TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
AUSTIN
******
**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**469.71*446.22*513.15
#**G0186**402.16*382.05*439.36
**G0339**2855.95*2713.15*3120.12
**G0340**2147.81*2040.42*2346.48
**G0398**140.54*133.51*153.54
**G0398*TC*101.58*96.50*110.98
**G0398*26*38.96*37.01*42.56
**G0399**96.89*92.05*105.86
**G0399*TC*53.88*51.19*58.87
**G0399*26*43.36*41.19*47.37
**G0400**100.15*95.14*109.41
**G0400*TC*59.80*56.81*65.33
**G0400*26*40.35*38.33*44.08
**G0460**827.79*786.40*904.36
#**G0460**120.62*114.59*131.78
**G0465**827.79*786.40*904.36
#**G0465**120.62*114.59*131.78
**G0498**153.27*145.61*167.45
**G6017**79.96*75.96*87.35
**0042T**234.56*222.83*256.25
**0054T**229.62*218.14*250.86
**0055T**229.62*218.14*250.86
**0071T**579.26*550.30*632.85
**0072T**579.26*550.30*632.85
**0075T**963.83*915.64*1052.99
**0075T*TC*963.83*915.64*1052.99
**0075T*26*963.83*915.64*1052.99
**0095T**628.21*596.80*686.32
**0098T**702.66*667.53*767.66
**0100T**1927.45*1831.08*2105.74
**0101T**321.04*304.99*350.74
#**0101T**228.77*217.33*249.93
**0102T**321.04*304.99*350.74
#**0102T**228.77*217.33*249.93
**0106T**35.00*33.25*38.24
**0107T**35.00*33.25*38.24
**0108T**35.00*33.25*38.24
**0109T**35.00*33.25*38.24
**0110T**35.00*33.25*38.24
**0164T**687.17*652.81*750.73
**0165T**703.92*668.72*769.03
**0184T**833.74*792.05*910.86
**0198T**87.77*83.38*95.89
#**0198T**32.06*30.46*35.03
**0200T**1841.31*1749.24*2011.63
#**0200T**404.68*384.45*442.12
**0201T**2761.96*2623.86*3017.44
#**0201T**607.03*576.68*663.18
**0207T**121.71*115.62*132.96
**0208T**39.65*37.67*43.32
**0209T**48.01*45.61*52.45
**0210T**30.25*28.74*33.05
**0211T**46.96*44.61*51.30
**0212T**36.95*35.10*40.37
#**0212T**31.72*30.13*34.65
**0213T**198.02*188.12*216.34
#**0213T**105.75*100.46*115.53
**0214T**99.37*94.40*108.56
#**0214T**58.98*56.03*64.43
**0215T**99.72*94.73*108.94
#**0215T**60.02*57.02*65.57
**0216T**182.60*173.47*199.49
#**0216T**91.02*86.47*99.44
**0217T**93.08*88.43*101.69
#**0217T**50.61*48.08*55.29
**0218T**93.08*88.43*101.69
#**0218T**51.65*49.07*56.43
**0219T**1328.77*1262.33*1451.68
**0220T**1306.16*1240.85*1426.98
**0221T**1598.34*1518.42*1746.18
**0222T**388.39*368.97*424.32
**0232T**827.79*786.40*904.36
#**0232T**120.62*114.59*131.78
**0234T**8908.81*8463.37*9732.88
#**0234T**577.04*548.19*630.42
**0235T**8908.81*8463.37*9732.88
#**0235T**577.04*548.19*630.42
**0236T**9060.91*8607.86*9899.04
#**0236T**668.21*634.80*730.02
**0237T**9060.91*8607.86*9899.04
#**0237T**668.21*634.80*730.02
**0238T**9060.91*8607.86*9899.04
#**0238T**668.21*634.80*730.02
**0266T**897.10*852.25*980.09
**0267T**156.91*149.06*171.42
**0268T**334.79*318.05*365.76
**0269T**850.86*808.32*929.57
**0270T**156.91*149.06*171.42
**0271T**334.79*318.05*365.76
**0272T**57.75*54.86*63.09
**0273T**73.54*69.86*80.34
**0274T**1118.63*1062.70*1222.11
**0278T**14.55*13.82*15.89
**0308T**1415.60*1344.82*1546.54
**0329T**87.77*83.38*95.89
#**0329T**32.06*30.46*35.03
**0330T**38.21*36.30*41.75
**0331T**189.97*180.47*207.54
**0332T**324.40*308.18*354.41
**0347T**141.65*134.57*154.76
**0348T**34.08*32.38*37.24
**0349T**36.20*34.39*39.55
**0350T**36.89*35.05*40.31
**0351T**175.83*167.04*192.10
**0352T**43.21*41.05*47.21
**0353T**175.83*167.04*192.10
**0354T**43.21*41.05*47.21
**0358T**28.16*26.75*30.76
**0362T**92.63*88.00*101.20
#**0362T**65.81*62.52*71.90
**0378T**24.90*23.66*27.21
**0394T**259.14*246.18*283.11
**0395T**625.65*594.37*683.53
**0397T**47.13*44.77*51.49
**0398T*26*1746.88*1659.54*1908.47
**0408T**509.46*483.99*556.59
**0409T**353.69*336.01*386.41
**0410T**368.12*349.71*402.17
**0411T**368.12*349.71*402.17
**0412T**232.97*221.32*254.52
**0413T**477.88*453.99*522.09
**0414T**368.69*350.26*402.80
**0415T**306.79*291.45*335.17
**0416T**342.11*325.00*373.75
**0417T**85.57*81.29*93.48
**0418T**57.75*54.86*63.09
**0419T**460.04*437.04*502.60
#**0419T**366.73*348.39*400.65
**0420T**651.48*618.91*711.75
#**0420T**536.23*509.42*585.83
**0421T**1653.46*1570.79*1806.41
#**0421T**696.29*661.48*760.70
**0437T**213.09*202.44*232.81
**0439T**73.90*70.21*80.74
**0440T**255.79*243.00*279.45
#**0440T**120.00*114.00*131.10
**0441T**255.79*243.00*279.45
#**0441T**120.00*114.00*131.10
**0442T**255.79*243.00*279.45
#**0442T**120.00*114.00*131.10
**0449T**774.75*736.01*846.41
**0464T**69.71*66.22*76.15
**0472T**68.86*65.42*75.23
**0473T**57.75*54.86*63.09
**0479T**63.48*60.31*69.36
**0480T**160.62*152.59*175.48
#**0480T**31.74*30.15*34.67
**0483T**1175.85*1117.06*1284.62
**0484T**1524.14*1447.93*1665.12
**0485T**24.09*22.89*26.32
**0485T*TC*9.18*8.72*10.03
**0485T*26*15.21*14.45*16.62
**0486T**48.18*45.77*52.64
**0486T*TC*18.06*17.16*19.73
**0486T*26*30.12*28.61*32.90
**0488T**63.62*60.44*69.51
#**0488T**50.04*47.54*54.67
**0505T**11155.28*10597.52*12187.15
#**0505T**538.78*511.84*588.62
**0507T**24.21*23.00*26.45
**0507T*TC*21.20*20.14*23.16
**0507T*26*3.01*2.86*3.29
**0510T**616.78*585.94*673.83
#**0510T**428.76*407.32*468.42
**0512T**321.04*304.99*350.74
#**0512T**228.77*217.33*249.93
**0513T**96.31*91.49*105.21
#**0513T**68.63*65.20*74.98
**0515T**509.46*483.99*556.59
**0516T**470.53*447.00*514.05
**0517T**334.79*318.05*365.76
**0518T**232.97*221.32*254.52
**0519T**335.88*319.09*366.95
**0520T**470.53*447.00*514.05
**0521T**57.75*54.86*63.09
**0521T*TC*37.56*35.68*41.03
**0521T*26*20.19*19.18*22.06
**0522T**68.86*65.42*75.23
**0522T*TC*38.26*36.35*41.80
**0522T*26*30.60*29.07*33.43
**0523T**155.43*147.66*169.81
**0524T**1707.00*1621.65*1864.90
#**0524T**174.62*165.89*190.77
**0525T**470.87*447.33*514.43
**0526T**368.12*349.71*402.17
**0527T**319.79*303.80*349.37
**0528T**68.86*65.42*75.23
**0528T*TC*38.26*36.35*41.80
**0528T*26*30.60*29.07*33.43
**0529T**57.75*54.86*63.09
**0529T*TC*37.56*35.68*41.03
**0529T*26*20.19*19.18*22.06
**0530T**628.46*597.04*686.60
**0531T**477.88*453.99*522.09
**0532T**335.88*319.09*366.95
**0540T**178.72*169.78*195.25
**0543T**1524.14*1447.93*1665.12
**0544T**1757.84*1669.95*1920.44
**0545T**1757.84*1669.95*1920.44
**0546T**73.62*69.94*80.43
**0552T**6.83*6.49*7.46
**0553T**2544.66*2417.43*2780.04
#**0553T**385.55*366.27*421.21
**0565T**625.91*594.61*683.80
#**0565T**521.80*495.71*570.07
**0566T**101.76*96.67*111.17
#**0566T**58.94*55.99*64.39
**0569T**1757.84*1669.95*1920.44
**0570T**410.96*390.41*448.97
**0571T**551.52*523.94*602.53
**0572T**448.57*426.14*490.06
**0573T**343.49*326.32*375.27
**0574T**397.41*377.54*434.17
**0575T**68.86*65.42*75.23
**0576T**57.75*54.86*63.09
**0577T**193.02*183.37*210.88
**0578T**29.20*27.74*31.90
**0579T**22.24*21.13*24.30
**0580T**214.06*203.36*233.86
**0581T**2358.20*2240.29*2576.33
#**0581T**208.49*198.07*227.78
**0582T**1717.85*1631.96*1876.75
#**0582T**387.43*368.06*423.27
**0583T**1522.66*1446.53*1663.51
#**0583T**135.56*128.78*148.10
**0587T**451.03*428.48*492.75
#**0587T**296.43*281.61*323.85
**0588T**372.65*354.02*407.12
#**0588T**231.64*220.06*253.07
**0589T**48.64*46.21*53.14
#**0589T**38.54*36.61*42.10
**0590T**57.62*54.74*62.95
#**0590T**39.86*37.87*43.55
**0596T**672.69*639.06*734.92
#**0596T**130.29*123.78*142.35
**0597T**672.69*639.06*734.92
#**0597T**130.29*123.78*142.35
**0598T**157.59*149.71*172.17
**0599T**104.73*99.49*114.41
**0600T**3704.44*3519.22*4047.10
#**0600T**719.09*683.14*785.61
**0601T**1446.73*1374.39*1580.55
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**202.03*191.93*220.72
**0611T**42.39*40.27*46.31
**0614T**367.96*349.56*401.99
**0615T**47.94*45.54*52.37
**0616T**671.07*637.52*733.15
**0617T**750.68*713.15*820.12
**0618T**909.11*863.65*993.20
**0619T**665.75*632.46*727.33
#**0619T**480.23*456.22*524.65
**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**266.65*253.32*291.32
#**0627T**99.52*94.54*108.72
**0628T**79.99*75.99*87.39
#**0628T**29.85*28.36*32.61
**0629T**266.65*253.32*291.32
#**0629T**99.52*94.54*108.72
**0630T**79.99*75.99*87.39
#**0630T**29.85*28.36*32.61
**0631T**85.40*81.13*93.30
**0632T**566.04*537.74*618.40
**0633T**208.04*197.64*227.29
*C*0633T*TC*111.38*105.81*121.68
**0633T*26*58.76*55.82*64.19
**0634T**208.04*197.64*227.29
**0634T*TC*149.28*141.82*163.09
**0634T*26*58.76*55.82*64.19
**0635T**208.04*197.64*227.29
**0635T*TC*149.28*141.82*163.09
**0635T*26*58.76*55.82*64.19
**0636T**208.04*197.64*227.29
**0636T*TC*149.28*141.82*163.09
**0636T*26*58.76*55.82*64.19
**0637T**208.04*197.64*227.29
**0637T*TC*149.28*141.82*163.09
**0637T*26*58.76*55.82*64.19
**0638T**208.04*197.64*227.29
**0638T*TC*149.28*141.82*163.09
**0638T*26*58.76*55.82*64.19
**0639T**85.40*81.13*93.30
**0640T**24.21*23.00*26.45
**0640T*TC*21.32*20.25*23.29
**0640T*26*3.01*2.86*3.29
**0644T**1200.76*1140.72*1311.83
#**0644T**235.24*223.48*257.00
**0646T**1757.84*1669.95*1920.44
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**61.40*58.33*67.08
**0652T**296.14*281.33*323.53
#**0652T**122.05*115.95*133.34
**0653T**387.78*368.39*423.65
#**0653T**137.78*130.89*150.52
**0654T**141.32*134.25*154.39
**0655T**1653.46*1570.79*1806.41
#**0655T**696.29*661.48*760.70
**0658T**99.19*94.23*108.36
**0659T**2787.73*2648.34*3045.59
#**0659T**424.93*403.68*464.23
**0671T**1041.32*989.25*1137.64
**0673T**3567.70*3389.32*3897.72
#**0673T**361.24*343.18*394.66
**0699T**114.65*108.92*125.26
#**0699T**91.67*87.09*100.15
**0707T**382.25*363.14*417.61
#**0707T**285.80*271.51*312.24
**0714T**1457.45*1384.58*1592.27
#**0714T**362.06*343.96*395.55
**0730T**269.12*255.66*294.01
#**0730T**240.17*228.16*262.38
**0738T**71.13*67.57*77.71
**0739T**1653.46*1570.79*1806.41
#**0739T**696.29*661.48*760.70
**0740T**20.80*19.76*22.72
**0741T**49.40*46.93*53.97
**0742T**97.32*92.45*106.32
**0742T*TC*78.28*74.37*85.53
**0742T*26*19.04*18.09*20.80
**0743T**55.12*52.36*60.21
**0744T**872.57*828.94*953.28
**0745T**268.49*255.07*293.33
**0746T**225.93*214.63*246.82
**0747T**1038.24*986.33*1134.28
**0748T**184.62*175.39*201.70
**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**4.39*4.17*4.80
**0765T**8.05*7.65*8.80
**0771T**26.24*24.93*28.67
**0772T**26.24*24.93*28.67
**0773T**24.05*22.85*26.28
**0774T**24.05*22.85*26.28
**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**455.89*433.10*498.07
**0779T*TC*429.97*408.47*469.74
**0779T*26*25.93*24.63*28.32
**0780T**24.05*22.85*26.28
**0783T**14.93*14.18*16.31
**0784T**2205.02*2094.77*2408.99
#**0784T**325.50*309.23*355.61
**0785T**248.93*236.48*271.95
#**0785T**146.22*138.91*159.75
**0786T**754.43*716.71*824.22
#**0786T**303.88*288.69*331.99
**0787T**248.93*236.48*271.95
#**0787T**146.22*138.91*159.75
**0788T**18.83*17.89*20.57
#**0788T**18.13*17.22*19.80
**0789T**26.05*24.75*28.46
#**0789T**22.67*21.54*24.77
**0790T**1924.43*1828.21*2102.44
**0791T**9.19*8.73*10.04
**0793T**566.04*537.74*618.40
**0794T**130.35*123.83*142.40
**0795T**705.79*670.50*771.08
**0796T**470.53*447.00*514.05
**0797T**470.53*447.00*514.05
**0798T**744.31*707.09*813.15
**0799T**496.21*471.40*542.11
**0800T**496.21*471.40*542.11
**0801T**966.73*918.39*1056.15
**0802T**483.37*459.20*528.08
**0803T**483.37*459.20*528.08
**0804T**80.51*76.48*87.95
**0804T*TC*44.18*41.97*48.27
**0804T*26*36.34*34.52*39.70
**0805T**3077.51*2923.63*3362.17
#**0805T**320.91*304.86*350.59
**0806T**4103.34*3898.17*4482.90
#**0806T**427.88*406.49*467.46
**0807T**43.93*41.73*47.99
**0807T*TC*29.20*27.74*31.90
**0807T*26*14.73*13.99*16.09
**0808T**43.93*41.73*47.99
**0808T*TC*29.20*27.74*31.90
**0808T*26*14.73*13.99*16.09
**0810T**1146.59*1089.26*1252.65
**0811T**20.80*19.76*22.72
**0813T**2708.07*2572.67*2958.57
#**0813T**179.53*170.55*196.13
**0814T**477.82*453.93*522.02
#**0814T**357.26*339.40*390.31
**0818T**372.65*354.02*407.12
#**0818T**231.64*220.06*253.07
**0820T**147.74*140.35*161.40
#**0820T**129.29*122.83*141.25
**0821T**147.74*140.35*161.40
#**0821T**129.29*122.83*141.25
**0822T**125.58*119.30*137.20
#**0822T**109.89*104.40*120.06
**0823T**705.79*670.50*771.08
**0824T**744.31*707.09*813.15
**0825T**966.73*918.39*1056.15
**0826T**68.86*65.42*75.23
**0826T*TC*38.26*36.35*41.80
**0826T*26*30.60*29.07*33.43
**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**24.21*23.00*26.45
**0859T*TC*21.20*20.14*23.16
**0859T*26*3.01*2.86*3.29
**0864T**321.04*304.99*350.74
#**0864T**228.77*217.33*249.93
**10011**440.90*418.86*481.69
#**10011**106.99*101.64*116.89
**10012**242.02*229.92*264.41
#**10012**70.71*67.17*77.25
**15847**355.27*337.51*388.14
**21742**1152.27*1094.66*1258.86
**21743**1321.41*1255.34*1443.64
**32855**339.53*322.55*370.93
**32856**446.89*424.55*488.23
**33928**3264.78*3101.54*3566.77
**33929**1222.99*1161.84*1336.12
**33933**519.19*493.23*567.21
**33944**519.19*493.23*567.21
**34841**2043.07*1940.92*2232.06
**34842**2268.85*2155.41*2478.72
**34843**2494.63*2369.90*2725.39
**34844**2720.42*2584.40*2972.06
**34845**2043.07*1940.92*2232.06
**34846**2268.85*2155.41*2478.72
**34847**2494.63*2369.90*2725.39
**34848**2720.42*2584.40*2972.06
**43496**2060.38*1957.36*2250.96
**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**762.10*724.00*832.60
**53452**381.05*362.00*416.30
**53453**647.80*615.41*707.72
**53454**57.86*54.97*63.22
#**53454**35.22*33.46*38.48
**63043**577.18*548.32*630.57
**63044**499.10*474.15*545.27
**64596**2205.02*2094.77*2408.99
#**64596**325.50*309.23*355.61
**64597**661.50*628.43*722.69
#**64597**97.65*92.77*106.69
**64598**248.93*236.48*271.95
#**64598**146.22*138.91*159.75
**65757**121.10*115.05*132.31
**66983**671.07*637.52*733.15
**66987**770.78*732.24*842.08
**66988**642.84*610.70*702.31
*C*70170**262.64*249.51*286.94
*C*70170*TC*248.21*235.80*271.17
**70555**233.47*221.80*255.07
**70555*TC*116.02*110.22*126.75
*C*70557**710.47*674.95*776.19
*C*70557*TC*558.80*530.86*610.49
*C*70558**353.42*335.75*386.11
*C*70558*TC*186.24*176.93*203.47
*C*70559**342.45*325.33*374.13
*C*70559*TC*186.24*176.93*203.47
*C*74190**580.56*551.53*634.26
*C*74190*TC*558.80*530.86*610.49
**74235**148.05*140.65*161.75
**74235*TC*91.99*87.39*100.50
**74300**86.73*82.39*94.75
**74300*TC*73.65*69.97*80.47
**74301**26.65*25.32*29.12
**74301*TC*16.92*16.07*18.48
**74328**175.06*166.31*191.26
**74328*TC*152.19*144.58*166.27
**74329**144.67*137.44*158.06
**74329*TC*121.45*115.38*132.69
**74330**262.59*249.46*286.88
**74330*TC*235.72*223.93*257.52
**74340**86.58*82.25*94.59
**74340*TC*61.42*58.35*67.10
**74355**86.58*82.25*94.59
**74355*TC*50.66*48.13*55.35
**74360**86.58*82.25*94.59
**74360*TC*59.77*56.78*65.30
**74363**175.06*166.31*191.26
**74363*TC*134.15*127.44*146.56
*C*74445**164.47*156.25*179.69
*C*74445*TC*111.38*105.81*121.68
*C*74450**263.68*250.50*288.08
*C*74450*TC*248.21*235.80*271.17
*C*74470**583.26*554.10*637.22
*C*74470*TC*558.80*530.86*610.49
**74742**233.47*221.80*255.07
**74742*TC*204.59*194.36*223.51
*C*74775**277.42*263.55*303.08
*C*74775*TC*248.21*235.80*271.17
*C*75801**678.50*644.58*741.27
*C*75801*TC*636.44*604.62*695.31
*C*75803**1677.90*1594.01*1833.11
*C*75803*TC*1622.51*1541.38*1772.59
*C*75805**3267.67*3104.29*3569.93
*C*75805*TC*3229.39*3067.92*3528.11
*C*75807**3281.22*3117.16*3584.73
*C*75807*TC*3229.39*3067.92*3528.11
*C*75810**3276.65*3112.82*3579.74
*C*75810*TC*3229.39*3067.92*3528.11
**75894**926.89*880.55*1012.63
**75894*TC*856.61*813.78*935.85
*C*75898**3318.95*3153.00*3625.95
*C*75898*TC*3229.39*3067.92*3528.11
**75970**452.20*429.59*494.03
**75970*TC*415.09*394.34*453.49
**76125**40.43*38.41*44.17
**76125*TC*27.35*25.98*29.88
**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*50.66*48.13*55.35
**76940**157.77*149.88*172.36
**76940*TC*58.96*56.01*64.41
**76941**116.87*111.03*127.68
**76941*TC*53.25*50.59*58.18
**76945**85.17*80.91*93.05
**76945*TC*53.51*50.83*58.45
*C*76975**288.62*274.19*315.32
*C*76975*TC*248.21*235.80*271.17
**76998**175.06*166.31*191.26
**76998*TC*129.11*122.65*141.05
**77013**434.43*412.71*474.62
**77013*TC*254.66*241.93*278.22
**77022**483.55*459.37*528.28
**77022*TC*286.97*272.62*313.51
**77371**621.24*590.18*678.71
**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**432.82*411.18*472.86
*C*78282*TC*417.78*396.89*456.42
**78414**514.99*489.24*562.63
**78414*TC*494.14*469.43*539.84
*C*78429**1662.73*1579.59*1816.53
*C*78429*TC*1584.90*1505.66*1731.51
*C*78430**1659.08*1576.13*1812.55
*C*78430*TC*1584.90*1505.66*1731.51
*C*78431**2479.71*2355.72*2709.08
*C*78431*TC*2393.05*2273.40*2614.41
*C*78432**2060.18*1957.17*2250.75
*C*78432*TC*1967.56*1869.18*2149.56
*C*78433**2175.45*2066.68*2376.68
*C*78433*TC*2074.11*1970.40*2265.96
**78434**731.76*695.17*799.45
**78434*TC*703.22*668.06*768.27
*C*78459**1510.80*1435.26*1650.55
*C*78459*TC*1438.67*1366.74*1571.75
*C*78491**1655.76*1572.97*1808.92
*C*78491*TC*1584.90*1505.66*1731.51
*C*78492**1668.24*1584.83*1822.55
*C*78492*TC*1584.90*1505.66*1731.51
*C*78608**1653.03*1570.38*1805.94
*C*78608*TC*1584.90*1505.66*1731.51
*C*78811**1508.77*1433.33*1648.33
*C*78811*TC*1438.67*1366.74*1571.75
*C*78812**1673.48*1589.81*1828.28
*C*78812*TC*1584.90*1505.66*1731.51
*C*78813**1675.46*1591.69*1830.44
*C*78813*TC*1584.90*1505.66*1731.51
*C*78814**1685.20*1600.94*1841.08
*C*78814*TC*1584.90*1505.66*1731.51
*C*78815**1696.63*1611.80*1853.57
*C*78815*TC*1584.90*1505.66*1731.51
*C*78816**1697.63*1612.75*1854.66
*C*78816*TC*1584.90*1505.66*1731.51
**79300**237.04*225.19*258.97
**79300*TC*174.47*165.75*190.61
**79445**237.04*225.19*258.97
**79445*TC*129.56*123.08*141.54
**86485**17.28*16.42*18.88
**90867**308.30*292.89*336.82
#**90867**137.51*130.63*150.22
**90868**205.58*195.30*224.60
#**90868**105.80*100.51*115.59
**90869**283.18*269.02*309.37
#**90869**163.10*154.95*178.19
**92978**248.76*236.32*271.77
**92978*TC*156.91*149.06*171.42
**92979**150.45*142.93*164.37
**92979*TC*77.54*73.66*84.71
*C*93315**682.76*648.62*745.91
*C*93315*TC*558.80*530.86*610.49
**93317**216.52*205.69*236.54
**93317*TC*130.38*123.86*142.44
*C*93318**658.39*625.47*719.29
*C*93318*TC*558.80*530.86*610.49
**93571**247.73*235.34*270.64
**93571*TC*177.82*168.93*194.27
**93572**148.10*140.70*161.81
**93572*TC*97.19*92.33*106.18
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.13*3272.87*3763.80
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.13*3274.77*3765.99
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.13*3274.77*3765.99
**93609**2134.69*2027.96*2332.15
**93609*TC*1870.35*1776.83*2043.35
**93610**3557.81*3379.92*3886.91
**93610*TC*3401.51*3231.43*3716.14
**93612**3557.81*3379.92*3886.91
**93612*TC*3403.81*3233.62*3718.66
**93615**49.47*47.00*54.05
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6742.30*6405.19*7365.97
**93620**7115.62*6759.84*7773.82
**93620*TC*6516.71*6190.87*7119.50
**93621**7115.62*6759.84*7773.82
**93621*TC*7035.97*6684.17*7686.80
**93622**7115.62*6759.84*7773.82
**93622*TC*6951.30*6603.74*7594.30
**93623**2134.69*2027.96*2332.15
**93623*TC*2068.08*1964.68*2259.38
**93624**3557.81*3379.92*3886.91
**93624*TC*3325.96*3159.66*3633.61
**93631**7115.62*6759.84*7773.82
**93631*TC*6733.94*6397.24*7356.83
**93640**1133.95*1077.25*1238.84
**93640*TC*963.00*914.85*1052.08
**93641**1133.95*1077.25*1238.84
**93641*TC*835.14*793.38*912.39
**93662**430.20*408.69*469.99
**93662*TC*361.20*343.14*394.61
**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*520.93*494.88*569.11
**95966**537.50*510.63*587.22
**95966*TC*345.30*328.04*377.25
**95967**452.01*429.41*493.82
**95967*TC*285.34*271.07*311.73
**96020**376.67*357.84*411.52
**96547**775.38*736.61*847.10
#**96547**135.76*128.97*148.32
**96548**387.69*368.31*423.56
#**96548**67.88*64.49*74.16
**97151**49.87*47.38*54.49
#**97151**43.95*41.75*48.01
**97152**42.39*40.27*46.31
#**97152**37.36*35.49*40.81
**97153**33.74*32.05*36.86
#**97153**29.39*27.92*32.11
**97154**4.60*4.37*5.03
#**97154**4.16*3.95*4.54
**97155**33.74*32.05*36.86
#**97155**29.39*27.92*32.11
**97156**35.58*33.80*38.87
#**97156**31.05*29.50*33.93
**97157**10.41*9.89*11.37
#**97157**9.37*8.90*10.24
**97158**5.36*5.09*5.85
#**97158**4.84*4.60*5.29
**98978**49.40*46.93*53.97
# - 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.