TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
FORT WORTH
******
**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**456.54*433.71*498.77
#**G0186**392.10*372.50*428.38
**G0339**2771.30*2632.74*3027.65
**G0340**2084.19*1979.98*2276.98
**G0398**135.75*128.96*148.30
**G0398*TC*96.94*92.09*105.90
**G0398*26*38.81*36.87*42.40
**G0399**94.26*89.55*102.98
**G0399*TC*51.43*48.86*56.19
**G0399*26*43.16*41.00*47.15
**G0400**97.21*92.35*106.20
**G0400*TC*57.08*54.23*62.36
**G0400*26*40.14*38.13*43.85
**G0460**794.44*754.72*867.93
#**G0460**119.72*113.73*130.79
**G0465**794.44*754.72*867.93
#**G0465**119.72*113.73*130.79
**G0498**146.70*139.37*160.28
**G6017**77.86*73.97*85.07
**0042T**227.51*216.13*248.55
**0054T**227.53*216.15*248.57
**0055T**227.53*216.15*248.57
**0071T**571.06*542.51*623.89
**0072T**571.06*542.51*623.89
**0075T**958.96*911.01*1047.66
**0075T*TC*958.96*911.01*1047.66
**0075T*26*957.78*909.89*1046.37
**0095T**619.75*588.76*677.07
**0098T**693.53*658.85*757.68
**0100T**1893.07*1798.42*2068.18
**0101T**313.14*297.48*342.10
#**0101T**225.11*213.85*245.93
**0102T**313.14*297.48*342.10
#**0102T**225.11*213.85*245.93
**0106T**33.51*31.83*36.60
**0107T**33.51*31.83*36.60
**0108T**33.51*31.83*36.60
**0109T**33.51*31.83*36.60
**0110T**33.51*31.83*36.60
**0164T**677.63*643.75*740.31
**0165T**694.22*659.51*758.44
**0184T**820.60*779.57*896.51
**0198T**84.91*80.66*92.76
#**0198T**31.76*30.17*34.70
**0200T**1771.76*1683.17*1935.65
#**0200T**401.06*381.01*438.16
**0201T**2657.64*2524.76*2903.47
#**0201T**601.59*571.51*657.24
**0207T**121.71*115.62*132.96
**0208T**37.84*35.95*41.34
**0209T**45.81*43.52*50.05
**0210T**28.87*27.43*31.54
**0211T**44.82*42.58*48.97
**0212T**36.41*34.59*39.78
#**0212T**31.42*29.85*34.33
**0213T**192.56*182.93*210.37
#**0213T**104.53*99.30*114.20
**0214T**97.12*92.26*106.10
#**0214T**58.59*55.66*64.01
**0215T**97.46*92.59*106.48
#**0215T**59.58*56.60*65.09
**0216T**177.25*168.39*193.65
#**0216T**89.87*85.38*98.19
**0217T**90.81*86.27*99.21
#**0217T**50.28*47.77*54.94
**0218T**90.81*86.27*99.21
#**0218T**51.27*48.71*56.02
**0219T**1306.84*1241.50*1427.73
**0220T**1284.69*1220.46*1403.53
**0221T**1576.27*1497.46*1722.08
**0222T**384.82*365.58*420.42
**0232T**794.44*754.72*867.93
#**0232T**119.72*113.73*130.79
**0234T**8524.78*8098.54*9313.32
#**0234T**575.34*546.57*628.56
**0235T**8524.78*8098.54*9313.32
#**0235T**575.34*546.57*628.56
**0236T**8674.03*8240.33*9476.38
#**0236T**666.46*633.14*728.11
**0237T**8674.03*8240.33*9476.38
#**0237T**666.46*633.14*728.11
**0238T**8674.03*8240.33*9476.38
#**0238T**666.46*633.14*728.11
**0266T**887.57*843.19*969.67
**0267T**156.11*148.30*170.55
**0268T**330.63*314.10*361.22
**0269T**840.99*798.94*918.78
**0270T**156.11*148.30*170.55
**0271T**330.63*314.10*361.22
**0272T**55.93*53.13*61.10
**0273T**71.62*68.04*78.25
**0274T**1100.40*1045.38*1202.19
**0278T**14.36*13.64*15.69
**0308T**1389.57*1320.09*1518.10
**0329T**84.91*80.66*92.76
#**0329T**31.76*30.17*34.70
**0330T**38.21*36.30*41.75
**0331T**182.84*173.70*199.76
**0332T**312.22*296.61*341.10
**0347T**140.37*133.35*153.35
**0348T**32.91*31.26*35.95
**0349T**34.90*33.16*38.13
**0350T**35.56*33.78*38.85
**0351T**169.31*160.84*184.97
**0352T**42.77*40.63*46.72
**0353T**169.31*160.84*184.97
**0354T**42.77*40.63*46.72
**0358T**26.88*25.54*29.37
**0362T**90.94*86.39*99.35
#**0362T**65.36*62.09*71.40
**0378T**24.70*23.47*26.99
**0394T**249.32*236.85*272.38
**0395T**604.41*574.19*660.32
**0397T**46.74*44.40*51.06
**0398T*26*1746.88*1659.54*1908.47
**0408T**504.14*478.93*550.77
**0409T**349.22*331.76*381.52
**0410T**363.14*344.98*396.73
**0411T**363.14*344.98*396.73
**0412T**228.95*217.50*250.13
**0413T**472.18*448.57*515.86
**0414T**364.05*345.85*397.73
**0415T**303.15*287.99*331.19
**0416T**336.71*319.87*367.85
**0417T**83.29*79.13*91.00
**0418T**55.93*53.13*61.10
**0419T**448.53*426.10*490.02
#**0419T**359.50*341.53*392.76
**0420T**636.79*604.95*695.69
#**0420T**526.83*500.49*575.56
**0421T**1602.08*1521.98*1750.28
#**0421T**688.83*654.39*752.55
**0437T**210.93*200.38*230.44
**0439T**71.60*68.02*78.22
**0440T**248.01*235.61*270.95
#**0440T**118.45*112.53*129.41
**0441T**248.01*235.61*270.95
#**0441T**118.45*112.53*129.41
**0442T**248.01*235.61*270.95
#**0442T**118.45*112.53*129.41
**0449T**758.45*720.53*828.61
**0464T**67.19*63.83*73.40
**0472T**66.96*63.61*73.15
**0473T**55.93*53.13*61.10
**0479T**62.79*59.65*68.60
**0480T**155.48*147.71*169.87
#**0480T**31.40*29.83*34.30
**0483T**1169.66*1111.18*1277.86
**0484T**1516.54*1440.71*1656.82
**0485T**23.51*22.33*25.68
**0485T*TC*8.77*8.33*9.58
**0485T*26*15.03*14.28*16.42
**0486T**47.01*44.66*51.36
**0486T*TC*17.24*16.38*18.84
**0486T*26*29.77*28.28*32.52
**0488T**62.66*59.53*68.46
#**0488T**49.71*47.22*54.30
**0505T**10790.31*10250.79*11788.41
#**0505T**537.75*510.86*587.49
**0507T**23.21*22.05*25.36
**0507T*TC*20.23*19.22*22.10
**0507T*26*2.98*2.83*3.25
**0510T**600.82*570.78*656.40
#**0510T**421.43*400.36*460.41
**0512T**313.14*297.48*342.10
#**0512T**225.11*213.85*245.93
**0513T**93.94*89.24*102.63
#**0513T**67.53*64.15*73.77
**0515T**504.14*478.93*550.77
**0516T**465.47*442.20*508.53
**0517T**330.63*314.10*361.22
**0518T**228.95*217.50*250.13
**0519T**331.61*315.03*362.28
**0520T**465.47*442.20*508.53
**0521T**55.93*53.13*61.10
**0521T*TC*35.85*34.06*39.17
**0521T*26*20.09*19.09*21.95
**0522T**66.96*63.61*73.15
**0522T*TC*36.51*34.68*39.88
**0522T*26*30.45*28.93*33.27
**0523T**151.28*143.72*165.28
**0524T**1636.01*1554.21*1787.34
#**0524T**173.96*165.26*190.05
**0525T**465.80*442.51*508.89
**0526T**363.14*344.98*396.73
**0527T**315.75*299.96*344.95
**0528T**66.96*63.61*73.15
**0528T*TC*36.51*34.68*39.88
**0528T*26*30.45*28.93*33.27
**0529T**55.93*53.13*61.10
**0529T*TC*35.85*34.06*39.17
**0529T*26*20.09*19.09*21.95
**0530T**620.62*589.59*678.03
**0531T**472.18*448.57*515.86
**0532T**331.61*315.03*362.28
**0540T**176.40*167.58*192.72
**0543T**1516.54*1440.71*1656.82
**0544T**1745.64*1658.36*1907.11
**0545T**1745.64*1658.36*1907.11
**0546T**71.69*68.11*78.33
**0552T**6.64*6.31*7.26
**0553T**2444.58*2322.35*2670.70
#**0553T**384.55*365.32*420.12
**0565T**611.18*580.62*667.71
#**0565T**511.85*486.26*559.20
**0566T**99.33*94.36*108.51
#**0566T**58.47*55.55*63.88
**0569T**1745.64*1658.36*1907.11
**0570T**408.92*388.47*446.74
**0571T**545.50*518.23*595.96
**0572T**443.91*421.71*484.97
**0573T**339.23*322.27*370.61
**0574T**392.98*373.33*429.33
**0575T**66.96*63.61*73.15
**0576T**55.93*53.13*61.10
**0577T**190.02*180.52*207.60
**0578T**29.03*27.58*31.72
**0579T**21.23*20.17*23.20
**0580T**210.70*200.17*230.20
**0581T**2257.92*2145.02*2466.77
#**0581T**206.86*196.52*226.00
**0582T**1650.98*1568.43*1803.69
#**0582T**381.61*362.53*416.91
**0583T**1522.66*1446.53*1663.51
#**0583T**132.48*125.86*144.74
**0587T**440.72*418.68*481.48
#**0587T**293.21*278.55*320.33
**0588T**363.29*345.13*396.90
#**0588T**228.74*217.30*249.90
**0589T**47.95*45.55*52.38
#**0589T**38.32*36.40*41.86
**0590T**56.57*53.74*61.80
#**0590T**39.62*37.64*43.29
**0596T**672.69*639.06*734.92
#**0596T**130.32*123.80*142.37
**0597T**672.69*639.06*734.92
#**0597T**130.32*123.80*142.37
**0598T**150.87*143.33*164.83
**0599T**100.40*95.38*109.69
**0600T**3564.37*3386.15*3894.07
#**0600T**716.01*680.21*782.24
**0601T**1432.77*1361.13*1565.30
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**195.66*185.88*213.76
**0611T**40.47*38.45*44.22
**0614T**363.39*345.22*397.00
**0615T**47.04*44.69*51.39
**0616T**659.05*626.10*720.02
**0617T**736.43*699.61*804.55
**0618T**891.56*846.98*974.03
**0619T**650.47*617.95*710.64
#**0619T**473.39*449.72*517.18
**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**258.00*245.10*281.87
#**0627T**98.54*93.61*107.65
**0628T**77.40*73.53*84.56
#**0628T**29.56*28.08*32.29
**0629T**258.00*245.10*281.87
#**0629T**98.54*93.61*107.65
**0630T**77.40*73.53*84.56
#**0630T**29.56*28.08*32.29
**0631T**82.00*77.90*89.59
**0632T**561.77*533.68*613.73
**0633T**200.94*190.89*219.52
*C*0633T*TC*106.28*100.97*116.12
**0633T*26*58.49*55.57*63.91
**0634T**200.94*190.89*219.52
**0634T*TC*142.45*135.33*155.63
**0634T*26*58.49*55.57*63.91
**0635T**200.94*190.89*219.52
**0635T*TC*142.45*135.33*155.63
**0635T*26*58.49*55.57*63.91
**0636T**200.94*190.89*219.52
**0636T*TC*142.45*135.33*155.63
**0636T*26*58.49*55.57*63.91
**0637T**200.94*190.89*219.52
**0637T*TC*142.45*135.33*155.63
**0637T*26*58.49*55.57*63.91
**0638T**200.94*190.89*219.52
**0638T*TC*142.45*135.33*155.63
**0638T*26*58.49*55.57*63.91
**0639T**82.00*77.90*89.59
**0640T**23.21*22.05*25.36
**0640T*TC*20.35*19.33*22.23
**0640T*26*2.98*2.83*3.25
**0644T**1155.99*1098.19*1262.92
#**0644T**234.77*223.03*256.48
**0646T**1745.64*1658.36*1907.11
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.59*56.61*65.10
**0652T**286.77*272.43*313.29
#**0652T**120.67*114.64*131.84
**0653T**374.81*356.07*409.48
#**0653T**136.28*129.47*148.89
**0654T**139.88*132.89*152.82
**0655T**1602.08*1521.98*1750.28
#**0655T**688.83*654.39*752.55
**0658T**94.65*89.92*103.41
**0659T**2678.28*2544.37*2926.03
#**0659T**423.91*402.71*463.12
**0671T**1019.58*968.60*1113.89
**0673T**3418.35*3247.43*3734.54
#**0673T**359.04*341.09*392.25
**0699T**112.23*106.62*122.61
#**0699T**90.30*85.79*98.66
**0707T**370.50*351.98*404.78
#**0707T**278.48*264.56*304.24
**0714T**1401.49*1331.42*1531.13
#**0714T**356.36*338.54*389.32
**0730T**261.87*248.78*286.10
#**0730T**234.66*222.93*256.37
**0738T**70.40*66.88*76.91
**0739T**1602.08*1521.98*1750.28
#**0739T**688.83*654.39*752.55
**0740T**19.87*18.88*21.71
**0741T**47.14*44.78*51.50
**0742T**93.67*88.99*102.34
**0742T*TC*74.70*70.97*81.62
**0742T*26*18.97*18.02*20.72
**0743T**53.19*50.53*58.11
**0744T**868.61*825.18*948.96
**0745T**256.24*243.43*279.94
**0746T**223.86*212.67*244.57
**0747T**990.85*941.31*1082.51
**0748T**182.10*173.00*198.95
**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**8.01*7.61*8.75
**0771T**26.10*24.80*28.52
**0772T**26.10*24.80*28.52
**0773T**23.30*22.14*25.46
**0774T**23.30*22.14*25.46
**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**435.99*414.19*476.32
**0779T*TC*410.25*389.74*448.20
**0779T*26*25.74*24.45*28.12
**0780T**23.30*22.14*25.46
**0783T**14.25*13.54*15.57
**0784T**2115.36*2009.59*2311.03
#**0784T**322.09*305.99*351.89
**0785T**241.80*229.71*264.17
#**0785T**143.80*136.61*157.10
**0786T**730.85*694.31*798.46
#**0786T**300.97*285.92*328.81
**0787T**241.80*229.71*264.17
#**0787T**143.80*136.61*157.10
**0788T**18.66*17.73*20.39
#**0788T**17.99*17.09*19.65
**0789T**25.80*24.51*28.19
#**0789T**22.49*21.37*24.58
**0790T**1907.98*1812.58*2084.47
**0791T**9.03*8.58*9.87
**0793T**561.77*533.68*613.73
**0794T**130.35*123.83*142.40
**0795T**698.20*663.29*762.78
**0796T**465.47*442.20*508.53
**0797T**465.47*442.20*508.53
**0798T**737.53*700.65*805.75
**0799T**491.69*467.11*537.18
**0800T**491.69*467.11*537.18
**0801T**957.16*909.30*1045.70
**0802T**478.58*454.65*522.85
**0803T**478.58*454.65*522.85
**0804T**78.31*74.39*85.55
**0804T*TC*42.16*40.05*46.06
**0804T*26*36.15*34.34*39.49
**0805T**2949.89*2802.40*3222.76
#**0805T**319.79*303.80*349.37
**0806T**3933.19*3736.53*4297.01
#**0806T**426.39*405.07*465.83
**0807T**42.52*40.39*46.45
**0807T*TC*27.87*26.48*30.45
**0807T*26*14.65*13.92*16.01
**0808T**42.52*40.39*46.45
**0808T*TC*27.87*26.48*30.45
**0808T*26*14.65*13.92*16.01
**0810T**1126.18*1069.87*1230.35
**0811T**19.87*18.88*21.71
**0813T**2590.37*2460.85*2829.98
#**0813T**177.87*168.98*194.33
**0814T**463.13*439.97*505.97
#**0814T**348.10*330.70*380.31
**0818T**363.29*345.13*396.90
#**0818T**228.74*217.30*249.90
**0820T**147.27*139.91*160.90
#**0820T**129.66*123.18*141.66
**0821T**147.27*139.91*160.90
#**0821T**129.66*123.18*141.66
**0822T**125.18*118.92*136.76
#**0822T**110.22*104.71*120.42
**0823T**698.20*663.29*762.78
**0824T**737.53*700.65*805.75
**0825T**957.16*909.30*1045.70
**0826T**66.96*63.61*73.15
**0826T*TC*36.51*34.68*39.88
**0826T*26*30.45*28.93*33.27
**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**23.21*22.05*25.36
**0859T*TC*20.23*19.22*22.10
**0859T*26*2.98*2.83*3.25
**0864T**313.14*297.48*342.10
#**0864T**225.11*213.85*245.93
**10011**425.17*403.91*464.50
#**10011**106.58*101.25*116.44
**10012**234.25*222.54*255.92
#**10012**70.80*67.26*77.35
**15847**349.69*332.21*382.04
**21742**1142.00*1084.90*1247.64
**21743**1310.10*1244.60*1431.29
**32855**343.94*326.74*375.75
**32856**444.45*422.23*485.56
**33928**3253.93*3091.23*3554.91
**33929**1218.94*1157.99*1331.69
**33933**526.57*500.24*575.28
**33944**526.57*500.24*575.28
**34841**2056.06*1953.26*2246.25
**34842**2281.84*2167.75*2492.91
**34843**2507.62*2382.24*2739.58
**34844**2733.39*2596.72*2986.23
**34845**2056.06*1953.26*2246.25
**34846**2281.84*2167.75*2492.91
**34847**2507.62*2382.24*2739.58
**34848**2733.39*2596.72*2986.23
**43496**2063.25*1960.09*2254.10
**43647**442.49*420.37*483.43
**43648**523.86*497.67*572.32
#**43648**236.68*224.85*258.58
**43881**660.57*627.54*721.67
#**43881**604.86*574.62*660.81
**43882**701.13*666.07*765.98
#**43882**641.15*609.09*700.45
**47143**411.70*391.12*449.79
**47144**488.91*464.46*534.13
**47145**463.17*440.01*506.01
**48551**263.06*249.91*287.40
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**753.33*715.66*823.01
**53452**376.67*357.84*411.52
**53453**640.29*608.28*699.52
**53454**56.59*53.76*61.82
#**53454**34.99*33.24*38.23
**63043**568.07*539.67*620.62
**63044**503.26*478.10*549.82
**64596**2115.36*2009.59*2311.03
#**64596**322.09*305.99*351.89
**64597**634.61*602.88*693.31
#**64597**96.63*91.80*105.57
**64598**241.80*229.71*264.17
#**64598**143.80*136.61*157.10
**65757**118.96*113.01*129.96
**66983**659.05*626.10*720.02
**66987**761.23*723.17*831.65
**66988**633.22*601.56*691.79
*C*70170**251.18*238.62*274.41
*C*70170*TC*236.83*224.99*258.74
**70555**233.47*221.80*255.07
**70555*TC*116.48*110.66*127.26
*C*70557**683.50*649.33*746.73
*C*70557*TC*533.16*506.50*582.48
*C*70558**343.41*326.24*375.18
*C*70558*TC*177.70*168.82*194.14
*C*70559**333.06*316.41*363.87
*C*70559*TC*177.70*168.82*194.14
*C*74190**554.87*527.13*606.20
*C*74190*TC*533.16*506.50*582.48
**74235**143.74*136.55*157.03
**74235*TC*87.94*83.54*96.07
**74300**83.39*79.22*91.10
**74300*TC*70.38*66.86*76.89
**74301**25.64*24.36*28.01
**74301*TC*15.95*15.15*17.42
**74328**175.06*166.31*191.26
**74328*TC*152.33*144.71*166.42
**74329**139.58*132.60*152.49
**74329*TC*116.52*110.69*127.29
**74330**262.59*249.46*286.88
**74330*TC*235.87*224.08*257.69
**74340**86.58*82.25*94.59
**74340*TC*61.53*58.45*67.22
**74355**86.58*82.25*94.59
**74355*TC*50.83*48.29*55.53
**74360**86.58*82.25*94.59
**74360*TC*59.93*56.93*65.47
**74363**175.06*166.31*191.26
**74363*TC*134.31*127.59*146.73
*C*74445**159.13*151.17*173.85
*C*74445*TC*106.28*100.97*116.12
*C*74450**252.23*239.62*275.56
*C*74450*TC*236.83*224.99*258.74
*C*74470**557.55*529.67*609.12
*C*74470*TC*533.16*506.50*582.48
**74742**233.47*221.80*255.07
**74742*TC*204.73*194.49*223.66
*C*74775**265.91*252.61*290.50
*C*74775*TC*236.83*224.99*258.74
*C*75801**649.04*616.59*709.08
*C*75801*TC*607.25*576.89*663.42
*C*75803**1603.19*1523.03*1751.48
*C*75803*TC*1548.06*1470.66*1691.26
*C*75805**3119.30*2963.34*3407.84
*C*75805*TC*3081.21*2927.15*3366.22
*C*75807**3132.95*2976.30*3422.75
*C*75807*TC*3081.21*2927.15*3366.22
*C*75810**3128.56*2972.13*3417.95
*C*75810*TC*3081.21*2927.15*3366.22
**75894**888.20*843.79*970.36
**75894*TC*818.40*777.48*894.10
*C*75898**3170.14*3011.63*3463.37
*C*75898*TC*3081.21*2927.15*3366.22
**75970**433.68*412.00*473.80
**75970*TC*396.64*376.81*433.33
**76125**39.16*37.20*42.78
**76125*TC*26.15*24.84*28.57
**76390**202.90*192.76*221.67
**76390*TC*151.90*144.31*165.96
**76390*26*51.00*48.45*55.72
**76932**83.61*79.43*91.34
**76932*TC*48.39*45.97*52.87
**76940**154.97*147.22*169.30
**76940*TC*56.63*53.80*61.87
**76941**114.24*108.53*124.81
**76941*TC*50.97*48.42*55.68
**76945**82.66*78.53*90.31
**76945*TC*51.17*48.61*55.90
*C*76975**276.95*263.10*302.57
*C*76975*TC*236.83*224.99*258.74
**76998**175.06*166.31*191.26
**76998*TC*129.33*122.86*141.29
**77013**417.47*396.60*456.09
**77013*TC*238.15*226.24*260.18
**77022**467.22*443.86*510.44
**77022*TC*271.41*257.84*296.52
**77371**602.93*572.78*658.70
**77520**874.92*831.17*955.85
**77522**874.92*831.17*955.85
**77523**1004.63*954.40*1097.56
**77525**1134.33*1077.61*1239.25
*C*78282**413.70*393.02*451.97
*C*78282*TC*398.62*378.69*435.49
**78414**514.99*489.24*562.63
**78414*TC*494.23*469.52*539.95
*C*78429**1589.83*1510.34*1736.89
*C*78429*TC*1512.18*1436.57*1652.06
*C*78430**1586.17*1506.86*1732.89
*C*78430*TC*1512.18*1436.57*1652.06
*C*78431**2369.58*2251.10*2588.77
*C*78431*TC*2283.24*2169.08*2494.44
*C*78432**1969.64*1871.16*2151.83
*C*78432*TC*1877.28*1783.42*2050.93
*C*78433**2079.99*1975.99*2272.39
*C*78433*TC*1978.94*1879.99*2161.99
**78434**699.27*664.31*763.96
**78434*TC*670.82*637.28*732.87
*C*78459**1444.59*1372.36*1578.21
*C*78459*TC*1372.66*1304.03*1499.63
*C*78491**1582.80*1503.66*1729.21
*C*78491*TC*1512.18*1436.57*1652.06
*C*78492**1595.16*1515.40*1742.71
*C*78492*TC*1512.18*1436.57*1652.06
*C*78608**1580.08*1501.08*1726.24
*C*78608*TC*1512.18*1436.57*1652.06
*C*78811**1442.53*1370.40*1575.96
*C*78811*TC*1372.66*1304.03*1499.63
*C*78812**1600.44*1520.42*1748.48
*C*78812*TC*1512.18*1436.57*1652.06
*C*78813**1602.46*1522.34*1750.69
*C*78813*TC*1512.18*1436.57*1652.06
*C*78814**1612.15*1531.54*1761.27
*C*78814*TC*1512.18*1436.57*1652.06
*C*78815**1623.51*1542.33*1773.68
*C*78815*TC*1512.18*1436.57*1652.06
*C*78816**1624.57*1543.34*1774.84
*C*78816*TC*1512.18*1436.57*1652.06
**79300**237.04*225.19*258.97
**79300*TC*174.29*165.58*190.42
**79445**237.04*225.19*258.97
**79445*TC*129.81*123.32*141.82
**86485**17.28*16.42*18.88
**90867**298.48*283.56*326.09
#**90867**135.53*128.75*148.06
**90868**200.40*190.38*218.94
#**90868**104.99*99.74*114.70
**90869**276.44*262.62*302.01
#**90869**159.87*151.88*174.66
**92978**241.11*229.05*263.41
**92978*TC*149.73*142.24*163.58
**92979**146.51*139.18*160.06
**92979*TC*73.96*70.26*80.80
*C*93315**656.63*623.80*717.37
*C*93315*TC*533.16*506.50*582.48
**93317**210.41*199.89*229.87
**93317*TC*124.62*118.39*136.15
*C*93318**632.38*600.76*690.87
*C*93318*TC*533.16*506.50*582.48
**93571**240.13*228.12*262.34
**93571*TC*170.57*162.04*186.35
**93572**144.25*137.04*157.60
**93572*TC*93.60*88.92*102.26
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.88*3273.59*3764.63
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.81*3275.42*3766.73
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.81*3275.42*3766.73
**93609**2134.69*2027.96*2332.15
**93609*TC*1872.09*1778.49*2045.26
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.42*3232.30*3717.15
**93612**3557.81*3379.92*3886.91
**93612*TC*3404.65*3234.42*3719.58
**93615**49.27*46.81*53.83
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6744.74*6407.50*7368.63
**93620**7115.62*6759.84*7773.82
**93620*TC*6520.61*6194.58*7123.77
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.50*6684.68*7687.38
**93622**7115.62*6759.84*7773.82
**93622*TC*6952.38*6604.76*7595.47
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.10*1965.65*2260.50
**93624**3557.81*3379.92*3886.91
**93624*TC*3327.10*3160.75*3634.86
**93631**7115.62*6759.84*7773.82
**93631*TC*6735.55*6398.77*7358.59
**93640**1133.95*1077.25*1238.84
**93640*TC*964.07*915.87*1053.25
**93641**1133.95*1077.25*1238.84
**93641*TC*837.02*795.17*914.45
**93662**412.79*392.15*450.97
**93662*TC*344.19*326.98*376.03
**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**925.58*879.30*1011.20
**95965*TC*528.85*502.41*577.77
**95966**536.37*509.55*585.98
**95966*TC*345.30*328.04*377.25
**95967**451.10*428.55*492.83
**95967*TC*285.34*271.07*311.73
**96020**376.62*357.79*411.46
**96547**743.95*706.75*812.76
#**96547**133.69*127.01*146.06
**96548**371.98*353.38*406.39
#**96548**66.84*63.50*73.03
**97151**49.70*47.22*54.30
#**97151**44.05*41.85*48.13
**97152**42.24*40.13*46.15
#**97152**37.44*35.57*40.91
**97153**33.65*31.97*36.77
#**97153**29.50*28.03*32.23
**97154**4.58*4.35*5.00
#**97154**4.15*3.94*4.53
**97155**33.65*31.97*36.77
#**97155**29.50*28.03*32.23
**97156**35.50*33.73*38.79
#**97156**31.18*29.62*34.06
**97157**10.36*9.84*11.32
#**97157**9.37*8.90*10.24
**97158**5.33*5.06*5.82
#**97158**4.83*4.59*5.28
**98978**47.14*44.78*51.50
# - 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.