TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
REST OF STATE
******
**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**480.01*456.01*524.41
#**G0186**412.46*391.84*450.62
**G0339**2581.74*2452.65*2820.55
**G0340**1941.66*1844.58*2121.27
**G0398**119.18*113.22*130.20
**G0398*TC*82.52*78.39*90.15
**G0398*26*36.65*34.82*40.04
**G0399**89.67*85.19*97.97
**G0399*TC*48.60*46.17*53.10
**G0399*26*41.08*39.03*44.88
**G0400**90.75*86.21*99.14
**G0400*TC*52.57*49.94*57.43
**G0400*26*38.18*36.27*41.71
**G0460**735.04*698.29*803.03
#**G0460**114.22*108.51*124.79
**G0498**135.46*128.69*147.99
**G0552**128.87*122.43*140.79
**G6017**74.13*70.42*80.98
**0042T**212.47*201.85*232.13
**0054T**219.25*208.29*239.53
**0055T**219.25*208.29*239.53
**0071T**533.44*506.77*582.79
**0072T**533.44*506.77*582.79
**0075T*26*916.72*870.88*1001.51
**0076T**1004.76*954.52*1097.70
**0095T**594.51*564.78*649.50
**0098T**665.78*632.49*727.36
**0101T**290.62*276.09*317.50
#**0101T**212.98*202.33*232.68
**0102T**290.62*276.09*317.50
#**0102T**212.98*202.33*232.68
**0106T**30.04*28.54*32.82
**0107T**30.04*28.54*32.82
**0108T**30.04*28.54*32.82
**0109T**30.04*28.54*32.82
**0110T**30.04*28.54*32.82
**0164T**650.04*617.54*710.17
**0165T**665.69*632.41*727.27
**0184T**781.03*741.98*853.28
**0198T**78.72*74.78*86.00
#**0198T**30.12*28.61*32.90
**0200T**1596.98*1517.13*1744.70
#**0200T**384.68*365.45*420.27
**0201T**2395.47*2275.70*2617.06
#**0201T**577.01*548.16*630.38
**0207T**128.90*122.46*140.83
**0208T**36.68*34.85*40.08
**0209T**44.32*42.10*48.42
**0210T**27.81*26.42*30.38
**0211T**43.10*40.95*47.09
**0212T**34.38*32.66*37.56
#**0212T**30.10*28.60*32.89
**0213T**179.25*170.29*195.83
#**0213T**99.77*94.78*109.00
**0214T**91.58*87.00*100.05
#**0214T**56.43*53.61*61.65
**0215T**91.28*86.72*99.73
#**0215T**56.74*53.90*61.99
**0216T**165.27*157.01*180.56
#**0216T**86.10*81.80*94.07
**0217T**84.89*80.65*92.75
#**0217T**48.21*45.80*52.67
**0218T**83.98*79.78*91.75
#**0218T**48.52*46.09*53.00
**0219T**1250.58*1188.05*1366.26
**0220T**1231.22*1169.66*1345.11
**0221T**1507.65*1432.27*1647.11
**0222T**370.18*351.67*404.42
**0232T**844.43*802.21*922.54
#**0232T**85.74*81.45*93.67
**0234T**7486.43*7112.11*8178.93
#**0234T**551.59*524.01*602.61
**0235T**7486.43*7112.11*8178.93
#**0235T**551.59*524.01*602.61
**0236T**7650.15*7267.64*8357.79
#**0236T**640.73*608.69*699.99
**0237T**7650.15*7267.64*8357.79
#**0237T**640.73*608.69*699.99
**0238T**7650.15*7267.64*8357.79
#**0238T**640.73*608.69*699.99
**0266T**848.22*805.81*926.68
**0267T**150.09*142.59*163.98
**0268T**314.95*299.20*344.08
**0269T**802.19*762.08*876.39
**0270T**150.09*142.59*163.98
**0271T**314.95*299.20*344.08
**0272T**51.50*48.93*56.27
**0273T**66.12*62.81*72.23
**0274T**1056.12*1003.31*1153.81
**0278T**13.89*13.20*15.18
**0308T**1308.01*1242.61*1429.00
**0329T**78.72*74.78*86.00
#**0329T**30.12*28.61*32.90
**0330T**39.25*37.29*42.88
**0331T**167.69*159.31*183.21
**0332T**283.04*268.89*309.22
**0347T**135.10*128.35*147.60
**0348T**30.61*29.08*33.44
**0349T**32.10*30.50*35.08
**0350T**33.02*31.37*36.08
**0351T**154.25*146.54*168.52
**0352T**40.84*38.80*44.62
**0353T**154.25*146.54*168.52
**0354T**40.84*38.80*44.62
**0358T**24.14*22.93*26.37
**0362T**86.34*82.02*94.32
#**0362T**62.50*59.38*68.29
**0378T**23.77*22.58*25.97
**0394T**231.71*220.12*253.14
**0395T**568.18*539.77*620.74
**0397T**44.09*41.89*48.17
**0408T**482.16*458.05*526.76
**0409T**332.83*316.19*363.62
**0410T**346.40*329.08*378.44
**0411T**346.40*329.08*378.44
**0412T**217.47*206.60*237.59
**0413T**451.35*428.78*493.10
**0414T**347.00*329.65*379.10
**0415T**289.88*275.39*316.70
**0416T**320.63*304.60*350.29
**0417T**77.00*73.15*84.12
**0418T**51.50*48.93*56.27
**0419T**423.13*401.97*462.27
#**0419T**342.74*325.60*374.44
**0420T**601.39*571.32*657.02
#**0420T**501.74*476.65*548.15
**0421T**1448.90*1376.46*1582.93
#**0421T**658.73*625.79*719.66
**0437T**202.49*192.37*221.23
**0439T**65.92*62.62*72.01
**0440T**231.18*219.62*252.56
#**0440T**114.10*108.40*124.66
**0441T**231.18*219.62*252.56
#**0441T**114.10*108.40*124.66
**0442T**231.18*219.62*252.56
#**0442T**114.10*108.40*124.66
**0449T**711.43*675.86*777.24
**0464T**61.14*58.08*66.79
**0472T**61.97*58.87*67.70
**0473T**51.50*48.93*56.27
**0479T**47.92*45.52*52.35
**0480T**65.38*62.11*71.43
#**0480T**23.96*22.76*26.17
**0483T**1123.58*1067.40*1227.51
**0484T**1459.27*1386.31*1594.26
**0485T**22.03*20.93*24.07
**0485T*TC*8.10*7.70*8.86
**0485T*26*14.23*13.52*15.55
**0486T**44.05*41.85*48.13
**0486T*TC*15.89*15.10*17.37
**0486T*26*28.16*26.75*30.76
**0488T**58.92*55.97*64.37
#**0488T**47.00*44.65*51.35
**0505T**10287.47*9773.10*11239.07
#**0505T**534.02*507.32*583.42
**0507T**21.17*20.11*23.13
**0507T*TC*18.34*17.42*20.03
**0507T*26*2.84*2.70*3.11
**0510T**561.06*533.01*612.96
#**0510T**401.50*381.43*438.64
**0512T**290.62*276.09*317.50
#**0512T**212.98*202.33*232.68
**0513T**87.19*82.83*95.25
#**0513T**63.89*60.70*69.81
**0515T**482.16*458.05*526.76
**0516T**444.56*422.33*485.68
**0517T**314.95*299.20*344.08
**0518T**217.47*206.60*237.59
**0519T**316.12*300.31*345.36
**0520T**444.56*422.33*485.68
**0521T**51.50*48.93*56.27
**0521T*TC*32.40*30.78*35.40
**0521T*26*19.10*18.15*20.87
**0522T**61.97*58.87*67.70
**0522T*TC*32.70*31.07*35.73
**0522T*26*29.27*27.81*31.98
**0523T**141.86*134.77*154.99
**0524T**1452.73*1380.09*1587.10
#**0524T**167.37*159.00*182.85
**0525T**446.39*424.07*487.68
**0526T**346.40*329.08*378.44
**0527T**302.56*287.43*330.54
**0528T**61.97*58.87*67.70
**0528T*TC*32.70*31.07*35.73
**0528T*26*29.27*27.81*31.98
**0529T**51.50*48.93*56.27
**0529T*TC*32.40*30.78*35.40
**0529T*26*19.10*18.15*20.87
**0530T**592.71*563.07*647.53
**0531T**451.35*428.78*493.10
**0532T**316.12*300.31*345.36
**0543T**1459.27*1386.31*1594.26
**0544T**1672.70*1589.07*1827.43
**0545T**1672.70*1589.07*1827.43
**0546T**67.05*63.70*73.26
**0552T**6.52*6.19*7.12
**0565T**578.55*549.62*632.06
#**0565T**488.69*464.26*533.90
**0566T**92.99*88.34*101.59
#**0566T**56.00*53.20*61.18
**0569T**1672.70*1589.07*1827.43
**0570T**392.81*373.17*429.15
**0571T**521.66*495.58*569.92
**0572T**424.78*403.54*464.07
**0573T**325.27*309.01*355.36
**0574T**374.79*356.05*409.46
**0575T**61.97*58.87*67.70
**0576T**51.50*48.93*56.27
**0577T**178.39*169.47*194.89
**0578T**27.65*26.27*30.21
**0579T**18.34*17.42*20.03
**0580T**200.79*190.75*219.36
**0581T**2005.65*1905.37*2191.18
#**0581T**199.11*189.15*217.52
**0582T**1476.01*1402.21*1612.54
#**0582T**363.66*345.48*397.30
**0583T**1392.07*1322.47*1520.84
#**0583T**125.90*119.61*137.55
**0587T**388.77*369.33*424.73
#**0587T**279.95*265.95*305.84
**0588T**315.58*299.80*344.77
#**0588T**218.68*207.75*238.91
**0589T**45.08*42.83*49.25
#**0589T**36.52*34.69*39.89
**0590T**53.36*50.69*58.29
#**0590T**37.47*35.60*40.94
**0596T**2235.23*2123.47*2441.99
#**0596T**124.63*118.40*136.16
**0597T**124.63*118.40*136.16
**0598T**136.97*130.12*149.64
**0599T**92.84*88.20*101.43
**0600T**3210.59*3050.06*3507.57
#**0600T**690.30*655.79*754.16
**0601T**1373.73*1305.04*1500.80
**0604T**18.64*17.71*20.37
**0605T**40.65*38.62*44.41
**0606T**55.94*53.14*61.11
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**179.89*170.90*196.54
**0611T**38.51*36.58*42.07
**0614T**346.73*329.39*378.80
**0615T**43.98*41.78*48.05
**0619T**594.48*564.76*649.47
#**0619T**452.64*430.01*494.51
**0620T**1414.22*1343.51*1545.04
**0627T**236.37*224.55*258.23
#**0627T**93.93*89.23*102.61
**0628T**70.91*67.36*77.46
#**0628T**28.18*26.77*30.79
**0629T**236.37*224.55*258.23
#**0629T**93.93*89.23*102.61
**0630T**70.91*67.36*77.46
#**0630T**28.18*26.77*30.79
**0631T**75.32*71.55*82.28
**0632T**538.57*511.64*588.39
**0633T**184.68*175.45*201.77
*C*0633T*TC*100.56*95.53*109.86
**0633T*26*56.00*53.20*61.18
**0634T**184.68*175.45*201.77
**0634T*TC*128.68*122.25*140.59
**0634T*26*56.00*53.20*61.18
**0635T**184.68*175.45*201.77
**0635T*TC*128.68*122.25*140.59
**0635T*26*56.00*53.20*61.18
**0636T**184.68*175.45*201.77
**0636T*TC*128.68*122.25*140.59
**0636T*26*56.00*53.20*61.18
**0637T**184.68*175.45*201.77
**0637T*TC*128.68*122.25*140.59
**0637T*26*56.00*53.20*61.18
**0638T**184.68*175.45*201.77
**0638T*TC*128.68*122.25*140.59
**0638T*26*56.00*53.20*61.18
**0639T**75.32*71.55*82.28
**0640T**21.17*20.11*23.13
**0640T*TC*18.34*17.42*20.03
**0640T*26*2.84*2.70*3.11
**0644T**1042.79*990.65*1139.25
#**0644T**227.25*215.89*248.27
**0646T**1672.70*1589.07*1827.43
**0650T**54.71*51.97*59.77
**0652T**264.67*251.44*289.16
#**0652T**115.19*109.43*125.84
**0653T**341.61*324.53*373.21
#**0653T**129.48*123.01*141.46
**0654T**133.61*126.93*145.97
**0655T**1448.90*1376.46*1582.93
#**0655T**658.73*625.79*719.66
**0658T**86.50*82.18*94.51
**0659T**2382.64*2263.51*2603.04
#**0659T**408.59*388.16*446.38
**0660T**711.43*675.86*777.24
**0671T**955.42*907.65*1043.80
**0673T**3061.51*2908.43*3344.69
#**0673T**345.90*328.61*377.90
**0699T**105.53*100.25*115.29
#**0699T**86.27*81.96*94.25
**0707T**337.26*320.40*368.46
#**0707T**257.17*244.31*280.96
**0714T**1255.65*1192.87*1371.80
#**0714T**339.85*322.86*371.29
**0738T**67.09*63.74*73.30
**0739T**1448.90*1376.46*1582.93
#**0739T**658.73*625.79*719.66
**0740T**18.64*17.71*20.37
**0741T**40.65*38.62*44.41
**0742T**84.91*80.66*92.76
**0742T*TC*66.85*63.51*73.04
**0742T*26*18.06*17.16*19.73
**0743T**50.04*47.54*54.67
**0744T**836.40*794.58*913.77
**0745T**237.79*225.90*259.79
**0746T**215.74*204.95*235.69
**0747T**897.06*852.21*980.04
**0748T**173.08*164.43*189.09
**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**4.03*3.83*4.40
**0765T**7.64*7.26*8.35
**0771T**24.91*23.66*27.21
**0772T**24.91*23.66*27.21
**0773T**21.71*20.62*23.71
**0774T**21.71*20.62*23.71
**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**383.31*364.14*418.76
**0779T*TC*358.86*340.92*392.06
**0779T*26*24.45*23.23*26.71
**0780T**21.71*20.62*23.71
**0783T**13.14*12.48*14.35
**0784T**1888.70*1794.27*2063.41
#**0784T**309.89*294.40*338.56
**0785T**223.12*211.96*243.75
#**0785T**136.62*129.79*149.26
**0786T**663.87*630.68*725.28
#**0786T**287.28*272.92*313.86
**0787T**223.12*211.96*243.75
#**0787T**136.62*129.79*149.26
**0788T**17.73*16.84*19.37
#**0788T**17.42*16.55*19.03
**0789T**22.16*21.05*24.21
#**0789T**21.78*20.69*23.79
**0790T**1819.76*1728.77*1988.09
**0791T**8.52*8.09*9.30
**0793T**538.57*511.64*588.39
**0794T**130.35*123.83*142.40
**0795T**666.84*633.50*728.53
**0796T**444.56*422.33*485.68
**0797T**444.56*422.33*485.68
**0798T**705.97*670.67*771.27
**0799T**470.65*447.12*514.19
**0800T**469.42*445.95*512.84
**0801T**915.21*869.45*999.87
**0802T**457.60*434.72*499.93
**0803T**457.60*434.72*499.93
**0804T**72.28*68.67*78.97
**0804T*TC*37.90*36.01*41.41
**0804T*26*34.38*32.66*37.56
**0805T**2625.08*2493.83*2867.90
#**0805T**307.76*292.37*336.23
**0806T**3500.11*3325.10*3823.87
#**0806T**410.35*389.83*448.30
**0807T**39.95*37.95*43.64
**0807T*TC*25.67*24.39*28.05
**0807T*26*14.28*13.57*15.61
**0808T**39.95*37.95*43.64
**0808T*TC*25.67*24.39*28.05
**0808T*26*14.28*13.57*15.61
**0810T**1061.17*1008.11*1159.33
**0811T**18.64*17.71*20.37
**0813T**2219.96*2108.96*2425.30
#**0813T**167.66*159.28*183.17
**0814T**395.28*375.52*431.85
#**0814T**295.17*280.41*322.47
**0820T**146.37*139.05*159.91
#**0820T**129.25*122.79*141.21
**0821T**146.37*139.05*159.91
#**0821T**129.25*122.79*141.21
**0822T**124.42*118.20*135.93
#**0822T**109.87*104.38*120.04
**0823T**666.84*633.50*728.53
**0824T**705.97*670.67*771.27
**0825T**915.21*869.45*999.87
**0826T**61.97*58.87*67.70
**0826T*TC*32.70*31.07*35.73
**0826T*26*29.27*27.81*31.98
**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**21.17*20.11*23.13
**0859T*TC*18.34*17.42*20.03
**0859T*26*2.84*2.70*3.11
**0864T**290.62*276.09*317.50
#**0864T**212.98*202.33*232.68
**0867T**1569.56*1491.08*1714.74
#**0867T**424.81*403.57*464.11
**0868T**383.31*364.14*418.76
**0868T*TC*358.86*340.92*392.06
**0868T*26*24.45*23.23*26.71
**0869T**337.26*320.40*368.46
#**0869T**257.17*244.31*280.96
**0876T**135.35*128.58*147.87
**0876T*TC*111.87*106.28*122.22
**0876T*26*25.43*24.16*27.78
**0884T**931.46*884.89*1017.62
#**0884T**177.21*168.35*193.60
**0885T**614.89*584.15*671.77
#**0885T**285.38*271.11*311.78
**0886T**508.57*483.14*555.61
#**0886T**99.94*94.94*109.18
**0897T**54.70*51.97*59.77
**0897T*TC*48.90*46.46*53.43
**0897T*26*7.64*7.26*8.35
**0898T**65.15*61.89*71.17
**0898T*TC*56.24*53.43*61.44
**0898T*26*8.91*8.46*9.73
**0899T**120.52*114.49*131.66
**0899T*TC*78.95*75.00*86.25
**0899T*26*39.74*37.75*43.41
**0900T**118.69*112.76*129.67
**0900T*TC*78.95*75.00*86.25
**0900T*26*39.74*37.75*43.41
**10011**387.26*367.90*423.09
#**10011**102.06*96.96*111.50
**10012**218.06*207.16*238.23
#**10012**68.58*65.15*74.92
**15847**335.14*318.38*366.14
**21742**1094.87*1040.13*1196.15
**21743**1293.42*1228.75*1413.06
**32855**332.85*316.21*363.64
**32856**425.98*404.68*465.38
**33928**3123.81*2967.62*3412.76
**33929**1170.11*1111.60*1278.34
**33933**509.92*484.42*557.08
**33944**509.92*484.42*557.08
**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**500.92*475.87*547.25
#**43648**227.64*216.26*248.70
**43881**629.52*598.04*687.75
#**43881**577.63*548.75*631.06
**43882**666.03*632.73*727.64
#**43882**610.17*579.66*666.61
**47143**399.92*379.92*436.91
**47144**474.88*451.14*518.81
**47145**449.89*427.40*491.51
**48551**252.82*240.18*276.21
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**719.81*683.82*786.39
**53452**359.91*341.91*393.20
**53453**611.83*581.24*668.43
**53454**53.19*50.53*58.11
#**53454**33.32*31.65*36.40
**63043**541.86*514.77*591.99
**63044**483.57*459.39*528.30
**64596**1888.70*1794.27*2063.41
#**64596**309.89*294.40*338.56
**64597**566.80*538.46*619.23
#**64597**93.16*88.50*101.78
**64598**223.12*211.96*243.75
#**64598**136.62*129.79*149.26
**65757**116.82*110.98*127.63
**66983**621.19*590.13*678.65
**66987**721.31*685.24*788.03
**66988**598.32*568.40*653.66
*C*70170**242.01*229.91*264.40
*C*70170*TC*228.34*216.92*249.46
**70555**241.72*229.63*264.07
**70555*TC*129.34*122.87*141.30
*C*70557**660.78*627.74*721.90
*C*70557*TC*518.11*492.20*566.03
*C*70558**325.98*309.68*356.13
*C*70558*TC*168.12*159.71*183.67
*C*70559**317.99*302.09*347.40
*C*70559*TC*168.12*159.71*183.67
*C*74190**538.83*511.89*588.67
*C*74190*TC*518.11*492.20*566.03
**74235**138.22*131.31*151.01
**74235*TC*84.77*80.53*92.61
**74300**79.47*75.50*86.83
**74300*TC*67.08*63.73*73.29
**74301**24.48*23.26*26.75
**74301*TC*14.94*14.19*16.32
**74328**175.06*166.31*191.26
**74328*TC*153.45*145.78*167.65
**74329**133.63*126.95*145.99
**74329*TC*111.71*106.12*122.04
**74330**262.59*249.46*286.88
**74330*TC*237.15*225.29*259.08
**74340**86.58*82.25*94.59
**74340*TC*62.40*59.28*68.17
**74355**86.58*82.25*94.59
**74355*TC*52.23*49.62*57.06
**74360**86.58*82.25*94.59
**74360*TC*61.18*58.12*66.84
**74363**175.06*166.31*191.26
**74363*TC*137.45*130.58*150.17
*C*74445**151.18*143.62*165.16
*C*74445*TC*100.56*95.53*109.86
*C*74450**242.98*230.83*265.45
*C*74450*TC*228.34*216.92*249.46
*C*74470**541.99*514.89*592.12
*C*74470*TC*518.11*492.20*566.03
**74742**233.47*221.80*255.07
**74742*TC*206.11*195.80*225.17
*C*74775**256.33*243.51*280.04
*C*74775*TC*228.34*216.92*249.46
*C*75801**624.66*593.43*682.44
*C*75801*TC*584.14*554.93*638.17
*C*75803**1520.35*1444.33*1660.98
*C*75803*TC*1467.85*1394.46*1603.63
*C*75805**3011.09*2860.54*3289.62
*C*75805*TC*2974.51*2825.78*3249.65
*C*75807**3023.95*2872.75*3303.66
*C*75807*TC*2974.51*2825.78*3249.65
*C*75810**3020.52*2869.49*3299.91
*C*75810*TC*2974.51*2825.78*3249.65
**75894**846.31*803.99*924.59
**75894*TC*778.66*739.73*850.69
*C*75898**3060.16*2907.15*3343.22
*C*75898*TC*2974.51*2825.78*3249.65
**75970**413.43*392.76*451.67
**75970*TC*378.04*359.14*413.01
**76125**37.60*35.72*41.08
**76125*TC*24.90*23.66*27.21
**76390**193.80*184.11*211.73
**76390*TC*143.96*136.76*157.27
**76390*26*49.92*47.42*54.53
**76932**80.38*76.36*87.81
**76932*TC*47.12*44.76*51.47
**76940**150.99*143.44*164.96
**76940*TC*55.83*53.04*61.00
**76941**110.35*104.83*120.55
**76941*TC*50.20*47.69*54.84
**76945**79.45*75.48*86.80
**76945*TC*49.53*47.05*54.11
*C*76975**266.45*253.13*291.10
*C*76975*TC*228.34*216.92*249.46
**76998**175.06*166.31*191.26
**76998*TC*131.01*124.46*143.13
**77013**397.51*377.63*434.27
**77013*TC*224.82*213.58*245.62
**77022**446.62*424.29*487.93
**77022*TC*258.20*245.29*282.08
**77520**815.08*774.33*890.48
**77522**815.08*774.33*890.48
**77523**935.93*889.13*1022.50
**77525**1056.76*1003.92*1154.51
*C*78282**394.07*374.37*430.53
*C*78282*TC*379.64*360.66*414.76
**78414**514.99*489.24*562.63
**78414*TC*495.24*470.48*541.05
*C*78429**1452.92*1380.27*1587.31
*C*78429*TC*1378.28*1309.37*1505.78
*C*78430**1448.79*1376.35*1582.80
*C*78430*TC*1378.28*1309.37*1505.78
*C*78431**2209.11*2098.65*2413.45
*C*78431*TC*2126.57*2020.24*2323.28
*C*78432**1839.53*1747.55*2009.68
*C*78432*TC*1748.76*1661.32*1910.52
*C*78433**1940.13*1843.12*2119.59
*C*78433*TC*1843.21*1751.05*2013.71
**78434**662.99*629.84*724.32
**78434*TC*635.59*603.81*694.38
*C*78459**1302.88*1237.74*1423.40
*C*78459*TC*1233.70*1172.02*1347.82
*C*78491**1446.15*1373.84*1579.92
*C*78491*TC*1378.28*1309.37*1505.78
*C*78492**1456.97*1384.12*1591.74
*C*78492*TC*1378.28*1309.37*1505.78
*C*78608**1443.29*1371.13*1576.80
*C*78608*TC*1378.28*1309.37*1505.78
*C*78811**1300.91*1235.86*1421.24
*C*78811*TC*1233.70*1172.02*1347.82
*C*78812**1462.69*1389.56*1597.99
*C*78812*TC*1378.28*1309.37*1505.78
*C*78813**1464.34*1391.12*1599.79
*C*78813*TC*1378.28*1309.37*1505.78
*C*78814**1474.17*1400.46*1610.53
*C*78814*TC*1378.28*1309.37*1505.78
*C*78815**1485.59*1411.31*1623.01
*C*78815*TC*1378.28*1309.37*1505.78
*C*78816**1486.32*1412.00*1623.80
*C*78816*TC*1378.28*1309.37*1505.78
**79300**237.04*225.19*258.97
**79300*TC*176.73*167.89*193.07
**79445**237.04*225.19*258.97
**79445*TC*133.18*126.52*145.50
**86485**17.28*16.42*18.88
**90867**278.43*264.51*304.19
#**90867**128.50*122.08*140.39
**90868**187.98*178.58*205.37
#**90868**105.94*100.64*115.74
**90869**225.28*214.02*246.12
#**90869**150.69*143.16*164.63
**92978**231.49*219.92*252.91
**92978*TC*143.74*136.55*157.03
**92979**141.15*134.09*154.20
**92979*TC*71.13*67.57*77.71
*C*93315**635.36*603.59*694.13
*C*93315*TC*518.11*492.20*566.03
**93317**202.46*192.34*221.19
**93317*TC*120.06*114.06*131.17
*C*93318**613.59*582.91*670.35
*C*93318*TC*518.11*492.20*566.03
**93571**230.57*219.04*251.90
**93571*TC*163.71*155.52*178.85
**93572**138.99*132.04*151.85
**93572*TC*90.51*85.98*98.88
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.86*3278.32*3770.07
**93602**3557.81*3379.92*3886.91
**93602*TC*3452.08*3279.48*3771.40
**93603**3557.81*3379.92*3886.91
**93603*TC*3452.08*3279.48*3771.40
**93609**2134.69*2027.96*2332.15
**93609*TC*1883.43*1789.26*2057.65
**93610**3557.81*3379.92*3886.91
**93610*TC*3408.97*3238.52*3724.30
**93612**3557.81*3379.92*3886.91
**93612*TC*3410.48*3239.96*3725.95
**93615**48.53*46.10*53.02
**93615*TC*15.16*14.40*16.56
**93619**7115.62*6759.84*7773.82
**93619*TC*6761.77*6423.68*7387.23
**93620**7115.62*6759.84*7773.82
**93620*TC*6545.72*6218.43*7151.19
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.99*6687.99*7691.19
**93622**7115.62*6759.84*7773.82
**93622*TC*6958.70*6610.77*7602.39
**93623**2134.69*2027.96*2332.15
**93623*TC*2084.10*1979.90*2276.89
**93624**3557.81*3379.92*3886.91
**93624*TC*3336.66*3169.83*3645.30
**93631**7115.62*6759.84*7773.82
**93631*TC*6752.36*6414.74*7376.95
**93640**1133.95*1077.25*1238.84
**93640*TC*971.25*922.69*1061.09
**93641**1133.95*1077.25*1238.84
**93641*TC*850.66*808.13*929.35
**93662**362.71*344.57*396.26
**93662*TC*297.85*282.96*325.40
**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**906.02*860.72*989.83
**95965*TC*526.29*499.98*574.98
**95966**532.48*505.86*581.74
**95966*TC*346.94*329.59*379.03
**95967**447.80*425.41*489.22
**95967*TC*287.67*273.29*314.28
**96020**376.72*357.88*411.56
**97151**48.80*46.36*53.31
#**97151**42.14*40.03*46.03
**97152**40.24*38.23*43.96
#**97152**35.82*34.03*39.13
**97153**33.50*31.83*36.60
#**97153**29.53*28.05*32.26
**97154**4.37*4.15*4.77
#**97154**3.98*3.78*4.35
**97155**32.07*30.47*35.04
#**97155**28.24*26.83*30.85
**97156**33.84*32.15*36.97
#**97156**29.86*28.37*32.63
**97157**9.86*9.37*10.78
#**97157**8.95*8.50*9.78
**97158**5.08*4.83*5.55
#**97158**4.62*4.39*5.05
**98978**40.65*38.62*44.41
# - 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.