TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
GALVESTON
******
**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**457.04*434.19*499.32
#**G0186**392.47*372.85*428.78
**G0339**2819.77*2678.78*3080.60
**G0340**2120.74*2014.70*2316.91
**G0398**135.97*129.17*148.55
**G0398*TC*97.10*92.25*106.09
**G0398*26*38.86*36.92*42.46
**G0399**94.40*89.68*103.13
**G0399*TC*51.50*48.93*56.27
**G0399*26*43.23*41.07*47.23
**G0400**97.35*92.48*106.35
**G0400*TC*57.16*54.30*62.45
**G0400*26*40.20*38.19*43.92
**G0460**795.50*755.73*869.09
#**G0460**119.43*113.46*130.48
**G0465**795.50*755.73*869.09
#**G0465**119.43*113.46*130.48
**G0498**146.89*139.55*160.48
**G6017**77.92*74.02*85.12
**0042T**227.91*216.51*248.99
**0054T**225.91*214.61*246.80
**0055T**225.91*214.61*246.80
**0071T**570.03*541.53*622.76
**0072T**570.03*541.53*622.76
**0075T**958.15*910.24*1046.78
**0075T*TC*958.15*910.24*1046.78
**0075T*26*952.83*905.19*1040.97
**0095T**615.31*584.54*672.22
**0098T**688.47*654.05*752.16
**0100T**1894.25*1799.54*2069.47
**0101T**313.40*297.73*342.39
#**0101T**225.18*213.92*246.01
**0102T**313.40*297.73*342.39
#**0102T**225.18*213.92*246.01
**0106T**33.55*31.87*36.65
**0107T**33.55*31.87*36.65
**0108T**33.55*31.87*36.65
**0109T**33.55*31.87*36.65
**0110T**33.55*31.87*36.65
**0164T**672.85*639.21*735.09
**0165T**689.30*654.84*753.07
**0184T**819.14*778.18*894.91
**0198T**85.07*80.82*92.94
#**0198T**31.81*30.22*34.75
**0200T**1773.81*1685.12*1937.89
#**0200T**400.36*380.34*437.39
**0201T**2660.71*2527.67*2906.82
#**0201T**600.55*570.52*656.10
**0207T**121.71*115.62*132.96
**0208T**37.90*36.01*41.41
**0209T**45.89*43.60*50.14
**0210T**28.91*27.46*31.58
**0211T**44.89*42.65*49.05
**0212T**36.47*34.65*39.85
#**0212T**31.47*29.90*34.39
**0213T**192.71*183.07*210.53
#**0213T**104.50*99.28*114.17
**0214T**97.16*92.30*106.15
#**0214T**58.55*55.62*63.96
**0215T**97.49*92.62*106.51
#**0215T**59.55*56.57*65.06
**0216T**177.41*168.54*193.82
#**0216T**89.86*85.37*98.18
**0217T**90.86*86.32*99.27
#**0217T**50.25*47.74*54.90
**0218T**90.86*86.32*99.27
#**0218T**51.25*48.69*55.99
**0219T**1300.08*1235.08*1420.34
**0220T**1278.46*1214.54*1396.72
**0221T**1569.24*1490.78*1714.40
**0222T**382.42*363.30*417.80
**0232T**795.50*755.73*869.09
#**0232T**119.43*113.46*130.48
**0234T**8538.12*8111.21*9327.89
#**0234T**572.75*544.11*625.73
**0235T**8538.12*8111.21*9327.89
#**0235T**572.75*544.11*625.73
**0236T**8687.33*8252.96*9490.90
#**0236T**663.71*630.52*725.10
**0237T**8687.33*8252.96*9490.90
#**0237T**663.71*630.52*725.10
**0238T**8687.33*8252.96*9490.90
#**0238T**663.71*630.52*725.10
**0266T**884.31*840.09*966.10
**0267T**155.50*147.73*169.89
**0268T**329.50*313.03*359.98
**0269T**837.98*796.08*915.49
**0270T**155.50*147.73*169.89
**0271T**329.50*313.03*359.98
**0272T**56.03*53.23*61.21
**0273T**71.72*68.13*78.35
**0274T**1095.15*1040.39*1196.45
**0278T**14.38*13.66*15.71
**0308T**1390.47*1320.95*1519.09
**0329T**85.07*80.82*92.94
#**0329T**31.81*30.22*34.75
**0330T**38.21*36.30*41.75
**0331T**183.12*173.96*200.05
**0332T**312.73*297.09*341.65
**0347T**139.94*132.94*152.88
**0348T**32.95*31.30*36.00
**0349T**34.94*33.19*38.17
**0350T**35.60*33.82*38.89
**0351T**169.61*161.13*185.30
**0352T**42.84*40.70*46.81
**0353T**169.61*161.13*185.30
**0354T**42.84*40.70*46.81
**0358T**26.91*25.56*29.39
**0362T**91.00*86.45*99.42
#**0362T**65.37*62.10*71.42
**0378T**24.71*23.47*26.99
**0394T**249.71*237.22*272.80
**0395T**605.30*575.04*661.30
**0397T**46.79*44.45*51.12
**0398T*26*1746.88*1659.54*1908.47
**0408T**502.29*477.18*548.76
**0409T**348.07*330.67*380.27
**0410T**361.99*343.89*395.47
**0411T**361.99*343.89*395.47
**0412T**228.34*216.92*249.46
**0413T**470.57*447.04*514.10
**0414T**362.82*344.68*396.38
**0415T**302.09*286.99*330.04
**0416T**335.72*318.93*366.77
**0417T**83.42*79.25*91.14
**0418T**56.03*53.23*61.21
**0419T**448.72*426.28*490.22
#**0419T**359.51*341.53*392.76
**0420T**636.64*604.81*695.53
#**0420T**526.46*500.14*575.16
**0421T**1603.26*1523.10*1751.57
#**0421T**688.19*653.78*751.85
**0437T**210.32*199.80*229.77
**0439T**71.60*68.02*78.22
**0440T**248.23*235.82*271.19
#**0440T**118.41*112.49*129.36
**0441T**248.23*235.82*271.19
#**0441T**118.41*112.49*129.36
**0442T**248.23*235.82*271.19
#**0442T**118.41*112.49*129.36
**0449T**759.02*721.07*829.23
**0464T**67.31*63.94*73.53
**0472T**67.07*63.72*73.28
**0473T**56.03*53.23*61.21
**0479T**62.88*59.74*68.70
**0480T**155.75*147.96*170.15
#**0480T**31.44*29.87*34.35
**0483T**1164.22*1106.01*1271.91
**0484T**1509.51*1434.03*1649.13
**0485T**23.55*22.37*25.73
**0485T*TC*8.77*8.33*9.58
**0485T*26*15.06*14.31*16.46
**0486T**47.09*44.74*51.45
**0486T*TC*17.26*16.40*18.86
**0486T*26*29.83*28.34*32.59
**0488T**62.71*59.57*68.51
#**0488T**49.73*47.24*54.33
**0505T**11065.01*10511.76*12088.52
#**0505T**552.51*524.88*603.61
**0507T**23.23*22.07*25.38
**0507T*TC*20.26*19.25*22.14
**0507T*26*2.97*2.82*3.24
**0510T**600.50*570.48*656.05
#**0510T**420.75*399.71*459.67
**0512T**313.40*297.73*342.39
#**0512T**225.18*213.92*246.01
**0513T**94.02*89.32*102.72
#**0513T**67.55*64.17*73.80
**0515T**502.29*477.18*548.76
**0516T**463.78*440.59*506.68
**0517T**329.50*313.03*359.98
**0518T**228.34*216.92*249.46
**0519T**330.48*313.96*361.05
**0520T**463.78*440.59*506.68
**0521T**56.03*53.23*61.21
**0521T*TC*35.90*34.11*39.23
**0521T*26*20.12*19.11*21.98
**0522T**67.07*63.72*73.28
**0522T*TC*36.57*34.74*39.95
**0522T*26*30.50*28.98*33.33
**0523T**151.21*143.65*165.20
**0524T**1638.23*1556.32*1789.77
#**0524T**173.25*164.59*189.28
**0525T**464.11*440.90*507.04
**0526T**361.99*343.89*395.47
**0527T**314.68*298.95*343.79
**0528T**67.07*63.72*73.28
**0528T*TC*36.57*34.74*39.95
**0528T*26*30.50*28.98*33.33
**0529T**56.03*53.23*61.21
**0529T*TC*35.90*34.11*39.23
**0529T*26*20.12*19.11*21.98
**0530T**618.51*587.58*675.72
**0531T**470.57*447.04*514.10
**0532T**330.48*313.96*361.05
**0540T**176.52*167.69*192.84
**0543T**1509.51*1434.03*1649.13
**0544T**1738.13*1651.22*1898.90
**0545T**1738.13*1651.22*1898.90
**0546T**71.82*68.23*78.46
**0552T**6.64*6.31*7.26
**0553T**2446.91*2324.56*2673.24
#**0553T**382.75*363.61*418.15
**0565T**610.59*580.06*667.07
#**0565T**511.06*485.51*558.34
**0566T**99.32*94.35*108.50
#**0566T**58.37*55.45*63.77
**0569T**1738.13*1651.22*1898.90
**0570T**407.06*386.71*444.72
**0571T**543.54*516.36*593.81
**0572T**442.24*420.13*483.15
**0573T**338.07*321.17*369.35
**0574T**391.53*371.95*427.74
**0575T**67.07*63.72*73.28
**0576T**56.03*53.23*61.21
**0577T**190.34*180.82*207.94
**0578T**29.05*27.60*31.74
**0579T**21.26*20.20*23.23
**0580T**210.08*199.58*229.52
**0581T**2261.02*2147.97*2470.17
#**0581T**205.85*195.56*224.89
**0582T**1653.30*1570.64*1806.24
#**0582T**381.38*362.31*416.66
**0583T**1522.66*1446.53*1663.51
#**0583T**132.42*125.80*144.67
**0587T**440.58*418.55*481.33
#**0587T**292.78*278.14*319.86
**0588T**363.23*345.07*396.83
#**0588T**228.41*216.99*249.54
**0589T**47.96*45.56*52.39
#**0589T**38.31*36.39*41.85
**0590T**56.58*53.75*61.81
#**0590T**39.60*37.62*43.26
**0596T**672.69*639.06*734.92
#**0596T**130.39*123.87*142.45
**0597T**672.69*639.06*734.92
#**0597T**130.39*123.87*142.45
**0598T**151.15*143.59*165.13
**0599T**100.60*95.57*109.91
**0600T**3569.43*3390.96*3899.60
#**0600T**715.36*679.59*781.53
**0601T**1426.79*1355.45*1558.77
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**195.94*186.14*214.06
**0611T**40.51*38.48*44.25
**0614T**362.17*344.06*395.67
**0615T**47.10*44.75*51.46
**0616T**659.72*626.73*720.74
**0617T**736.95*700.10*805.12
**0618T**892.19*847.58*974.72
**0619T**650.53*618.00*710.70
#**0619T**473.09*449.44*516.86
**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**258.28*245.37*282.18
#**0627T**98.50*93.58*107.62
**0628T**77.48*73.61*84.65
#**0628T**29.55*28.07*32.28
**0629T**258.28*245.37*282.18
#**0629T**98.50*93.58*107.62
**0630T**77.48*73.61*84.65
#**0630T**29.55*28.07*32.28
**0631T**82.10*78.00*89.70
**0632T**559.46*531.49*611.21
**0633T**201.25*191.19*219.87
*C*0633T*TC*106.47*101.15*116.32
**0633T*26*58.55*55.62*63.96
**0634T**201.25*191.19*219.87
**0634T*TC*142.71*135.57*155.91
**0634T*26*58.55*55.62*63.96
**0635T**201.25*191.19*219.87
**0635T*TC*142.71*135.57*155.91
**0635T*26*58.55*55.62*63.96
**0636T**201.25*191.19*219.87
**0636T*TC*142.71*135.57*155.91
**0636T*26*58.55*55.62*63.96
**0637T**201.25*191.19*219.87
**0637T*TC*142.71*135.57*155.91
**0637T*26*58.55*55.62*63.96
**0638T**201.25*191.19*219.87
**0638T*TC*142.71*135.57*155.91
**0638T*26*58.55*55.62*63.96
**0639T**82.10*78.00*89.70
**0640T**23.23*22.07*25.38
**0640T*TC*20.37*19.35*22.25
**0640T*26*2.97*2.82*3.24
**0644T**1156.82*1098.98*1263.83
#**0644T**233.76*222.07*255.38
**0646T**1738.13*1651.22*1898.90
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.68*56.70*65.21
**0652T**286.99*272.64*313.54
#**0652T**120.55*114.52*131.70
**0653T**375.15*356.39*409.85
#**0653T**136.14*129.33*148.73
**0654T**139.71*132.72*152.63
**0655T**1603.26*1523.10*1751.57
#**0655T**688.19*653.78*751.85
**0658T**94.82*90.08*103.59
**0659T**2680.83*2546.79*2928.81
#**0659T**421.94*400.84*460.97
**0671T**1020.35*969.33*1114.73
**0673T**3423.68*3252.50*3740.38
#**0673T**358.23*340.32*391.37
**0699T**112.32*106.70*122.71
#**0699T**90.35*85.83*98.70
**0707T**370.76*352.22*405.05
#**0707T**278.55*264.62*304.31
**0714T**1403.41*1333.24*1533.23
#**0714T**356.18*338.37*389.13
**0730T**268.19*254.78*293.00
#**0730T**240.14*228.13*262.35
**0738T**70.46*66.94*76.98
**0739T**1603.26*1523.10*1751.57
#**0739T**688.19*653.78*751.85
**0740T**19.88*18.89*21.72
**0741T**47.22*44.86*51.59
**0742T**93.82*89.13*102.50
**0742T*TC*74.82*71.08*81.74
**0742T*26*18.99*18.04*20.75
**0743T**53.26*50.60*58.19
**0744T**864.09*820.89*944.02
**0745T**256.64*243.81*280.38
**0746T**224.16*212.95*244.89
**0747T**992.43*942.81*1084.23
**0748T**181.78*172.69*198.59
**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**4.29*4.08*4.69
**0765T**8.02*7.62*8.76
**0771T**26.06*24.76*28.47
**0772T**26.06*24.76*28.47
**0773T**23.34*22.17*25.50
**0774T**23.34*22.17*25.50
**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**436.83*414.99*477.24
**0779T*TC*411.05*390.50*449.08
**0779T*26*25.78*24.49*28.16
**0780T**23.34*22.17*25.50
**0783T**14.27*13.56*15.59
**0784T**2118.77*2012.83*2314.75
#**0784T**321.91*305.81*351.68
**0785T**241.87*229.78*264.25
#**0785T**143.67*136.49*156.96
**0786T**731.29*694.73*798.94
#**0786T**300.55*285.52*328.35
**0787T**241.87*229.78*264.25
#**0787T**143.67*136.49*156.96
**0788T**18.66*17.73*20.39
#**0788T**17.99*17.09*19.65
**0789T**25.67*24.39*28.05
#**0789T**22.49*21.37*24.58
**0790T**1906.96*1811.61*2083.35
**0791T**9.04*8.59*9.88
**0793T**559.46*531.49*611.21
**0794T**130.35*123.83*142.40
**0795T**695.67*660.89*760.02
**0796T**463.78*440.59*506.68
**0797T**463.78*440.59*506.68
**0798T**734.57*697.84*802.52
**0799T**489.72*465.23*535.01
**0800T**489.72*465.23*535.01
**0801T**953.50*905.83*1041.70
**0802T**476.75*452.91*520.85
**0803T**476.75*452.91*520.85
**0804T**78.44*74.52*85.70
**0804T*TC*42.23*40.12*46.14
**0804T*26*36.21*34.40*39.56
**0805T**2954.49*2806.77*3227.79
#**0805T**319.12*303.16*348.63
**0806T**3939.32*3742.35*4303.70
#**0806T**425.49*404.22*464.85
**0807T**42.55*40.42*46.48
**0807T*TC*27.91*26.51*30.49
**0807T*26*14.64*13.91*16.00
**0808T**42.55*40.42*46.48
**0808T*TC*27.91*26.51*30.49
**0808T*26*14.64*13.91*16.00
**0810T**1126.88*1070.54*1231.12
**0811T**19.88*18.89*21.72
**0813T**2594.54*2464.81*2834.53
#**0813T**177.21*168.35*193.60
**0814T**463.44*440.27*506.31
#**0814T**348.19*330.78*380.40
**0818T**363.23*345.07*396.83
#**0818T**228.41*216.99*249.54
**0820T**147.51*140.13*161.15
#**0820T**129.87*123.38*141.89
**0821T**147.51*140.13*161.15
#**0821T**129.87*123.38*141.89
**0822T**125.38*119.11*136.98
#**0822T**110.39*104.87*120.60
**0823T**695.67*660.89*760.02
**0824T**734.57*697.84*802.52
**0825T**953.50*905.83*1041.70
**0826T**67.07*63.72*73.28
**0826T*TC*36.57*34.74*39.95
**0826T*26*30.50*28.98*33.33
**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**23.23*22.07*25.38
**0859T*TC*20.26*19.25*22.14
**0859T*26*2.97*2.82*3.24
**0864T**313.40*297.73*342.39
#**0864T**225.18*213.92*246.01
**10011**425.74*404.45*465.12
#**10011**106.51*101.18*116.36
**10012**234.43*222.71*256.12
#**10012**70.66*67.13*77.20
**15847**348.91*331.46*381.18
**21742**1137.89*1081.00*1243.15
**21743**1304.28*1239.07*1424.93
**32855**355.66*337.88*388.56
**32856**442.25*420.14*483.16
**33928**3237.70*3075.82*3537.19
**33929**1212.93*1152.28*1325.12
**33933**545.30*518.04*595.75
**33944**545.30*518.04*595.75
**34841**2129.34*2022.87*2326.30
**34842**2355.13*2237.37*2572.98
**34843**2580.92*2451.87*2819.65
**34844**2806.69*2666.36*3066.31
**34845**2129.34*2022.87*2326.30
**34846**2355.13*2237.37*2572.98
**34847**2580.92*2451.87*2819.65
**34848**2806.69*2666.36*3066.31
**43496**2125.52*2019.24*2322.13
**43647**442.49*420.37*483.43
**43648**537.21*510.35*586.90
#**43648**242.33*230.21*264.74
**43881**685.47*651.20*748.88
#**43881**628.80*597.36*686.96
**43882**726.52*690.19*793.72
#**43882**665.51*632.23*727.06
**47143**425.67*404.39*465.05
**47144**505.48*480.21*552.24
**47145**478.87*454.93*523.17
**48551**270.77*257.23*295.81
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**752.68*715.05*822.31
**53452**376.34*357.52*411.15
**53453**639.74*607.75*698.91
**53454**56.63*53.80*61.87
#**53454**34.99*33.24*38.23
**63043**563.78*535.59*615.93
**63044**523.31*497.14*571.71
**64596**2118.77*2012.83*2314.75
#**64596**321.91*305.81*351.68
**64597**635.63*603.85*694.43
#**64597**96.57*91.74*105.50
**64598**241.87*229.78*264.25
#**64598**143.67*136.49*156.96
**65757**118.89*112.95*129.89
**66983**659.72*626.73*720.74
**66987**761.40*723.33*831.83
**66988**633.78*602.09*692.40
*C*70170**251.65*239.07*274.93
*C*70170*TC*237.29*225.43*259.24
**70555**233.47*221.80*255.07
**70555*TC*116.36*110.54*127.12
*C*70557**684.73*650.49*748.06
*C*70557*TC*534.22*507.51*583.64
*C*70558**343.96*326.76*375.77
*C*70558*TC*178.04*169.14*194.51
*C*70559**333.40*316.73*364.24
*C*70559*TC*178.04*169.14*194.51
*C*74190**555.93*528.13*607.35
*C*74190*TC*534.22*507.51*583.64
**74235**144.02*136.82*157.34
**74235*TC*88.16*83.75*96.31
**74300**83.60*79.42*91.33
**74300*TC*70.59*67.06*77.12
**74301**25.67*24.39*28.05
**74301*TC*15.97*15.17*17.45
**74328**175.06*166.31*191.26
**74328*TC*152.30*144.69*166.39
**74329**139.72*132.73*152.64
**74329*TC*116.63*110.80*127.42
**74330**262.59*249.46*286.88
**74330*TC*235.84*224.05*257.66
**74340**86.58*82.25*94.59
**74340*TC*61.51*58.43*67.19
**74355**86.58*82.25*94.59
**74355*TC*50.80*48.26*55.50
**74360**86.58*82.25*94.59
**74360*TC*59.94*56.94*65.48
**74363**175.06*166.31*191.26
**74363*TC*134.28*127.57*146.71
*C*74445**159.40*151.43*174.14
*C*74445*TC*106.47*101.15*116.32
*C*74450**252.71*240.07*276.08
*C*74450*TC*237.29*225.43*259.24
*C*74470**558.62*530.69*610.29
*C*74470*TC*534.22*507.51*583.64
**74742**233.47*221.80*255.07
**74742*TC*204.70*194.47*223.64
*C*74775**266.40*253.08*291.04
*C*74775*TC*237.29*225.43*259.24
*C*75801**650.14*617.63*710.27
*C*75801*TC*608.45*578.03*664.73
*C*75803**1606.33*1526.01*1754.91
*C*75803*TC*1551.15*1473.59*1694.63
*C*75805**3125.50*2969.23*3414.61
*C*75805*TC*3087.37*2933.00*3372.95
*C*75807**3139.12*2982.16*3429.48
*C*75807*TC*3087.37*2933.00*3372.95
*C*75810**3134.68*2977.95*3424.64
*C*75810*TC*3087.37*2933.00*3372.95
**75894**888.17*843.76*970.32
**75894*TC*818.63*777.70*894.36
*C*75898**3175.94*3017.14*3469.71
*C*75898*TC*3087.37*2933.00*3372.95
**75970**433.74*412.05*473.86
**75970*TC*396.69*376.86*433.39
**76125**39.21*37.25*42.84
**76125*TC*26.20*24.89*28.62
**76390**203.46*193.29*222.28
**76390*TC*152.16*144.55*166.23
**76390*26*51.30*48.74*56.05
**76932**83.76*79.57*91.51
**76932*TC*48.60*46.17*53.10
**76940**154.85*147.11*169.18
**76940*TC*56.69*53.86*61.94
**76941**114.57*108.84*125.17
**76941*TC*51.18*48.62*55.91
**76945**82.83*78.69*90.49
**76945*TC*51.28*48.72*56.03
*C*76975**277.47*263.60*303.14
*C*76975*TC*237.29*225.43*259.24
**76998**175.06*166.31*191.26
**76998*TC*129.47*123.00*141.45
**77013**418.57*397.64*457.29
**77013*TC*239.16*227.20*261.28
**77022**468.81*445.37*512.18
**77022*TC*272.83*259.19*298.07
**77371**613.67*582.99*670.44
**77520**890.35*845.83*972.70
**77522**890.35*845.83*972.70
**77523**1022.34*971.22*1116.90
**77525**1154.30*1096.59*1261.08
*C*78282**414.51*393.78*452.85
*C*78282*TC*399.40*379.43*436.34
**78414**514.99*489.24*562.63
**78414*TC*494.19*469.48*539.90
*C*78429**1592.96*1513.31*1740.31
*C*78429*TC*1515.20*1439.44*1655.36
*C*78430**1589.30*1509.84*1736.32
*C*78430*TC*1515.20*1439.44*1655.36
*C*78431**2374.28*2255.57*2593.91
*C*78431*TC*2287.80*2173.41*2499.42
*C*78432**1973.53*1874.85*2156.08
*C*78432*TC*1881.03*1786.98*2055.03
*C*78433**2084.08*1979.88*2276.86
*C*78433*TC*1982.89*1883.75*2166.31
**78434**700.66*665.63*765.47
**78434*TC*672.17*638.56*734.34
*C*78459**1447.42*1375.05*1581.31
*C*78459*TC*1375.39*1306.62*1502.61
*C*78491**1585.92*1506.62*1732.61
*C*78491*TC*1515.20*1439.44*1655.36
*C*78492**1598.30*1518.39*1746.15
*C*78492*TC*1515.20*1439.44*1655.36
*C*78608**1583.18*1504.02*1729.62
*C*78608*TC*1515.20*1439.44*1655.36
*C*78811**1445.34*1373.07*1579.03
*C*78811*TC*1375.39*1306.62*1502.61
*C*78812**1603.54*1523.36*1751.86
*C*78812*TC*1515.20*1439.44*1655.36
*C*78813**1605.57*1525.29*1754.08
*C*78813*TC*1515.20*1439.44*1655.36
*C*78814**1615.27*1534.51*1764.69
*C*78814*TC*1515.20*1439.44*1655.36
**78815**1625.65*1544.37*1776.03
*C*78815*TC*1515.20*1439.44*1655.36
*C*78816**1627.73*1546.34*1778.29
*C*78816*TC*1515.20*1439.44*1655.36
**79300**237.04*225.19*258.97
**79300*TC*174.14*165.43*190.24
**79445**237.04*225.19*258.97
**79445*TC*129.74*123.25*141.74
**86485**17.28*16.42*18.88
**90867**298.60*283.67*326.22
#**90867**135.32*128.55*147.83
**90868**200.45*190.43*218.99
#**90868**105.19*99.93*114.92
**90869**276.67*262.84*302.27
#**90869**159.84*151.85*174.63
**92978**241.58*229.50*263.93
**92978*TC*150.51*142.98*164.43
**92979**146.88*139.54*160.47
**92979*TC*74.56*70.83*81.45
*C*93315**657.87*624.98*718.73
*C*93315*TC*534.22*507.51*583.64
**93317**210.83*200.29*230.33
**93317*TC*125.00*118.75*136.56
*C*93318**633.50*601.83*692.10
*C*93318*TC*534.22*507.51*583.64
**93571**240.60*228.57*262.86
**93571*TC*171.26*162.70*187.11
**93572**144.63*137.40*158.01
**93572*TC*94.15*89.44*102.86
**93600**3557.81*3379.92*3886.91
**93600*TC*3446.24*3273.93*3765.02
**93602**3557.81*3379.92*3886.91
**93602*TC*3448.14*3275.73*3767.09
**93603**3557.81*3379.92*3886.91
**93603*TC*3448.14*3275.73*3767.09
**93609**2134.69*2027.96*2332.15
**93609*TC*1872.93*1779.28*2046.17
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.89*3232.75*3717.66
**93612**3557.81*3379.92*3886.91
**93612*TC*3405.08*3234.83*3720.05
**93615**49.34*46.87*53.90
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6745.93*6408.63*7369.92
**93620**7115.62*6759.84*7773.82
**93620*TC*6522.55*6196.42*7125.88
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.76*6684.92*7687.66
**93622**7115.62*6759.84*7773.82
**93622*TC*6952.92*6605.27*7596.06
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.24*1965.78*2260.65
**93624**3557.81*3379.92*3886.91
**93624*TC*3327.92*3161.52*3635.75
**93631**7115.62*6759.84*7773.82
**93631*TC*6737.04*6400.19*7360.22
**93640**1133.95*1077.25*1238.84
**93640*TC*964.61*916.38*1053.84
**93641**1133.95*1077.25*1238.84
**93641*TC*838.03*796.13*915.55
**93662**418.79*397.85*457.53
**93662*TC*350.07*332.57*382.46
**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**931.39*884.82*1017.54
**95965*TC*534.17*507.46*583.58
**95966**536.47*509.65*586.10
**95966*TC*345.30*328.04*377.25
**95967**451.16*428.60*492.89
**95967*TC*285.34*271.07*311.73
**96020**372.54*353.91*407.00
**96547**745.29*708.03*814.23
#**96547**133.80*127.11*146.18
**96548**372.64*354.01*407.11
#**96548**66.90*63.56*73.09
**97151**49.78*47.29*54.38
#**97151**44.12*41.91*48.20
**97152**42.31*40.19*46.22
#**97152**37.50*35.63*40.97
**97153**33.71*32.02*36.82
#**97153**29.55*28.07*32.28
**97154**4.57*4.34*4.99
#**97154**4.15*3.94*4.53
**97155**33.71*32.02*36.82
#**97155**29.55*28.07*32.28
**97156**35.57*33.79*38.86
#**97156**31.24*29.68*34.13
**97157**10.37*9.85*11.33
#**97157**9.37*8.90*10.24
**97158**5.33*5.06*5.82
#**97158**4.83*4.59*5.28
**98978**47.22*44.86*51.59
# - 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.