42*376.60*433.09
**0201T**2607.44*2477.07*2848.63
#**0201T**594.63*564.90*649.64
**0207T**128.90*122.46*140.83
**0208T**40.56*38.53*44.31
**0209T**49.02*46.57*53.56
**0210T**30.75*29.21*33.59
**0211T**47.66*45.28*52.07
**0212T**35.90*34.11*39.23
#**0212T**31.16*29.60*34.04
**0213T**191.45*181.88*209.16
#**0213T**103.48*98.31*113.06
**0214T**96.85*92.01*105.81
#**0214T**57.94*55.04*63.30
**0215T**96.56*91.73*105.49
#**0215T**58.33*55.41*63.72
**0216T**177.05*168.20*193.43
#**0216T**89.42*84.95*97.69
**0217T**90.11*85.60*98.44
#**0217T**49.51*47.03*54.08
**0218T**89.19*84.73*97.44
#**0218T**49.94*47.44*54.56
**0219T**1300.64*1235.61*1420.95
**0220T**1280.83*1216.79*1399.31
**0221T**1561.71*1483.62*1706.16
**0222T**379.49*360.52*414.60
**0232T**927.85*881.46*1013.68
#**0232T**88.07*83.67*96.22
**0234T**8236.33*7824.51*8998.19
#**0234T**560.31*532.29*612.13
**0235T**8236.33*7824.51*8998.19
#**0235T**560.31*532.29*612.13
**0236T**8409.42*7988.95*9187.29
#**0236T**650.84*618.30*711.05
**0237T**8409.42*7988.95*9187.29
#**0237T**650.84*618.30*711.05
**0238T**8409.42*7988.95*9187.29
#**0238T**650.84*618.30*711.05
**0266T**874.28*830.57*955.16
**0267T**153.15*145.49*167.31
**0268T**325.79*309.50*355.93
**0269T**828.34*786.92*904.96
**0270T**153.15*145.49*167.31
**0271T**325.79*309.50*355.93
**0272T**55.44*52.67*60.57
**0273T**70.44*66.92*76.96
**0274T**1098.42*1043.50*1200.03
**0278T**14.47*13.75*15.81
**0308T**1373.55*1304.87*1500.60
**0329T**84.95*80.70*92.81
#**0329T**31.15*29.59*34.03
**0330T**39.25*37.29*42.88
**0331T**182.57*173.44*199.46
**0332T**308.21*292.80*336.72
**0347T**138.96*132.01*151.81
**0348T**33.11*31.45*36.17
**0349T**34.83*33.09*38.05
**0350T**35.85*34.06*39.17
**0351T**167.81*159.42*183.33
**0352T**42.33*40.21*46.24
**0353T**167.81*159.42*183.33
**0354T**42.33*40.21*46.24
**0358T**26.69*25.36*29.16
**0362T**90.68*86.15*99.07
#**0362T**64.29*61.08*70.24
**0378T**24.53*23.30*26.80
**0394T**252.53*239.90*275.89
**0395T**614.69*583.96*671.55
**0397T**45.51*43.23*49.71
**0408T**496.83*471.99*542.79
**0409T**344.33*327.11*376.18
**0410T**359.11*341.15*392.32
**0411T**359.11*341.15*392.32
**0412T**227.11*215.75*248.11
**0413T**466.40*443.08*509.54
**0414T**359.03*341.08*392.24
**0415T**299.51*284.53*327.21
**0416T**333.83*317.14*364.71
**0417T**82.14*78.03*89.73
**0418T**55.44*52.67*60.57
**0419T**449.74*427.25*491.34
#**0419T**360.76*342.72*394.13
**0420T**635.90*604.11*694.73
#**0420T**525.60*499.32*574.22
**0421T**1556.05*1478.25*1699.99
#**0421T**681.43*647.36*744.46
**0437T**208.84*198.40*228.16
**0439T**70.80*67.26*77.35
**0440T**248.22*235.81*271.18
#**0440T**118.64*112.71*129.62
**0441T**248.22*235.81*271.18
#**0441T**118.64*112.71*129.62
**0442T**248.22*235.81*271.18
#**0442T**118.64*112.71*129.62
**0449T**750.80*713.26*820.25
**0464T**66.39*63.07*72.53
**0472T**66.24*62.93*72.37
**0473T**55.44*52.67*60.57
**0479T**50.02*47.52*54.65
**0480T**70.86*67.32*77.42
#**0480T**25.01*23.76*27.32
**0483T**1145.87*1088.58*1251.87
**0484T**1487.53*1413.15*1625.12
**0485T**23.41*22.24*25.58
**0485T*TC*8.92*8.47*9.74
**0485T*26*14.78*14.04*16.15
**0486T**46.82*44.48*51.15
**0486T*TC*17.55*16.67*19.17
**0486T*26*29.27*27.81*31.98
**0488T**61.53*58.45*67.22
#**0488T**48.33*45.91*52.80
**0505T**11155.28*10597.52*12187.15
#**0505T**538.78*511.84*588.62
**0507T**23.19*22.03*25.33
**0507T*TC*20.26*19.25*22.14
**0507T*26*2.93*2.78*3.20
**0510T**596.43*566.61*651.60
#**0510T**419.81*398.82*458.64
**0512T**308.67*293.24*337.23
#**0512T**222.73*211.59*243.33
**0513T**92.60*87.97*101.17
#**0513T**66.82*63.48*73.00
**0515T**496.83*471.99*542.79
**0516T**458.33*435.41*500.72
**0517T**325.79*309.50*355.93
**0518T**227.11*215.75*248.11
**0519T**327.19*310.83*357.45
**0520T**458.33*435.41*500.72
**0521T**55.44*52.67*60.57
**0521T*TC*35.82*34.03*39.13
**0521T*26*19.62*18.64*21.44
**0522T**66.24*62.93*72.37
**0522T*TC*36.16*34.35*39.50
**0522T*26*30.08*28.58*32.87
**0523T**151.03*143.48*165.00
**0524T**1593.14*1513.48*1740.50
#**0524T**170.41*161.89*186.17
**0525T**460.27*437.26*502.85
**0526T**359.11*341.15*392.32
**0527T**313.12*297.46*342.08
**0528T**66.24*62.93*72.37
**0528T*TC*36.16*34.35*39.50
**0528T*26*30.08*28.58*32.87
**0529T**55.44*52.67*60.57
**0529T*TC*35.82*34.03*39.13
**0529T*26*19.62*18.64*21.44
**0530T**613.15*582.49*669.86
**0531T**466.40*443.08*509.54
**0532T**327.19*310.83*357.45
**0543T**1487.53*1413.15*1625.12
**0544T**1711.62*1626.04*1869.95
**0545T**1711.62*1626.04*1869.95
**0546T**71.54*67.96*78.15
**0552T**6.97*6.62*7.61
**0565T**612.28*581.67*668.92
#**0565T**512.80*487.16*560.23
**0566T**98.51*93.58*107.62
#**0566T**57.57*54.69*62.89
**0569T**1711.62*1626.04*1869.95
**0570T**400.40*380.38*437.44
**0571T**538.01*511.11*587.78
**0572T**437.58*415.70*478.06
**0573T**336.49*319.67*367.62
**0574T**386.68*367.35*422.45
**0575T**66.24*62.93*72.37
**0576T**55.44*52.67*60.57
**0577T**186.60*177.27*203.86
**0578T**28.37*26.95*30.99
**0579T**20.26*19.25*22.14
**0580T**209.07*198.62*228.41
**0581T**2203.61*2093.43*2407.44
#**0581T**203.99*193.79*222.86
**0582T**1610.51*1529.98*1759.48
#**0582T**379.27*360.31*414.36
**0583T**1534.57*1457.84*1676.52
#**0583T**133.08*126.43*145.39
**0587T**409.94*389.44*447.86
#**0587T**289.49*275.02*316.27
**0588T**334.08*317.38*364.99
#**0588T**226.82*215.48*247.80
**0589T**46.97*44.62*51.31
#**0589T**37.49*35.62*40.96
**0590T**56.03*53.23*61.21
#**0590T**38.44*36.52*42.00
**0596T**2235.23*2123.47*2441.99
#**0596T**126.60*120.27*138.31
**0597T**126.60*120.27*138.31
**0598T**150.54*143.01*164.46
**0599T**101.78*96.69*111.19
**0600T**3495.89*3321.10*3819.27
#**0600T**706.24*670.93*771.57
**0601T**1412.86*1342.22*1543.55
**0604T**20.55*19.52*22.45
**0605T**44.96*42.71*49.12
**0606T**60.00*57.00*65.55
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**193.65*183.97*211.57
**0611T**42.55*40.42*46.48
**0614T**358.66*340.73*391.84
**0615T**46.24*43.93*50.52
**0619T**628.34*596.92*686.46
#**0619T**471.35*447.78*514.95
**0620T**1414.22*1343.51*1545.04
**0627T**254.75*242.01*278.31
#**0627T**97.08*92.23*106.06
**0628T**76.43*72.61*83.50
#**0628T**29.13*27.67*31.82
**0629T**254.75*242.01*278.31
#**0629T**97.08*92.23*106.06
**0630T**76.43*72.61*83.50
#**0630T**29.13*27.67*31.82
**0631T**82.31*78.19*89.92
**0632T**551.78*524.19*602.82
**0633T**199.79*189.80*218.27
*C*0633T*TC*111.27*105.71*121.57
**0633T*26*57.43*54.56*62.74
**0634T**199.79*189.80*218.27
**0634T*TC*142.36*135.24*155.53
**0634T*26*57.43*54.56*62.74
**0635T**199.79*189.80*218.27
**0635T*TC*142.36*135.24*155.53
**0635T*26*57.43*54.56*62.74
**0636T**199.79*189.80*218.27
**0636T*TC*142.36*135.24*155.53
**0636T*26*57.43*54.56*62.74
**0637T**199.79*189.80*218.27
**0637T*TC*142.36*135.24*155.53
**0637T*26*57.43*54.56*62.74
**0638T**199.79*189.80*218.27
**0638T*TC*142.36*135.24*155.53
**0638T*26*57.43*54.56*62.74
**0639T**82.31*78.19*89.92
**0640T**23.19*22.03*25.33
**0640T*TC*20.26*19.25*22.14
**0640T*26*2.93*2.78*3.20
**0644T**1133.28*1076.62*1238.11
#**0644T**230.58*219.05*251.91
**0646T**1711.62*1626.04*1869.95
**0650T**58.65*55.72*64.08
**0652T**284.68*270.45*311.02
#**0652T**119.23*113.27*130.26
**0653T**368.74*350.30*402.85
#**0653T**133.93*127.23*146.31
**0654T**138.01*131.11*150.78
**0655T**1556.05*1478.25*1699.99
#**0655T**681.43*647.36*744.46
**0658T**95.71*90.92*104.56
**0659T**2599.60*2469.62*2840.06
#**0659T**414.57*393.84*452.92
**0660T**750.80*713.26*820.25
**0671T**1007.91*957.51*1101.14
**0673T**3360.27*3192.26*3671.10
#**0673T**354.42*336.70*387.21
**0699T**111.37*105.80*121.67
#**0699T**90.05*85.55*98.38
**0707T**362.10*344.00*395.60
#**0707T**273.45*259.78*298.75
**0714T**1368.59*1300.16*1495.18
#**0714T**354.91*337.16*387.73
**0738T**69.54*66.06*75.97
**0739T**1556.05*1478.25*1699.99
#**0739T**681.43*647.36*744.46
**0740T**20.55*19.52*22.45
**0741T**44.96*42.71*49.12
**0742T**92.46*87.84*101.02
**0742T*TC*73.94*70.24*80.78
**0742T*26*18.52*17.59*20.23
**0743T**54.24*51.53*59.26
**0744T**851.45*808.88*930.21
**0745T**262.93*249.78*287.25
**0746T**223.30*212.14*243.96
**0747T**991.89*942.30*1083.65
**0748T**179.65*170.67*196.27
**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**4.26*4.05*4.66
**0765T**7.82*7.43*8.54
**0771T**25.50*24.23*27.86
**0772T**25.50*24.23*27.86
**0773T**23.37*22.20*25.53
**0774T**23.37*22.20*25.53
**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**422.37*401.25*461.44
**0779T*TC*397.17*377.31*433.91
**0779T*26*25.19*23.93*27.52
**0780T**23.37*22.20*25.53
**0783T**14.51*13.78*15.85
**0784T**2068.20*1964.79*2259.51
#**0784T**320.66*304.63*350.32
**0785T**238.55*226.62*260.61
#**0785T**142.80*135.66*156.01
**0786T**713.23*677.57*779.21
#**0786T**296.39*281.57*323.81
**0787T**238.55*226.62*260.61
#**0787T**142.80*135.66*156.01
**0788T**18.30*17.39*20.00
#**0788T**17.96*17.06*19.62
**0789T**22.87*21.73*24.99
#**0789T**22.45*21.33*24.53
**0790T**1875.65*1781.87*2049.15
**0791T**8.93*8.48*9.75
**0793T**551.78*524.19*602.82
**0794T**130.35*123.83*142.40
**0795T**687.49*653.12*751.09
**0796T**458.33*435.41*500.72
**0797T**458.33*435.41*500.72
**0798T**725.43*689.16*792.53
**0799T**483.62*459.44*528.36
**0800T**482.18*458.07*526.78
**0801T**941.94*894.84*1029.07
**0802T**470.97*447.42*514.53
**0803T**470.97*447.42*514.53
**0804T**77.22*73.36*84.36
**0804T*TC*41.91*39.81*45.78
**0804T*26*35.31*33.54*38.57
**0805T**2878.86*2734.92*3145.16
#**0805T**313.87*298.18*342.91
**0806T**3838.47*3646.55*4193.53
#**0806T**418.49*397.57*457.21
**0807T**43.03*40.88*47.01
**0807T*TC*28.38*26.96*31.00
**0807T*26*14.65*13.92*16.01
**0808T**43.03*40.88*47.01
**0808T*TC*28.38*26.96*31.00
**0808T*26*14.65*13.92*16.01
**0810T**1113.21*1057.55*1216.18
**0811T**20.55*19.52*22.45
**0813T**2444.46*2322.24*2670.58
#**0813T**172.81*164.17*188.80
**0814T**424.03*402.83*463.25
#**0814T**313.22*297.56*342.19
**0820T**149.77*142.28*163.62
#**0820T**130.82*124.28*142.92
**0821T**149.77*142.28*163.62
#**0821T**130.82*124.28*142.92
**0822T**127.30*120.94*139.08
#**0822T**111.20*105.64*121.49
**0823T**687.49*653.12*751.09
**0824T**725.43*689.16*792.53
**0825T**941.94*894.84*1029.07
**0826T**66.24*62.93*72.37
**0826T*TC*36.16*34.35*39.50
**0826T*26*30.08*28.58*32.87
**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**23.19*22.03*25.33
**0859T*TC*20.26*19.25*22.14
**0859T*26*2.93*2.78*3.20
**0864T**308.67*293.24*337.23
#**0864T**222.73*211.59*243.33
**0867T**1710.74*1625.20*1868.98
#**0867T**443.64*421.46*484.68
**0868T**422.37*401.25*461.44
**0868T*TC*397.17*377.31*433.91
**0868T*26*25.19*23.93*27.52
**0869T**362.10*344.00*395.60
#**0869T**273.45*259.78*298.75
**0876T**147.70*140.32*161.37
**0876T*TC*123.71*117.52*135.15
**0876T*26*25.94*24.64*28.34
**0884T**1017.67*966.79*1111.81
#**0884T**182.81*173.67*199.72
**0885T**659.17*626.21*720.14
#**0885T**294.44*279.72*321.68
**0886T**554.02*526.32*605.27
#**0886T**103.98*98.78*113.60
**0897T**59.84*56.85*65.38
**0897T*TC*54.05*51.35*59.05
**0897T*26*7.82*7.43*8.54
**0898T**71.30*67.74*77.90
**0898T*TC*62.17*59.06*67.92
**0898T*26*9.13*8.67*9.97
**0899T**130.12*123.61*142.15
**0899T*TC*87.36*82.99*95.44
**0899T*26*40.73*38.69*44.49
**0900T**128.09*121.69*139.94
**0900T*TC*87.36*82.99*95.44
**0900T*26*40.73*38.69*44.49
**10011**419.98*398.98*458.83
#**10011**104.31*99.09*113.95
**10012**234.84*223.10*256.57
#**10012**69.39*65.92*75.81
**15847**349.32*331.85*381.63
**21742**1125.33*1069.06*1229.42
**21743**1325.54*1259.26*1448.15
**32855**339.53*322.55*370.93
**32856**434.26*412.55*474.43
**33928**3172.48*3013.86*3465.94
**33929**1188.42*1129.00*1298.35
**33933**519.19*493.23*567.21
**33944**519.19*493.23*567.21
**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**525.10*498.85*573.68
#**43648**236.08*224.28*257.92
**43881**660.92*627.87*722.05
#**43881**603.52*573.34*659.34
**43882**704.09*668.89*769.22
#**43882**642.30*610.19*701.72
**47143**410.01*389.51*447.94
**47144**486.91*462.56*531.94
**47145**461.29*438.23*503.96
**48551**262.01*248.91*286.25
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**745.72*708.43*814.69
**53452**372.86*354.22*407.35
**53453**633.93*602.23*692.56
**53454**56.26*53.45*61.47
#**53454**34.27*32.56*37.44
**63043**560.87*532.83*612.75
**63044**499.10*474.15*545.27
**64596**2068.20*1964.79*2259.51
#**64596**320.66*304.63*350.32
**64597**620.66*589.63*678.07
#**64597**96.39*91.57*105.31
**64598**238.55*226.62*260.61
#**64598**142.80*135.66*156.01
**65757**122.96*116.81*134.33
**66983**652.10*619.50*712.43
**66987**748.99*711.54*818.27
**66988**624.67*593.44*682.46
*C*70170**266.72*253.38*291.39
*C*70170*TC*252.70*240.07*276.08
**70555**241.72*229.63*264.07
**70555*TC*126.62*120.29*138.33
*C*70557**720.84*684.80*787.52
*C*70557*TC*573.45*544.78*626.50
*C*70558**349.14*331.68*381.43
*C*70558*TC*186.05*176.75*203.26
*C*70559**339.79*322.80*371.22
*C*70559*TC*186.05*176.75*203.26
*C*74190**594.60*564.87*649.60
*C*74190*TC*573.45*544.78*626.50
**74235**148.05*140.65*161.75
**74235*TC*93.19*88.53*101.81
**74300**86.73*82.39*94.75
**74300*TC*74.02*70.32*80.87
**74301**26.65*25.32*29.12
**74301*TC*16.85*16.01*18.41
**74328**175.06*166.31*191.26
**74328*TC*152.84*145.20*166.98
**74329**144.67*137.44*158.06
**74329*TC*122.11*116.00*133.40
**74330**262.59*249.46*286.88
**74330*TC*236.44*224.62*258.31
**74340**86.58*82.25*94.59
**74340*TC*61.80*58.71*67.52
**74355**86.58*82.25*94.59
**74355*TC*51.34*48.77*56.09
**74360**86.58*82.25*94.59
**74360*TC*60.49*57.47*66.09
**74363**175.06*166.31*191.26
**74363*TC*136.70*129.87*149.35
*C*74445**163.20*155.04*178.30
*C*74445*TC*111.27*105.71*121.57
*C*74450**267.73*254.34*292.49
*C*74450*TC*252.70*240.07*276.08
*C*74470**597.90*568.01*653.21
*C*74470*TC*573.45*544.78*626.50
**74742**233.47*221.80*255.07
**74742*TC*205.41*195.14*224.41
*C*74775**281.42*267.35*307.45
*C*74775*TC*252.70*240.07*276.08
*C*75801**688.08*653.68*751.73
*C*75801*TC*646.53*614.20*706.33
*C*75803**1678.56*1594.63*1833.82
*C*75803*TC*1624.69*1543.46*1774.98
*C*75805**3329.92*3163.42*3637.93
*C*75805*TC*3292.39*3127.77*3596.94
*C*75807**3342.79*3175.65*3652.00
*C*75807*TC*3292.39*3127.77*3596.94
*C*75810**3338.98*3172.03*3647.83
*C*75810*TC*3292.39*3127.77*3596.94
**75894**926.89*880.55*1012.63
**75894*TC*857.63*814.75*936.96
*C*75898**3380.09*3211.09*3692.75
*C*75898*TC*3292.39*3127.77*3596.94
**75970**452.20*429.59*494.03
**75970*TC*416.09*395.29*454.58
**76125**40.43*38.41*44.17
**76125*TC*27.38*26.01*29.91
**76390**210.35*199.83*229.80
**76390*TC*159.18*151.22*173.90
**76390*26*51.17*48.61*55.90
**76932**86.15*81.84*94.12
**76932*TC*51.96*49.36*56.76
**76940**157.77*149.88*172.36
**76940*TC*60.44*57.42*66.03
**76941**116.87*111.03*127.68
**76941*TC*55.04*52.29*60.13
**76945**85.17*80.91*93.05
**76945*TC*54.41*51.69*59.44
*C*76975**291.97*277.37*318.98
*C*76975*TC*252.70*240.07*276.08
**76998**175.06*166.31*191.26
**76998*TC*130.07*123.57*142.11
**77013**434.43*412.71*474.62
**77013*TC*258.05*245.15*281.92
**77022**483.55*459.37*528.28
**77022*TC*290.58*276.05*317.46
**77520**901.54*856.46*984.93
**77522**901.54*856.46*984.93
**77523**1035.23*983.47*1130.99
**77525**1168.92*1110.47*1277.04
*C*78282**434.80*413.06*475.02
*C*78282*TC*420.18*399.17*459.05
**78414**514.99*489.24*562.63
**78414*TC*494.72*469.98*540.48
*C*78429**1601.89*1521.80*1750.07
*C*78429*TC*1525.55*1449.27*1666.66
*C*78430**1597.67*1517.79*1745.46
*C*78430*TC*1525.55*1449.27*1666.66
*C*78431**2438.41*2316.49*2663.96
*C*78431*TC*2353.82*2236.13*2571.55
*C*78432**2028.67*1927.24*2216.33
*C*78432*TC*1935.63*1838.85*2114.68
*C*78433**2139.37*2032.40*2337.26
*C*78433*TC*2040.17*1938.16*2228.88
**78434**731.76*695.17*799.45
**78434*TC*703.69*668.51*768.79
*C*78459**1436.33*1364.51*1569.19
*C*78459*TC*1365.52*1297.24*1491.83
*C*78491**1595.08*1515.33*1742.63
*C*78491*TC*1525.55*1449.27*1666.66
*C*78492**1606.23*1525.92*1754.81
*C*78492*TC*1525.55*1449.27*1666.66
*C*78608**1592.13*1512.52*1739.40
*C*78608*TC*1525.55*1449.27*1666.66
**78811**1434.26*1362.55*1566.93
*C*78811*TC*1365.52*1297.24*1491.83
*C*78812**1612.00*1531.40*1761.11
*C*78812*TC*1525.55*1449.27*1666.66
*C*78813**1613.59*1532.91*1762.85
*C*78813*TC*1525.55*1449.27*1666.66
*C*78814**1623.69*1542.51*1773.89
*C*78814*TC*1525.55*1449.27*1666.66
*C*78815**1635.43*1553.66*1786.71
*C*78815*TC*1525.55*1449.27*1666.66
*C*78816**1636.10*1554.30*1787.45
*C*78816*TC*1525.55*1449.27*1666.66
**79300**237.04*225.19*258.97
**79300*TC*175.90*167.11*192.18
**79445**237.04*225.19*258.97
**79445*TC*130.99*124.44*143.11
**86485**17.28*16.42*18.88
**90867**299.58*284.60*327.29
#**90867**133.62*126.94*145.98
**90868**199.77*189.78*218.25
#**90868**108.96*103.51*119.04
**90869**241.05*229.00*263.35
#**90869**158.49*150.57*173.16
**92978**248.76*236.32*271.77
**92978*TC*159.17*151.21*173.89
**92979**150.45*142.93*164.37
**92979*TC*78.97*75.02*86.27
*C*93315**693.62*658.94*757.78
*C*93315*TC*573.45*544.78*626.50
**93317**216.52*205.69*236.54
**93317*TC*132.14*125.53*144.36
*C*93318**671.11*637.55*733.18
*C*93318*TC*573.45*544.78*626.50
**93571**247.73*235.34*270.64
**93571*TC*179.46*170.49*196.06
**93572**148.10*140.70*161.81
**93572*TC*98.59*93.66*107.71
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.31*3275.89*3767.27
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.62*3277.14*3768.71
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.62*3277.14*3768.71
**93609**2134.69*2027.96*2332.15
**93609*TC*1877.40*1783.53*2051.06
**93610**3557.81*3379.92*3886.91
**93610*TC*3405.63*3235.35*3720.65
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.15*3236.79*3722.31
**93615**49.47*47.00*54.05
**93615*TC*14.88*14.14*16.26
**93619**7115.62*6759.84*7773.82
**93619*TC*6753.36*6415.69*7378.04
**93620**7115.62*6759.84*7773.82
**93620*TC*6532.20*6205.59*7136.43
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.18*6686.27*7689.21
**93622**7115.62*6759.84*7773.82
**93622*TC*6954.98*6607.23*7598.31
**93623**2134.69*2027.96*2332.15
**93623*TC*2082.78*1978.64*2275.44
**93624**3557.81*3379.92*3886.91
**93624*TC*3332.13*3165.52*3640.35
**93631**7115.62*6759.84*7773.82
**93631*TC*6745.70*6408.42*7369.68
**93640**1133.95*1077.25*1238.84
**93640*TC*967.50*919.13*1057.00
**93641**1133.95*1077.25*1238.84
**93641*TC*844.05*801.85*922.13
**93662**392.58*372.95*428.89
**93662*TC*325.29*309.03*355.38
**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**920.79*874.75*1005.96
**95965*TC*525.97*499.67*574.62
**95966**537.50*510.63*587.22
**95966*TC*345.27*328.01*377.21
**95967**452.01*429.41*493.82
**95967*TC*286.24*271.93*312.72
**96020**376.67*357.84*411.52
**97151**49.93*47.43*54.54
#**97151**42.71*40.57*46.66
**97152**41.19*39.13*45.00
#**97152**36.30*34.49*39.66
**97153**34.26*32.55*37.43
#**97153**29.86*28.37*32.63
**97154**4.47*4.25*4.89
#**97154**4.04*3.84*4.42
**97155**32.79*31.15*35.82
#**97155**28.56*27.13*31.20
**97156**34.57*32.84*37.77
#**97156**30.18*28.67*32.97
**97157**10.12*9.61*11.05
#**97157**9.10*8.65*9.95
**97158**5.21*4.95*5.69
#**97158**4.70*4.47*5.14
**98978**44.96*42.71*49.12
# - 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.