TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**A2001**1174.20*1115.49*1282.81
**A2002**344.73*327.49*376.61
**A2004**13.78*13.09*15.05
**A2005**267.80*254.41*292.57
**A2007**84.75*80.51*92.59
**A2008**92.91*88.26*101.50
**A2013**1313.25*1247.59*1434.73
**A2014**61.16*58.10*66.82
**A2015**1236.00*1174.20*1350.33
**A2019**580.92*551.87*634.65
**A2021**1387.93*1318.53*1516.31
**A2022**1339.00*1272.05*1462.86
**A2023**15.45*14.68*16.88
**A2024**2008.50*1908.08*2194.29
**A2025**257.50*244.63*281.32
**G0186**439.24*417.28*479.87
#**G0186**378.22*359.31*413.21
**G0339**2581.74*2452.65*2820.55
**G0340**1941.66*1844.58*2121.27
**G0398**129.88*123.39*141.90
**G0398*TC*91.85*87.26*100.35
**G0398*26*38.03*36.13*41.55
**G0399**90.71*86.17*99.10
**G0399*TC*48.75*46.31*53.26
**G0399*26*42.27*40.16*46.18
**G0400**93.39*88.72*102.03
**G0400*TC*54.10*51.40*59.11
**G0400*26*39.29*37.33*42.93
**G0460**756.43*718.61*826.40
#**G0460**117.54*111.66*128.41
**G0465**756.43*718.61*826.40
#**G0465**117.54*111.66*128.41
**G0498**139.40*132.43*152.29
**G6017**75.03*71.28*81.97
**0042T**218.34*207.42*238.53
**0054T**224.37*213.15*245.12
**0055T**224.37*213.15*245.12
**0071T**557.44*529.57*609.01
**0072T**557.44*529.57*609.01
**0075T**944.32*897.10*1031.67
**0075T*TC*944.32*897.10*1031.67
**0075T*26*944.32*897.10*1031.67
**0095T**609.14*578.68*665.48
**0098T**682.01*647.91*745.10
**0100T**1837.25*1745.39*2007.20
**0101T**302.21*287.10*330.17
#**0101T**218.85*207.91*239.10
**0102T**302.21*287.10*330.17
#**0102T**218.85*207.91*239.10
**0106T**31.86*30.27*34.81
**0107T**31.86*30.27*34.81
**0108T**31.86*30.27*34.81
**0109T**31.86*30.27*34.81
**0110T**31.86*30.27*34.81
**0164T**665.72*632.43*727.29
**0165T**682.11*648.00*745.20
**0184T**799.97*759.97*873.97
**0198T**81.32*77.25*88.84
#**0198T**30.99*29.44*33.86
**0200T**1690.93*1606.38*1847.34
#**0200T**393.02*373.37*429.38
**0201T**2536.39*2409.57*2771.01
#**0201T**589.54*560.06*644.07
**0207T**121.71*115.62*132.96
**0208T**35.86*34.07*39.18
**0209T**43.41*41.24*47.43
**0210T**27.36*25.99*29.89
**0211T**42.46*40.34*46.39
**0212T**35.38*33.61*38.65
#**0212T**30.66*29.13*33.50
**0213T**185.40*176.13*202.55
#**0213T**102.04*96.94*111.48
**0214T**93.93*89.23*102.61
#**0214T**57.44*54.57*62.76
**0215T**94.25*89.54*102.97
#**0215T**58.39*55.47*63.79
**0216T**170.39*161.87*186.15
#**0216T**87.66*83.28*95.77
**0217T**87.67*83.29*95.78
#**0217T**49.29*46.83*53.85
**0218T**87.67*83.29*95.78
#**0218T**50.24*47.73*54.89
**0219T**1278.45*1214.53*1396.71
**0220T**1256.34*1193.52*1372.55
**0221T**1543.93*1466.73*1686.74
**0222T**379.05*360.10*414.12
**0232T**756.43*718.61*826.40
#**0232T**117.54*111.66*128.41
**0234T**8095.51*7690.73*8844.34
#**0234T**568.24*539.83*620.80
**0235T**8095.51*7690.73*8844.34
#**0235T**568.24*539.83*620.80
**0236T**8240.42*7828.40*9002.66
#**0236T**658.10*625.20*718.98
**0237T**8240.42*7828.40*9002.66
#**0237T**658.10*625.20*718.98
**0238T**8240.42*7828.40*9002.66
#**0238T**658.10*625.20*718.98
**0266T**870.68*827.15*951.22
**0267T**153.83*146.14*168.06
**0268T**323.79*307.60*353.74
**0269T**824.26*783.05*900.51
**0270T**153.83*146.14*168.06
**0271T**323.79*307.60*353.74
**0272T**53.63*50.95*58.59
**0273T**68.99*65.54*75.37
**0274T**1076.16*1022.35*1175.70
**0278T**13.98*13.28*15.27
**0308T**1347.95*1280.55*1472.63
**0329T**81.32*77.25*88.84
#**0329T**30.99*29.44*33.86
**0330T**38.21*36.30*41.75
**0331T**174.45*165.73*190.59
**0332T**297.87*282.98*325.43
**0347T**137.77*130.88*150.51
**0348T**31.50*29.93*34.42
**0349T**33.35*31.68*36.43
**0350T**33.98*32.28*37.12
**0351T**161.56*153.48*176.50
**0352T**41.72*39.63*45.57
**0353T**161.56*153.48*176.50
**0354T**41.72*39.63*45.57
**0358T**25.48*24.21*27.84
**0362T**88.22*83.81*96.38
#**0362T**64.00*60.80*69.92
**0378T**24.15*22.94*26.38
**0394T**237.81*225.92*259.81
**0395T**578.43*549.51*631.94
**0397T**45.69*43.41*49.92
**0398T*26*1746.88*1659.54*1908.47
**0408T**494.61*469.88*540.36
**0409T**341.89*324.80*373.52
**0410T**355.22*337.46*388.08
**0411T**355.22*337.46*388.08
**0412T**223.17*212.01*243.81
**0413T**462.59*439.46*505.38
**0414T**356.46*338.64*389.44
**0415T**297.05*282.20*324.53
**0416T**328.70*312.27*359.11
**0417T**80.18*76.17*87.60
**0418T**53.63*50.95*58.59
**0419T**432.93*411.28*472.97
#**0419T**348.62*331.19*380.87
**0420T**616.36*585.54*673.37
#**0420T**512.24*486.63*559.62
**0421T**1538.23*1461.32*1680.52
#**0421T**673.48*639.81*735.78
**0437T**206.80*196.46*225.93
**0439T**68.81*65.37*75.18
**0440T**238.22*226.31*260.26
#**0440T**115.53*109.75*126.21
**0441T**238.22*226.31*260.26
#**0441T**115.53*109.75*126.21
**0442T**238.22*226.31*260.26
#**0442T**115.53*109.75*126.21
**0449T**734.10*697.40*802.01
**0464T**64.18*60.97*70.12
**0472T**64.41*61.19*70.37
**0473T**53.63*50.95*58.59
**0479T**61.23*58.17*66.90
**0480T**148.99*141.54*162.77
#**0480T**30.61*29.08*33.44
**0483T**1153.42*1095.75*1260.11
**0484T**1495.74*1420.95*1634.09
**0485T**22.67*21.54*24.77
**0485T*TC*8.33*7.91*9.10
**0485T*26*14.65*13.92*16.01
**0486T**45.34*43.07*49.53
**0486T*TC*16.35*15.53*17.86
**0486T*26*28.98*27.53*31.66
**0488T**60.94*57.89*66.57
#**0488T**48.68*46.25*53.19
**0505T**10287.47*9773.10*11239.07
#**0505T**534.02*507.32*583.42
**0507T**22.10*21.00*24.15
**0507T*TC*19.18*18.22*20.95
**0507T*26*2.92*2.77*3.19
**0510T**580.20*551.19*633.87
#**0510T**410.34*389.82*448.29
**0512T**302.21*287.10*330.17
#**0512T**218.85*207.91*239.10
**0513T**90.66*86.13*99.05
#**0513T**65.66*62.38*71.74
**0515T**494.61*469.88*540.36
**0516T**456.54*433.71*498.77
**0517T**323.79*307.60*353.74
**0518T**223.17*212.01*243.81
**0519T**324.68*308.45*354.72
**0520T**456.54*433.71*498.77
**0521T**53.63*50.95*58.59
**0521T*TC*33.97*32.27*37.11
**0521T*26*19.66*18.68*21.48
**0522T**64.41*61.19*70.37
**0522T*TC*34.60*32.87*37.80
**0522T*26*29.81*28.32*32.57
**0523T**145.98*138.68*159.48
**0524T**1556.02*1478.22*1699.95
#**0524T**171.61*163.03*187.48
**0525T**456.86*434.02*499.12
**0526T**355.22*337.46*388.08
**0527T**309.16*293.70*337.76
**0528T**64.41*61.19*70.37
**0528T*TC*34.60*32.87*37.80
**0528T*26*29.81*28.32*32.57
**0529T**53.63*50.95*58.59
**0529T*TC*33.97*32.27*37.11
**0529T*26*19.66*18.68*21.48
**0530T**607.74*577.35*663.95
**0531T**462.59*439.46*505.38
**0532T**324.68*308.45*354.72
**0540T**171.83*163.24*187.73
**0543T**1495.74*1420.95*1634.09
**0544T**1718.50*1632.58*1877.47
**0545T**1718.50*1632.58*1877.47
**0546T**69.00*65.55*75.38
**0552T**6.40*6.08*6.99
**0553T**2330.61*2214.08*2546.19
#**0553T**379.98*360.98*415.13
**0565T**591.61*562.03*646.33
#**0565T**497.55*472.67*543.57
**0566T**96.01*91.21*104.89
#**0566T**57.32*54.45*62.62
**0569T**1718.50*1632.58*1877.47
**0570T**403.29*383.13*440.60
**0571T**534.94*508.19*584.42
**0572T**435.56*413.78*475.85
**0573T**332.21*315.60*362.94
**0574T**385.37*366.10*421.02
**0575T**64.41*61.19*70.37
**0576T**53.63*50.95*58.59
**0577T**184.52*175.29*201.58
**0578T**28.45*27.03*31.08
**0579T**20.13*19.12*21.99
**0580T**205.69*195.41*224.72
**0581T**2145.78*2038.49*2344.26
#**0581T**203.64*193.46*222.48
**0582T**1573.67*1494.99*1719.24
#**0582T**371.71*353.12*406.09
**0583T**1522.66*1446.53*1663.51
#**0583T**128.25*121.84*140.12
**0587T**426.50*405.18*465.96
#**0587T**286.83*272.49*313.36
**0588T**350.87*333.33*383.33
#**0588T**223.47*212.30*244.15
**0589T**46.70*44.37*51.03
#**0589T**37.58*35.70*41.06
**0590T**54.91*52.16*59.98
#**0590T**38.87*36.93*42.47
**0596T**672.69*639.06*734.92
#**0596T**128.25*121.84*140.12
**0597T**672.69*639.06*734.92
#**0597T**128.25*121.84*140.12
**0598T**143.28*136.12*156.54
**0599T**95.45*90.68*104.28
**0600T**3400.56*3230.53*3715.11
#**0600T**703.46*668.29*768.53
**0601T**1407.38*1337.01*1537.56
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**187.64*178.26*205.00
**0611T**38.37*36.45*41.92
**0614T**355.86*338.07*388.78
**0615T**45.57*43.29*49.78
**0616T**639.26*607.30*698.40
**0617T**713.98*678.28*780.02
**0618T**864.19*820.98*944.13
**0619T**629.15*597.69*687.34
#**0619T**461.41*438.34*504.09
**0620T**1414.22*1343.51*1545.04
**0623T**1600.00*1520.00*1748.00
**0624T**25.00*23.75*27.31
**0625T**1500.00*1425.00*1638.75
**0626T**75.00*71.25*81.94
**0627T**247.33*234.96*270.20
#**0627T**96.34*91.52*105.25
**0628T**74.20*70.49*81.06
#**0628T**28.90*27.46*31.58
**0629T**247.33*234.96*270.20
#**0629T**96.34*91.52*105.25
**0630T**74.20*70.49*81.06
#**0630T**28.90*27.46*31.58
**0631T**78.14*74.23*85.36
**0632T**552.66*525.03*603.78
**0633T**192.26*182.65*210.05
*C*0633T*TC*100.66*95.63*109.97
**0633T*26*57.32*54.45*62.62
**0634T**192.26*182.65*210.05
**0634T*TC*134.94*128.19*147.42
**0634T*26*57.32*54.45*62.62
**0635T**192.26*182.65*210.05
**0635T*TC*134.94*128.19*147.42
**0635T*26*57.32*54.45*62.62
**0636T**192.26*182.65*210.05
**0636T*TC*134.94*128.19*147.42
**0636T*26*57.32*54.45*62.62
**0637T**192.26*182.65*210.05
**0637T*TC*134.94*128.19*147.42
**0637T*26*57.32*54.45*62.62
**0638T**192.26*182.65*210.05
**0638T*TC*134.94*128.19*147.42
**0638T*26*57.32*54.45*62.62
**0639T**78.14*74.23*85.36
**0640T**22.10*21.00*24.15
**0640T*TC*19.31*18.34*21.09
**0640T*26*2.92*2.77*3.19
**0644T**1104.27*1049.06*1206.42
#**0644T**231.98*220.38*253.44
**0646T**1718.50*1632.58*1877.47
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**57.25*54.39*62.55
**0652T**275.20*261.44*300.66
#**0652T**117.92*112.02*128.82
**0653T**359.10*341.15*392.32
#**0653T**133.24*126.58*145.57
**0654T**136.87*130.03*149.53
**0655T**1538.23*1461.32*1680.52
#**0655T**673.48*639.81*735.78
**0658T**89.65*85.17*97.95
**0659T**2553.56*2425.88*2789.76
#**0659T**418.91*397.96*457.65
**0671T**986.99*937.64*1078.29
**0673T**3249.66*3087.18*3550.26
#**0673T**352.82*335.18*385.46
**0699T**108.61*103.18*118.66
#**0699T**87.84*83.45*95.97
**0707T**355.86*338.07*388.78
#**0707T**268.73*255.29*293.58
**0714T**1336.52*1269.69*1460.14
#**0714T**346.90*329.56*378.99
**0730T**254.75*242.01*278.31
#**0730T**228.64*217.21*249.79
**0738T**68.72*65.28*75.07
**0739T**1538.23*1461.32*1680.52
#**0739T**673.48*639.81*735.78
**0740T**18.87*17.93*20.62
**0741T**44.66*42.43*48.79
**0742T**89.36*84.89*97.62
**0742T*TC*70.77*67.23*77.31
**0742T*26*18.59*17.66*20.31
**0743T**50.87*48.33*55.58
**0744T**857.57*814.69*936.89
**0745T**242.82*230.68*265.28
**0746T**218.55*207.62*238.76
**0747T**938.89*891.95*1025.74
**0748T**177.81*168.92*194.26
**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**4.15*3.94*4.53
**0765T**7.86*7.47*8.59
**0771T**25.64*24.36*28.01
**0772T**25.64*24.36*28.01
**0773T**22.35*21.23*24.41
**0774T**22.35*21.23*24.41
**0777T**325.00*308.75*355.06
#**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*48.75*46.31*53.26
#**0777T*26*3.75*3.56*4.09
**0779T**413.65*392.97*451.92
**0779T*TC*388.49*369.07*424.43
**0779T*26*25.17*23.91*27.50
**0780T**22.35*21.23*24.41
**0783T**13.52*12.84*14.77
**0784T**2012.85*1912.21*2199.04
#**0784T**314.82*299.08*343.94
**0785T**232.76*221.12*254.29
#**0785T**139.96*132.96*152.90
**0786T**701.74*666.65*766.65
#**0786T**294.69*279.96*321.95
**0787T**232.76*221.12*254.29
#**0787T**139.96*132.96*152.90
**0788T**18.25*17.34*19.94
#**0788T**17.62*16.74*19.25
**0789T**25.37*24.10*27.72
#**0789T**22.02*20.92*24.06
**0790T**1867.65*1774.27*2040.41
**0791T**8.77*8.33*9.58
**0793T**552.66*525.03*603.78
**0794T**130.35*123.83*142.40
**0795T**684.81*650.57*748.16
**0796T**456.54*433.71*498.77
**0797T**456.54*433.71*498.77
**0798T**724.61*688.38*791.64
**0799T**483.07*458.92*527.76
**0800T**483.07*458.92*527.76
**0801T**939.62*892.64*1026.54
**0802T**469.81*446.32*513.27
**0803T**469.81*446.32*513.27
**0804T**75.32*71.55*82.28
**0804T*TC*39.95*37.95*43.64
**0804T*26*35.38*33.61*38.65
**0805T**2805.26*2665.00*3064.75
#**0805T**314.83*299.09*343.95
**0806T**3740.34*3553.32*4086.32
#**0806T**419.77*398.78*458.60
**0807T**40.80*38.76*44.57
**0807T*TC*26.42*25.10*28.87
**0807T*26*14.38*13.66*15.71
**0808T**40.80*38.76*44.57
**0808T*TC*26.42*25.10*28.87
**0808T*26*14.38*13.66*15.71
**0810T**1092.98*1038.33*1194.08
**0811T**18.87*17.93*20.62
**0813T**2459.06*2336.11*2686.53
#**0813T**174.68*165.95*190.84
**0814T**444.83*422.59*485.98
#**0814T**335.91*319.11*366.98
**0818T**350.87*333.33*383.33
#**0818T**223.47*212.30*244.15
**0820T**144.38*137.16*157.73
#**0820T**127.71*121.32*139.52
**0821T**144.38*137.16*157.73
#**0821T**127.71*121.32*139.52
**0822T**122.72*116.58*134.07
#**0822T**108.55*103.12*118.59
**0823T**684.81*650.57*748.16
**0824T**724.61*688.38*791.64
**0825T**939.62*892.64*1026.54
**0826T**64.41*61.19*70.37
**0826T*TC*34.60*32.87*37.80
**0826T*26*29.81*28.32*32.57
**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**22.10*21.00*24.15
**0859T*TC*19.18*18.22*20.95
**0859T*26*2.92*2.77*3.19
**0864T**302.21*287.10*330.17
#**0864T**218.85*207.91*239.10
**10011**406.39*386.07*443.98
#**10011**104.72*99.48*114.40
**10012**224.71*213.47*245.49
#**10012**69.95*66.45*76.42
**15847**341.11*324.05*372.66
**21742**1121.61*1065.53*1225.36
**21743**1288.37*1223.95*1407.54
**32855**332.85*316.21*363.64
**32856**438.37*416.45*478.92
**33928**3214.69*3053.96*3512.05
**33929**1204.15*1143.94*1315.53
**33933**509.92*484.42*557.08
**33944**509.92*484.42*557.08
**34841**2003.39*1903.22*2188.70
**34842**2229.18*2117.72*2435.38
**34843**2454.96*2332.21*2682.04
**34844**2680.75*2546.71*2928.72
**34845**2003.39*1903.22*2188.70
**34846**2229.18*2117.72*2435.38
**34847**2454.96*2332.21*2682.04
**34848**2680.75*2546.71*2928.72
**43496**1976.79*1877.95*2159.64
**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**736.03*699.23*804.11
**53452**368.01*349.61*402.05
**53453**625.54*594.26*683.40
**53454**54.74*52.00*59.80
#**53454**34.29*32.58*37.47
**63043**557.62*529.74*609.20
**63044**483.57*459.39*528.30
**64596**2012.85*1912.21*2199.04
#**64596**314.82*299.08*343.94
**64597**603.86*573.67*659.72
#**64597**94.45*89.73*103.19
**64598**232.76*221.12*254.29
#**64598**139.96*132.96*152.90
**65757**115.63*109.85*126.33
**66983**639.26*607.30*698.40
**66987**742.29*705.18*810.96
**66988**615.73*584.94*672.68
*C*70170**238.35*226.43*260.39
*C*70170*TC*224.28*213.07*245.03
**70555**233.47*221.80*255.07
**70555*TC*118.77*112.83*129.75
*C*70557**651.69*619.11*711.98
*C*70557*TC*504.88*479.64*551.59
*C*70558**330.12*313.61*360.65
*C*70558*TC*168.29*159.88*183.86
*C*70559**320.64*304.61*350.30
*C*70559*TC*168.29*159.88*183.86
*C*74190**526.19*499.88*574.86
*C*74190*TC*504.88*479.64*551.59
**74235**138.22*131.31*151.01
**74235*TC*83.53*79.35*91.25
**74300**79.47*75.50*86.83
**74300*TC*66.71*63.37*72.88
**74301**24.48*23.26*26.75
**74301*TC*14.98*14.23*16.36
**74328**175.06*166.31*191.26
**74328*TC*152.82*145.18*166.96
**74329**133.63*126.95*145.99
**74329*TC*111.07*105.52*121.35
**74330**262.59*249.46*286.88
**74330*TC*236.41*224.59*258.28
**74340**86.58*82.25*94.59
**74340*TC*62.01*58.91*67.75
**74355**86.58*82.25*94.59
**74355*TC*51.54*48.96*56.30
**74360**86.58*82.25*94.59
**74360*TC*60.44*57.42*66.03
**74363**175.06*166.31*191.26
**74363*TC*135.09*128.34*147.59
*C*74445**152.43*144.81*166.53
*C*74445*TC*100.66*95.63*109.97
*C*74450**239.35*227.38*261.49
*C*74450*TC*224.28*213.07*245.03
*C*74470**528.82*502.38*577.74
*C*74470*TC*504.88*479.64*551.59
**74742**233.47*221.80*255.07
**74742*TC*205.31*195.04*224.30
*C*74775**252.77*240.13*276.15
*C*74775*TC*224.28*213.07*245.03
*C*75801**616.10*585.30*673.10
*C*75801*TC*575.02*546.27*628.21
*C*75803**1519.90*1443.91*1660.50
*C*75803*TC*1465.88*1392.59*1601.48
*C*75805**2954.93*2807.18*3228.26
*C*75805*TC*2917.60*2771.72*3187.48
*C*75807**2968.47*2820.05*3243.06
*C*75807*TC*2917.60*2771.72*3187.48
*C*75810**2964.32*2816.10*3238.52
*C*75810*TC*2917.60*2771.72*3187.48
**75894**846.31*803.99*924.59
**75894*TC*777.64*738.76*849.57
*C*75898**3005.11*2854.85*3283.08
*C*75898*TC*2917.60*2771.72*3187.48
**75970**413.43*392.76*451.67
**75970*TC*377.02*358.17*411.90
**76125**37.60*35.72*41.08
**76125*TC*24.84*23.60*27.14
**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*45.84*43.55*50.08
**76940**150.99*143.44*164.96
**76940*TC*54.32*51.60*59.34
**76941**110.35*104.83*120.55
**76941*TC*48.45*46.03*52.93
**76945**79.45*75.48*86.80
**76945*TC*48.66*46.23*53.16
*C*76975**263.50*250.33*287.88
*C*76975*TC*224.28*213.07*245.03
**76998**175.06*166.31*191.26
**76998*TC*130.04*123.54*142.07
**77013**397.51*377.63*434.27
**77013*TC*221.37*210.30*241.85
**77022**446.62*424.29*487.93
**77022*TC*254.60*241.87*278.15
**77371**561.75*533.66*613.71
**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**392.32*372.70*428.61
*C*78282*TC*377.48*358.61*412.40
**78414**514.99*489.24*562.63
**78414*TC*494.67*469.94*540.43
*C*78429**1508.08*1432.68*1647.58
*C*78429*TC*1431.90*1360.31*1564.36
*C*78430**1504.46*1429.24*1643.63
*C*78430*TC*1431.90*1360.31*1564.36
*C*78431**2246.63*2134.30*2454.45
*C*78431*TC*2162.01*2053.91*2362.00
*C*78432**1868.20*1774.79*2041.01
*C*78432*TC*1777.61*1688.73*1942.04
*C*78433**1972.98*1874.33*2155.48
*C*78433*TC*1873.87*1780.18*2047.21
**78434**662.99*629.84*724.32
**78434*TC*635.11*603.35*693.85
*C*78459**1370.34*1301.82*1497.09
*C*78459*TC*1299.79*1234.80*1420.02
*C*78491**1501.12*1426.06*1639.97
*C*78491*TC*1431.90*1360.31*1564.36
*C*78492**1513.19*1437.53*1653.16
*C*78492*TC*1431.90*1360.31*1564.36
*C*78608**1498.49*1423.57*1637.11
*C*78608*TC*1431.90*1360.31*1564.36
*C*78811**1368.32*1299.90*1494.89
*C*78811*TC*1299.79*1234.80*1420.02
*C*78812**1518.45*1442.53*1658.91
*C*78812*TC*1431.90*1360.31*1564.36
*C*78813**1520.47*1444.45*1661.12
*C*78813*TC*1431.90*1360.31*1564.36
*C*78814**1529.95*1453.45*1671.47
*C*78814*TC*1431.90*1360.31*1564.36
*C*78815**1541.08*1464.03*1683.63
*C*78815*TC*1431.90*1360.31*1564.36
*C*78816**1542.14*1465.03*1684.78
*C*78816*TC*1431.90*1360.31*1564.36
**79300**237.04*225.19*258.97
**79300*TC*175.29*166.53*191.51
**79445**237.04*225.19*258.97
**79445*TC*131.72*125.13*143.90
**86485**17.28*16.42*18.88
**90867**286.53*272.20*313.03
#**90867**132.24*125.63*144.47
**90868**193.45*183.78*211.35
#**90868**102.56*97.43*112.04
**90869**266.95*253.60*291.64
#**90869**155.07*147.32*169.42
**92978**231.49*219.92*252.91
**92978*TC*141.50*134.43*154.59
**92979**141.15*134.09*154.20
**92979*TC*69.72*66.23*76.16
*C*93315**625.84*594.55*683.73
*C*93315*TC*504.88*479.64*551.59
**93317**202.46*192.34*221.19
**93317*TC*118.29*112.38*129.24
*C*93318**602.19*572.08*657.89
*C*93318*TC*504.88*479.64*551.59
**93571**230.57*219.04*251.90
**93571*TC*162.08*153.98*177.08
**93572**138.99*132.04*151.85
**93572*TC*89.10*84.65*97.35
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.75*3275.36*3766.66
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.63*3277.15*3768.72
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.63*3277.15*3768.72
**93609**2134.69*2027.96*2332.15
**93609*TC*1876.45*1782.63*2050.02
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.95*3234.70*3719.91
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.14*3236.78*3722.30
**93615**48.53*46.10*53.02
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6750.87*6413.33*7375.33
**93620**7115.62*6759.84*7773.82
**93620*TC*6530.41*6203.89*7134.47
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.80*6685.91*7688.80
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.08*6607.33*7598.43
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.68*1967.15*2262.22
**93624**3557.81*3379.92*3886.91
**93624*TC*3330.55*3164.02*3638.62
**93631**7115.62*6759.84*7773.82
**93631*TC*6740.85*6403.81*7364.38
**93640**1133.95*1077.25*1238.84
**93640*TC*966.83*918.49*1056.26
**93641**1133.95*1077.25*1238.84
**93641*TC*841.81*799.72*919.68
**93662**397.51*377.63*434.27
**93662*TC*330.40*313.88*360.96
**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*518.27*492.36*566.21
**95966**532.48*505.86*581.74
**95966*TC*345.30*328.04*377.25
**95967**447.80*425.41*489.22
**95967*TC*285.34*271.07*311.73
**96020**376.72*357.88*411.56
**96547**707.83*672.44*773.31
#**96547**129.97*123.47*141.99
**96548**353.92*336.22*386.65
#**96548**64.99*61.74*71.00
**97151**48.71*46.27*53.21
#**97151**43.37*41.20*47.38
**97152**41.41*39.34*45.24
#**97152**36.86*35.02*40.27
**97153**33.00*31.35*36.05
#**97153**29.07*27.62*31.76
**97154**4.49*4.27*4.91
#**97154**4.09*3.89*4.47
**97155**33.00*31.35*36.05
#**97155**29.07*27.62*31.76
**97156**34.82*33.08*38.04
#**97156**30.73*29.19*33.57
**97157**10.15*9.64*11.09
#**97157**9.21*8.75*10.06
**97158**5.23*4.97*5.72
#**97158**4.76*4.52*5.20
**98978**44.66*42.43*48.79
# - 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 2023 BY THE AMERICAN MEDICAL ASSOCIATION.