TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
DALLAS
******
**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**459.00*436.05*501.46
#**G0186**393.97*374.27*430.41
**G0339**2878.81*2734.87*3145.10
**G0340**2165.02*2056.77*2365.29
**G0398**136.66*129.83*149.30
**G0398*TC*97.79*92.90*106.84
**G0398*26*38.87*36.93*42.47
**G0399**94.77*90.03*103.53
**G0399*TC*51.87*49.28*56.67
**G0399*26*43.24*41.08*47.24
**G0400**97.78*92.89*106.82
**G0400*TC*57.57*54.69*62.89
**G0400*26*40.21*38.20*43.93
**G0460**800.51*760.48*874.55
#**G0460**119.71*113.72*130.78
**G0465**800.51*760.48*874.55
#**G0465**119.71*113.72*130.78
**G0498**147.89*140.50*161.58
**G6017**78.24*74.33*85.48
**0042T**228.90*217.46*250.08
**0054T**226.95*215.60*247.94
**0055T**226.95*215.60*247.94
**0071T**571.83*543.24*624.73
**0072T**571.83*543.24*624.73
**0075T**959.52*911.54*1048.27
**0075T*TC*959.52*911.54*1048.27
**0075T*26*955.98*908.18*1044.41
**0095T**618.61*587.68*675.83
**0098T**692.15*657.54*756.17
**0100T**1899.44*1804.47*2075.14
**0101T**314.59*298.86*343.69
#**0101T**225.76*214.47*246.64
**0102T**314.59*298.86*343.69
#**0102T**225.76*214.47*246.64
**0106T**33.78*32.09*36.90
**0107T**33.78*32.09*36.90
**0108T**33.78*32.09*36.90
**0109T**33.78*32.09*36.90
**0110T**33.78*32.09*36.90
**0164T**676.47*642.65*739.05
**0165T**693.01*658.36*757.11
**0184T**821.94*780.84*897.97
**0198T**85.47*81.20*93.38
#**0198T**31.84*30.25*34.79
**0200T**1784.33*1695.11*1949.38
#**0200T**401.27*381.21*438.39
**0201T**2676.49*2542.67*2924.07
#**0201T**601.91*571.81*657.58
**0207T**121.71*115.62*132.96
**0208T**38.17*36.26*41.70
**0209T**46.22*43.91*50.50
**0210T**29.12*27.66*31.81
**0211T**45.21*42.95*49.39
**0212T**36.53*34.70*39.91
#**0212T**31.50*29.93*34.42
**0213T**193.55*183.87*211.45
#**0213T**104.72*99.48*114.40
**0214T**97.52*92.64*106.54
#**0214T**58.63*55.70*64.06
**0215T**97.85*92.96*106.90
#**0215T**59.64*56.66*65.16
**0216T**178.22*169.31*194.71
#**0216T**90.06*85.56*98.39
**0217T**91.21*86.65*99.65
#**0217T**50.32*47.80*54.97
**0218T**91.21*86.65*99.65
#**0218T**51.32*48.75*56.06
**0219T**1306.60*1241.27*1427.46
**0220T**1284.68*1220.45*1403.52
**0221T**1575.91*1497.11*1721.68
**0222T**384.05*364.85*419.58
**0232T**800.51*760.48*874.55
#**0232T**119.71*113.72*130.78
**0234T**8595.29*8165.53*9390.36
#**0234T**574.17*545.46*627.28
**0235T**8595.29*8165.53*9390.36
#**0235T**574.17*545.46*627.28
**0236T**8744.99*8307.74*9553.90
#**0236T**665.20*631.94*726.73
**0237T**8744.99*8307.74*9553.90
#**0237T**665.20*631.94*726.73
**0238T**8744.99*8307.74*9553.90
#**0238T**665.20*631.94*726.73
**0266T**887.30*842.94*969.38
**0267T**155.90*148.11*170.33
**0268T**330.67*314.14*361.26
**0269T**840.92*798.87*918.70
**0270T**155.90*148.11*170.33
**0271T**330.67*314.14*361.26
**0272T**56.29*53.48*61.50
**0273T**72.00*68.40*78.66
**0274T**1100.41*1045.39*1202.20
**0278T**14.40*13.68*15.73
**0308T**1394.40*1324.68*1523.38
**0329T**85.47*81.20*93.38
#**0329T**31.84*30.25*34.79
**0330T**38.21*36.30*41.75
**0331T**184.17*174.96*201.20
**0332T**314.51*298.78*343.60
**0347T**140.34*133.32*153.32
**0348T**33.13*31.47*36.19
**0349T**35.13*33.37*38.38
**0350T**35.80*34.01*39.11
**0351T**170.55*162.02*186.32
**0352T**42.88*40.74*46.85
**0353T**170.55*162.02*186.32
**0354T**42.88*40.74*46.85
**0358T**27.11*25.75*29.61
**0362T**91.25*86.69*99.69
#**0362T**65.44*62.17*71.50
**0378T**24.74*23.50*27.03
**0394T**251.15*238.59*274.38
**0395T**608.41*577.99*664.69
**0397T**46.83*44.49*51.16
**0398T*26*1746.88*1659.54*1908.47
**0408T**503.97*478.77*550.59
**0409T**349.31*331.84*381.62
**0410T**363.31*345.14*396.91
**0411T**363.31*345.14*396.91
**0412T**229.26*217.80*250.47
**0413T**472.21*448.60*515.89
**0414T**364.12*345.91*397.80
**0415T**303.15*287.99*331.19
**0416T**337.04*320.19*368.22
**0417T**83.74*79.55*91.48
**0418T**56.29*53.48*61.50
**0419T**450.54*428.01*492.21
#**0419T**360.70*342.67*394.07
**0420T**639.13*607.17*698.25
#**0420T**528.18*501.77*577.04
**0421T**1611.19*1530.63*1760.22
#**0421T**689.72*655.23*753.51
**0437T**210.94*200.39*230.45
**0439T**71.97*68.37*78.63
**0440T**249.42*236.95*272.49
#**0440T**118.69*112.76*129.67
**0441T**249.42*236.95*272.49
#**0441T**118.69*112.76*129.67
**0442T**249.42*236.95*272.49
#**0442T**118.69*112.76*129.67
**0449T**761.47*723.40*831.91
**0464T**67.67*64.29*73.93
**0472T**67.33*63.96*73.55
**0473T**56.29*53.48*61.50
**0479T**62.96*59.81*68.78
**0480T**156.48*148.66*170.96
#**0480T**31.48*29.91*34.40
**0483T**1167.61*1109.23*1275.61
**0484T**1513.83*1438.14*1653.86
**0485T**23.62*22.44*25.81
**0485T*TC*8.84*8.40*9.66
**0485T*26*15.08*14.33*16.48
**0486T**47.25*44.89*51.62
**0486T*TC*17.39*16.52*19.00
**0486T*26*29.86*28.37*32.63
**0488T**62.85*59.71*68.67
#**0488T**49.78*47.29*54.38
**0505T**11087.91*10533.51*12113.54
#**0505T**544.21*517.00*594.55
**0507T**23.38*22.21*25.54
**0507T*TC*20.40*19.38*22.29
**0507T*26*2.98*2.83*3.25
**0510T**603.26*573.10*659.07
#**0510T**422.25*401.14*461.31
**0512T**314.59*298.86*343.69
#**0512T**225.76*214.47*246.64
**0513T**94.38*89.66*103.11
#**0513T**67.73*64.34*73.99
**0515T**503.97*478.77*550.59
**0516T**465.35*442.08*508.39
**0517T**330.67*314.14*361.26
**0518T**229.26*217.80*250.47
**0519T**331.67*315.09*362.35
**0520T**465.35*442.08*508.39
**0521T**56.29*53.48*61.50
**0521T*TC*36.16*34.35*39.50
**0521T*26*20.13*19.12*21.99
**0522T**67.33*63.96*73.55
**0522T*TC*36.83*34.99*40.24
**0522T*26*30.50*28.98*33.33
**0523T**151.92*144.32*165.97
**0524T**1648.91*1566.46*1801.43
#**0524T**173.67*164.99*189.74
**0525T**465.68*442.40*508.76
**0526T**363.31*345.14*396.91
**0527T**315.81*300.02*345.02
**0528T**67.33*63.96*73.55
**0528T*TC*36.83*34.99*40.24
**0528T*26*30.50*28.98*33.33
**0529T**56.29*53.48*61.50
**0529T*TC*36.16*34.35*39.50
**0529T*26*20.13*19.12*21.99
**0530T**620.72*589.68*678.13
**0531T**472.21*448.60*515.89
**0532T**331.67*315.09*362.35
**0540T**176.86*168.02*193.22
**0543T**1513.83*1438.14*1653.86
**0544T**1743.41*1656.24*1904.68
**0545T**1743.41*1656.24*1904.68
**0546T**72.08*68.48*78.75
**0552T**6.67*6.34*7.29
**0553T**2462.31*2339.19*2690.07
#**0553T**383.70*364.52*419.20
**0565T**613.27*582.61*670.00
#**0565T**513.04*487.39*560.50
**0566T**99.72*94.73*108.94
#**0566T**58.49*55.57*63.91
**0569T**1743.41*1656.24*1904.68
**0570T**408.21*387.80*445.97
**0571T**545.39*518.12*595.84
**0572T**443.74*421.55*484.78
**0573T**339.28*322.32*370.67
**0574T**392.89*373.25*429.24
**0575T**67.33*63.96*73.55
**0576T**56.29*53.48*61.50
**0577T**190.70*181.17*208.35
**0578T**29.07*27.62*31.76
**0579T**21.41*20.34*23.39
**0580T**210.90*200.36*230.41
**0581T**2276.11*2162.30*2486.65
#**0581T**206.55*196.22*225.65
**0582T**1663.26*1580.10*1817.12
#**0582T**382.45*363.33*417.83
**0583T**1522.66*1446.53*1663.51
#**0583T**132.96*126.31*145.26
**0587T**442.34*420.22*483.25
#**0587T**293.51*278.83*320.65
**0588T**364.80*346.56*398.54
#**0588T**229.04*217.59*250.23
**0589T**48.07*45.67*52.52
#**0589T**38.35*36.43*41.89
**0590T**56.75*53.91*62.00
#**0590T**39.65*37.67*43.32
**0596T**672.69*639.06*734.92
#**0596T**130.36*123.84*142.42
**0597T**672.69*639.06*734.92
#**0597T**130.36*123.84*142.42
**0598T**152.13*144.52*166.20
**0599T**101.22*96.16*110.58
**0600T**3590.23*3410.72*3922.33
#**0600T**716.18*680.37*782.43
**0601T**1431.69*1360.11*1564.13
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**196.86*187.02*215.07
**0611T**40.81*38.77*44.59
**0614T**363.45*345.28*397.07
**0615T**47.22*44.86*51.59
**0616T**661.43*628.36*722.61
**0617T**739.08*702.13*807.45
**0618T**894.82*850.08*977.59
**0619T**653.02*620.37*713.43
#**0619T**474.35*450.63*518.22
**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**259.58*246.60*283.59
#**0627T**98.68*93.75*107.81
**0628T**77.87*73.98*85.08
#**0628T**29.60*28.12*32.34
**0629T**259.58*246.60*283.59
#**0629T**98.68*93.75*107.81
**0630T**77.87*73.98*85.08
#**0630T**29.60*28.12*32.34
**0631T**82.61*78.48*90.25
**0632T**561.17*533.11*613.08
**0633T**202.28*192.17*221.00
*C*0633T*TC*107.22*101.86*117.14
**0633T*26*58.57*55.64*63.99
**0634T**202.28*192.17*221.00
**0634T*TC*143.72*136.53*157.01
**0634T*26*58.57*55.64*63.99
**0635T**202.28*192.17*221.00
**0635T*TC*143.72*136.53*157.01
**0635T*26*58.57*55.64*63.99
**0636T**202.28*192.17*221.00
**0636T*TC*143.72*136.53*157.01
**0636T*26*58.57*55.64*63.99
**0637T**202.28*192.17*221.00
**0637T*TC*143.72*136.53*157.01
**0637T*26*58.57*55.64*63.99
**0638T**202.28*192.17*221.00
**0638T*TC*143.72*136.53*157.01
**0638T*26*58.57*55.64*63.99
**0639T**82.61*78.48*90.25
**0640T**23.38*22.21*25.54
**0640T*TC*20.52*19.49*22.41
**0640T*26*2.98*2.83*3.25
**0644T**1163.80*1105.61*1271.45
#**0644T**234.28*222.57*255.96
**0646T**1743.41*1656.24*1904.68
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.94*56.94*65.48
**0652T**288.44*274.02*315.12
#**0652T**120.83*114.79*132.01
**0653T**377.13*358.27*412.01
#**0653T**136.45*129.63*149.07
**0654T**140.02*133.02*152.97
**0655T**1611.19*1530.63*1760.22
#**0655T**689.72*655.23*753.51
**0658T**95.49*90.72*104.33
**0659T**2697.67*2562.79*2947.21
#**0659T**422.97*401.82*462.09
**0671T**1023.61*972.43*1118.29
**0673T**3445.86*3273.57*3764.61
#**0673T**358.95*341.00*392.15
**0699T**112.68*107.05*123.11
#**0699T**90.56*86.03*98.93
**0707T**372.58*353.95*407.04
#**0707T**279.73*265.74*305.60
**0714T**1411.76*1341.17*1542.35
#**0714T**357.21*339.35*390.25
**0730T**267.13*253.77*291.84
#**0730T**239.08*227.13*261.20
**0738T**70.56*67.03*77.08
**0739T**1611.19*1530.63*1760.22
#**0739T**689.72*655.23*753.51
**0740T**20.03*19.03*21.88
**0741T**47.56*45.18*51.96
**0742T**94.35*89.63*103.07
**0742T*TC*75.36*71.59*82.33
**0742T*26*19.00*18.05*20.76
**0743T**53.54*50.86*58.49
**0744T**866.71*823.37*946.88
**0745T**258.48*245.56*282.39
**0746T**224.38*213.16*245.13
**0747T**999.51*949.53*1091.96
**0748T**182.34*173.22*199.20
**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**4.30*4.09*4.70
**0765T**8.02*7.62*8.76
**0771T**26.10*24.80*28.52
**0772T**26.10*24.80*28.52
**0773T**23.45*22.28*25.62
**0774T**23.45*22.28*25.62
**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**439.73*417.74*480.40
**0779T*TC*413.94*393.24*452.23
**0779T*26*25.79*24.50*28.18
**0780T**23.45*22.28*25.62
**0783T**14.37*13.65*15.70
**0784T**2132.00*2025.40*2329.21
#**0784T**322.56*306.43*352.39
**0785T**243.01*230.86*265.49
#**0785T**144.13*136.92*157.46
**0786T**734.97*698.22*802.95
#**0786T**301.22*286.16*329.08
**0787T**243.01*230.86*265.49
#**0787T**144.13*136.92*157.46
**0788T**18.69*17.76*20.42
#**0788T**18.02*17.12*19.69
**0789T**25.77*24.48*28.15
#**0789T**22.52*21.39*24.60
**0790T**1910.18*1814.67*2086.87
**0791T**9.06*8.61*9.90
**0793T**561.17*533.11*613.08
**0794T**130.35*123.83*142.40
**0795T**698.02*663.12*762.59
**0796T**465.35*442.08*508.39
**0797T**465.35*442.08*508.39
**0798T**736.98*700.13*805.15
**0799T**491.32*466.75*536.76
**0800T**491.32*466.75*536.76
**0801T**956.67*908.84*1045.17
**0802T**478.33*454.41*522.57
**0803T**478.33*454.41*522.57
**0804T**78.75*74.81*86.03
**0804T*TC*42.53*40.40*46.46
**0804T*26*36.22*34.41*39.57
**0805T**2973.42*2824.75*3248.46
#**0805T**319.60*303.62*349.16
**0806T**3964.56*3766.33*4331.28
#**0806T**426.14*404.83*465.55
**0807T**42.77*40.63*46.72
**0807T*TC*28.11*26.70*30.71
**0807T*26*14.66*13.93*16.02
**0808T**42.77*40.63*46.72
**0808T*TC*28.11*26.70*30.71
**0808T*26*14.66*13.93*16.02
**0810T**1129.96*1073.46*1234.48
**0811T**20.03*19.03*21.88
**0813T**2612.03*2481.43*2853.64
#**0813T**177.77*168.88*194.21
**0814T**465.72*442.43*508.79
#**0814T**349.66*332.18*382.01
**0818T**364.80*346.56*398.54
#**0818T**229.04*217.59*250.23
**0820T**147.49*140.12*161.14
#**0820T**129.73*123.24*141.73
**0821T**147.49*140.12*161.14
#**0821T**129.73*123.24*141.73
**0822T**125.37*119.10*136.97
#**0822T**110.27*104.76*120.47
**0823T**698.02*663.12*762.59
**0824T**736.98*700.13*805.15
**0825T**956.67*908.84*1045.17
**0826T**67.33*63.96*73.55
**0826T*TC*36.83*34.99*40.24
**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**23.38*22.21*25.54
**0859T*TC*20.40*19.38*22.29
**0859T*26*2.98*2.83*3.25
**0864T**314.59*298.86*343.69
#**0864T**225.76*214.47*246.64
**10011**428.08*406.68*467.68
#**10011**106.61*101.28*116.47
**10012**235.63*223.85*257.43
#**10012**70.71*67.17*77.25
**15847**350.17*332.66*382.56
**21742**1141.37*1084.30*1246.95
**21743**1308.67*1243.24*1429.73
**32855**349.86*332.37*382.23
**32856**443.61*421.43*484.64
**33928**3246.56*3084.23*3546.86
**33929**1216.22*1155.41*1328.72
**33933**535.43*508.66*584.96
**33944**535.43*508.66*584.96
**34841**2086.01*1981.71*2278.97
**34842**2311.78*2196.19*2525.62
**34843**2537.57*2410.69*2772.29
**34844**2763.34*2625.17*3018.95
**34845**2086.01*1981.71*2278.97
**34846**2311.78*2196.19*2525.62
**34847**2537.57*2410.69*2772.29
**34848**2763.34*2625.17*3018.95
**43496**2110.70*2005.17*2305.95
**43647**442.49*420.37*483.43
**43648**536.48*509.66*586.11
#**43648**241.61*229.53*263.96
**43881**677.72*643.83*740.40
#**43881**619.85*588.86*677.19
**43882**720.61*684.58*787.27
#**43882**658.32*625.40*719.21
**47143**418.01*397.11*456.68
**47144**496.38*471.56*542.29
**47145**470.26*446.75*513.76
**48551**268.65*255.22*293.50
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**754.43*716.71*824.22
**53452**377.21*358.35*412.10
**53453**641.23*609.17*700.55
**53454**56.82*53.98*62.08
#**53454**35.03*33.28*38.27
**63043**567.12*538.76*619.57
**63044**513.97*488.27*561.51
**64596**2132.00*2025.40*2329.21
#**64596**322.56*306.43*352.39
**64597**639.60*607.62*698.76
#**64597**96.77*91.93*105.72
**64598**243.01*230.86*265.49
#**64598**144.13*136.92*157.46
**65757**119.28*113.32*130.32
**66983**661.43*628.36*722.61
**66987**762.92*724.77*833.49
**66988**635.14*603.38*693.89
*C*70170**253.33*240.66*276.76
*C*70170*TC*238.96*227.01*261.06
**70555**233.47*221.80*255.07
**70555*TC*116.33*110.51*127.09
*C*70557**688.63*654.20*752.33
*C*70557*TC*537.96*511.06*587.72
*C*70558**345.37*328.10*377.32
*C*70558*TC*179.29*170.33*195.88
*C*70559**334.80*318.06*365.77
*C*70559*TC*179.29*170.33*195.88
*C*74190**559.68*531.70*611.46
*C*74190*TC*537.96*511.06*587.72
**74235**144.62*137.39*158.00
**74235*TC*88.74*84.30*96.95
**74300**84.06*79.86*91.84
**74300*TC*71.04*67.49*77.61
**74301**25.82*24.53*28.21
**74301*TC*16.11*15.30*17.60
**74328**175.06*166.31*191.26
**74328*TC*152.29*144.68*166.38
**74329**140.50*133.48*153.50
**74329*TC*117.39*111.52*128.25
**74330**262.59*249.46*286.88
**74330*TC*235.83*224.04*257.65
**74340**86.58*82.25*94.59
**74340*TC*61.50*58.43*67.19
**74355**86.58*82.25*94.59
**74355*TC*50.78*48.24*55.48
**74360**86.58*82.25*94.59
**74360*TC*59.91*56.91*65.45
**74363**175.06*166.31*191.26
**74363*TC*134.26*127.55*146.68
*C*74445**160.16*152.15*174.97
*C*74445*TC*107.22*101.86*117.14
*C*74450**254.38*241.66*277.91
*C*74450*TC*238.96*227.01*261.06
*C*74470**562.37*534.25*614.39
*C*74470*TC*537.96*511.06*587.72
**74742**233.47*221.80*255.07
**74742*TC*204.69*194.46*223.63
*C*74775**268.07*254.67*292.87
*C*74775*TC*238.96*227.01*261.06
*C*75801**654.49*621.77*715.04
*C*75801*TC*612.71*582.07*669.38
*C*75803**1617.22*1536.36*1766.81
*C*75803*TC*1562.01*1483.91*1706.50
*C*75805**3147.13*2989.77*3438.24
*C*75805*TC*3108.98*2953.53*3396.56
*C*75807**3160.75*3002.71*3453.12
*C*75807*TC*3108.98*2953.53*3396.56
*C*75810**3156.30*2998.49*3448.26
*C*75810*TC*3108.98*2953.53*3396.56
**75894**894.53*849.80*977.27
**75894*TC*824.80*783.56*901.09
*C*75898**3197.82*3037.93*3493.62
*C*75898*TC*3108.98*2953.53*3396.56
**75970**436.75*414.91*477.15
**75970*TC*399.69*379.71*436.67
**76125**39.40*37.43*43.04
**76125*TC*26.38*25.06*28.82
**76390**204.45*194.23*223.36
**76390*TC*153.24*145.58*167.42
**76390*26*51.21*48.65*55.95
**76932**84.12*79.91*91.90
**76932*TC*48.89*46.45*53.42
**76940**155.38*147.61*169.75
**76940*TC*57.06*54.21*62.34
**76941**114.88*109.14*125.51
**76941*TC*51.48*48.91*56.25
**76945**83.17*79.01*90.86
**76945*TC*51.61*49.03*56.38
*C*76975**279.16*265.20*304.98
*C*76975*TC*238.96*227.01*261.06
**76998**175.06*166.31*191.26
**76998*TC*129.37*122.90*141.34
**77013**420.89*399.85*459.83
**77013*TC*241.44*229.37*263.78
**77022**470.84*447.30*514.40
**77022*TC*274.80*261.06*300.22
**77371**626.29*594.98*684.23
**77520**908.83*863.39*992.90
**77522**908.83*863.39*992.90
**77523**1043.59*991.41*1140.12
**77525**1178.33*1119.41*1287.32
*C*78282**417.29*396.43*455.89
*C*78282*TC*402.20*382.09*439.40
**78414**514.99*489.24*562.63
**78414*TC*494.19*469.48*539.90
*C*78429**1603.55*1523.37*1751.88
*C*78429*TC*1525.81*1449.52*1666.95
*C*78430**1599.90*1519.91*1747.90
*C*78430*TC*1525.81*1449.52*1666.95
*C*78431**2390.30*2270.79*2611.41
*C*78431*TC*2303.82*2188.63*2516.92
*C*78432**1986.69*1887.36*2170.46
*C*78432*TC*1894.20*1799.49*2069.41
*C*78433**2097.96*1993.06*2292.02
*C*78433*TC*1996.77*1896.93*2181.47
**78434**705.38*670.11*770.63
**78434*TC*676.89*643.05*739.51
*C*78459**1457.05*1384.20*1591.83
*C*78459*TC*1385.02*1315.77*1513.14
*C*78491**1596.53*1516.70*1744.21
*C*78491*TC*1525.81*1449.52*1666.95
*C*78492**1608.92*1528.47*1757.74
*C*78492*TC*1525.81*1449.52*1666.95
*C*78608**1593.80*1514.11*1741.23
*C*78608*TC*1525.81*1449.52*1666.95
*C*78811**1454.98*1382.23*1589.56
*C*78811*TC*1385.02*1315.77*1513.14
*C*78812**1614.17*1533.46*1763.48
*C*78812*TC*1525.81*1449.52*1666.95
*C*78813**1616.19*1535.38*1765.69
*C*78813*TC*1525.81*1449.52*1666.95
*C*78814**1625.90*1544.61*1776.30
*C*78814*TC*1525.81*1449.52*1666.95
*C*78815**1637.28*1555.42*1788.73
*C*78815*TC*1525.81*1449.52*1666.95
*C*78816**1638.34*1556.42*1789.88
*C*78816*TC*1525.81*1449.52*1666.95
**79300**237.04*225.19*258.97
**79300*TC*174.23*165.52*190.35
**79445**237.04*225.19*258.97
**79445*TC*129.73*123.24*141.73
**86485**17.28*16.42*18.88
**90867**300.16*285.15*327.92
#**90867**135.74*128.95*148.29
**90868**201.28*191.22*219.90
#**90868**105.24*99.98*114.98
**90869**277.68*263.80*303.37
#**90869**160.39*152.37*175.23
**92978**242.66*230.53*265.11
**92978*TC*151.38*143.81*165.38
**92979**147.38*140.01*161.01
**92979*TC*74.90*71.16*81.83
*C*93315**661.62*628.54*722.82
*C*93315*TC*537.96*511.06*587.72
**93317**211.67*201.09*231.25
**93317*TC*125.80*119.51*137.44
*C*93318**637.28*605.42*696.23
*C*93318*TC*537.96*511.06*587.72
**93571**241.67*229.59*264.03
**93571*TC*172.18*163.57*188.11
**93572**145.12*137.86*158.54
**93572*TC*94.52*89.79*103.26
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.96*3273.66*3764.71
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.88*3275.49*3766.81
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.88*3275.49*3766.81
**93609**2134.69*2027.96*2332.15
**93609*TC*1872.28*1778.67*2045.47
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.53*3232.40*3717.26
**93612**3557.81*3379.92*3886.91
**93612*TC*3404.75*3234.51*3719.69
**93615**49.34*46.87*53.90
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6745.01*6407.76*7368.92
**93620**7115.62*6759.84*7773.82
**93620*TC*6521.05*6195.00*7124.25
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.56*6684.73*7687.44
**93622**7115.62*6759.84*7773.82
**93622*TC*6952.50*6604.88*7595.61
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.01*1965.56*2260.39
**93624**3557.81*3379.92*3886.91
**93624*TC*3327.37*3161.00*3635.15
**93631**7115.62*6759.84*7773.82
**93631*TC*6736.12*6399.31*7359.21
**93640**1133.95*1077.25*1238.84
**93640*TC*964.20*915.99*1053.39
**93641**1133.95*1077.25*1238.84
**93641*TC*837.28*795.42*914.73
**93662**419.72*398.73*458.54
**93662*TC*350.98*333.43*383.44
**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**931.72*885.13*1017.90
**95965*TC*534.17*507.46*583.58
**95966**536.62*509.79*586.26
**95966*TC*345.30*328.04*377.25
**95967**451.29*428.73*493.04
**95967*TC*285.34*271.07*311.73
**96020**374.11*355.40*408.71
**96547**749.87*712.38*819.24
#**96547**134.09*127.39*146.50
**96548**374.93*356.18*409.61
#**96548**67.05*63.70*73.26
**97151**49.77*47.28*54.37
#**97151**44.07*41.87*48.15
**97152**42.31*40.19*46.22
#**97152**37.46*35.59*40.93
**97153**33.70*32.02*36.82
#**97153**29.51*28.03*32.23
**97154**4.58*4.35*5.00
#**97154**4.15*3.94*4.53
**97155**33.70*32.02*36.82
#**97155**29.51*28.03*32.23
**97156**35.55*33.77*38.84
#**97156**31.20*29.64*34.09
**97157**10.38*9.86*11.34
#**97157**9.37*8.90*10.24
**97158**5.33*5.06*5.82
#**97158**4.83*4.59*5.28
**98978**47.56*45.18*51.96
# - 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.