TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
HOUSTON
******
**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**464.23*441.02*507.17
#**G0186**399.45*379.48*436.40
**G0339**2836.59*2694.76*3098.97
**G0340**2133.34*2026.67*2330.67
**G0398**137.21*130.35*149.90
**G0398*TC*97.76*92.87*106.80
**G0398*26*39.45*37.48*43.10
**G0399**95.50*90.73*104.34
**G0399*TC*52.02*49.42*56.83
**G0399*26*43.82*41.63*47.87
**G0400**98.48*93.56*107.59
**G0400*TC*57.70*54.82*63.04
**G0400*26*40.78*38.74*44.55
**G0460**804.45*764.23*878.86
#**G0460**126.35*120.03*138.03
**G0465**804.45*764.23*878.86
#**G0465**126.35*120.03*138.03
**G0498**148.60*141.17*162.35
**G6017**79.36*75.39*86.70
**0042T**229.68*218.20*250.93
**0054T**250.99*238.44*274.21
**0055T**250.99*238.44*274.21
**0071T**598.74*568.80*654.12
**0072T**598.74*568.80*654.12
**0075T**1043.28*991.12*1139.79
**0075T*TC*1043.28*991.12*1139.79
**0075T*26*1037.97*986.07*1133.98
**0095T**683.72*649.53*746.96
**0098T**766.06*727.76*836.92
**0100T**1936.80*1839.96*2115.95
**0101T**319.49*303.52*349.05
#**0101T**231.02*219.47*252.39
**0102T**319.49*303.52*349.05
#**0102T**231.02*219.47*252.39
**0106T**34.01*32.31*37.16
**0107T**34.01*32.31*37.16
**0108T**34.01*32.31*37.16
**0109T**34.01*32.31*37.16
**0110T**34.01*32.31*37.16
**0164T**746.70*709.37*815.78
**0165T**765.27*727.01*836.06
**0184T**859.84*816.85*939.38
**0198T**85.63*81.35*93.55
#**0198T**32.21*30.60*35.19
**0200T**1798.03*1708.13*1964.35
#**0200T**420.46*399.44*459.36
**0201T**2697.04*2562.19*2946.52
#**0201T**630.70*599.17*689.05
**0207T**121.71*115.62*132.96
**0208T**38.20*36.29*41.73
**0209T**46.21*43.90*50.49
**0210T**29.18*27.72*31.88
**0211T**45.21*42.95*49.39
**0212T**36.88*35.04*40.30
#**0212T**31.87*30.28*34.82
**0213T**196.41*186.59*214.58
#**0213T**107.94*102.54*117.92
**0214T**99.54*94.56*108.74
#**0214T**60.81*57.77*66.44
**0215T**99.87*94.88*109.11
#**0215T**61.81*58.72*67.53
**0216T**180.54*171.51*197.24
#**0216T**92.73*88.09*101.30
**0217T**92.87*88.23*101.46
#**0217T**52.13*49.52*56.95
**0218T**92.87*88.23*101.46
#**0218T**53.13*50.47*58.04
**0219T**1414.56*1343.83*1545.40
**0220T**1386.28*1316.97*1514.52
**0221T**1695.29*1610.53*1852.11
**0222T**421.10*400.05*460.06
**0232T**804.45*764.23*878.86
#**0232T**126.35*120.03*138.03
**0234T**8609.17*8178.71*9405.52
#**0234T**619.90*588.91*677.25
**0235T**8609.17*8178.71*9405.52
#**0235T**619.90*588.91*677.25
**0236T**8763.20*8325.04*9573.80
#**0236T**715.51*679.73*781.69
**0237T**8763.20*8325.04*9573.80
#**0237T**715.51*679.73*781.69
**0238T**8763.20*8325.04*9573.80
#**0238T**715.51*679.73*781.69
**0266T**947.86*900.47*1035.54
**0267T**167.22*158.86*182.69
**0268T**352.16*334.55*384.73
**0269T**897.11*852.25*980.09
**0270T**167.22*158.86*182.69
**0271T**352.16*334.55*384.73
**0272T**56.52*53.69*61.74
**0273T**72.60*68.97*79.32
**0274T**1186.68*1127.35*1296.45
**0278T**14.58*13.85*15.93
**0308T**1421.10*1350.05*1552.56
**0329T**85.63*81.35*93.55
#**0329T**32.21*30.60*35.19
**0330T**38.21*36.30*41.75
**0331T**184.87*175.63*201.97
**0332T**315.36*299.59*344.53
**0347T**149.10*141.65*162.90
**0348T**33.40*31.73*36.49
**0349T**35.39*33.62*38.66
**0350T**36.06*34.26*39.40
**0351T**170.78*162.24*186.58
**0352T**43.43*41.26*47.45
**0353T**170.78*162.24*186.58
**0354T**43.43*41.26*47.45
**0358T**27.18*25.82*29.69
**0362T**92.97*88.32*101.57
#**0362T**67.27*63.91*73.50
**0378T**25.29*24.03*27.63
**0394T**252.01*239.41*275.32
**0395T**611.69*581.11*668.28
**0397T**47.75*45.36*52.16
**0398T*26*1746.88*1659.54*1908.47
**0408T**538.36*511.44*588.16
**0409T**371.50*352.93*405.87
**0410T**385.81*366.52*421.50
**0411T**385.81*366.52*421.50
**0412T**241.92*229.82*264.29
**0413T**502.96*477.81*549.48
**0414T**387.55*368.17*423.40
**0415T**323.24*307.08*353.14
**0416T**356.80*338.96*389.80
**0417T**84.32*80.10*92.12
**0418T**56.52*53.69*61.74
**0419T**459.31*436.34*501.79
#**0419T**369.83*351.34*404.04
**0420T**656.70*623.87*717.45
#**0420T**546.19*518.88*596.71
**0421T**1634.19*1552.48*1785.35
#**0421T**716.37*680.55*782.63
**0437T**223.61*212.43*244.29
**0439T**73.59*69.91*80.40
**0440T**252.63*240.00*276.00
#**0440T**122.42*116.30*133.75
**0441T**252.63*240.00*276.00
#**0441T**122.42*116.30*133.75
**0442T**252.63*240.00*276.00
#**0442T**122.42*116.30*133.75
**0449T**774.57*735.84*846.22
**0464T**67.84*64.45*74.12
**0472T**67.75*64.36*74.01
**0473T**56.52*53.69*61.74
**0479T**63.87*60.68*69.78
**0480T**157.02*149.17*171.55
#**0480T**31.93*30.33*34.88
**0483T**1261.63*1198.55*1378.33
**0484T**1635.52*1553.74*1786.80
**0485T**23.77*22.58*25.97
**0485T*TC*8.98*8.53*9.81
**0485T*26*15.26*14.50*16.68
**0486T**47.54*45.16*51.93
**0486T*TC*17.50*16.63*19.12
**0486T*26*30.05*28.55*32.83
**0488T**64.08*60.88*70.01
#**0488T**51.06*48.51*55.79
**0505T**11083.22*10529.06*12108.42
#**0505T**560.31*532.29*612.13
**0507T**23.66*22.48*25.85
**0507T*TC*20.50*19.48*22.40
**0507T*26*3.16*3.00*3.45
**0510T**621.15*590.09*678.60
#**0510T**440.86*418.82*481.64
**0512T**319.49*303.52*349.05
#**0512T**231.02*219.47*252.39
**0513T**95.85*91.06*104.72
#**0513T**69.30*65.84*75.72
**0515T**538.36*511.44*588.16
**0516T**496.87*472.03*542.83
**0517T**352.16*334.55*384.73
**0518T**241.92*229.82*264.29
**0519T**353.15*335.49*385.81
**0520T**496.87*472.03*542.83
**0521T**56.52*53.69*61.74
**0521T*TC*36.19*34.38*39.54
**0521T*26*20.33*19.31*22.21
**0522T**67.75*64.36*74.01
**0522T*TC*36.86*35.02*40.27
**0522T*26*30.89*29.35*33.75
**0523T**156.29*148.48*170.75
**0524T**1656.01*1573.21*1809.19
#**0524T**186.63*177.30*203.90
**0525T**497.21*472.35*543.20
**0526T**385.81*366.52*421.50
**0527T**336.23*319.42*367.33
**0528T**67.75*64.36*74.01
**0528T*TC*36.86*35.02*40.27
**0528T*26*30.89*29.35*33.75
**0529T**56.52*53.69*61.74
**0529T*TC*36.19*34.38*39.54
**0529T*26*20.33*19.31*22.21
**0530T**660.85*627.81*721.98
**0531T**502.96*477.81*549.48
**0532T**353.15*335.49*385.81
**0540T**180.42*171.40*197.11
**0543T**1635.52*1553.74*1786.80
**0544T**1876.28*1782.47*2049.84
**0545T**1876.28*1782.47*2049.84
**0546T**72.33*68.71*79.02
**0552T**6.83*6.49*7.46
**0553T**2485.39*2361.12*2715.29
#**0553T**415.04*394.29*453.43
**0565T**634.69*602.96*693.40
#**0565T**534.86*508.12*584.34
**0566T**102.26*97.15*111.72
#**0566T**61.19*58.13*66.85
**0569T**1876.28*1782.47*2049.84
**0570T**440.70*418.67*481.47
**0571T**582.06*552.96*635.90
**0572T**474.38*450.66*518.26
**0573T**361.30*343.24*394.73
**0574T**419.76*398.77*458.59
**0575T**67.75*64.36*74.01
**0576T**56.52*53.69*61.74
**0577T**192.44*182.82*210.24
**0578T**29.81*28.32*32.57
**0579T**21.50*20.43*23.49
**0580T**223.25*212.09*243.90
**0581T**2284.86*2170.62*2496.21
#**0581T**223.53*212.35*244.20
**0582T**1671.06*1587.51*1825.64
#**0582T**395.32*375.55*431.88
**0583T**1522.66*1446.53*1663.51
#**0583T**136.89*130.05*149.56
**0587T**454.78*432.04*496.85
#**0587T**306.54*291.21*334.89
**0588T**374.21*355.50*408.83
#**0588T**238.99*227.04*261.10
**0589T**49.31*46.84*53.87
#**0589T**39.63*37.65*43.30
**0590T**58.13*55.22*63.50
#**0590T**41.11*39.05*44.91
**0596T**672.69*639.06*734.92
#**0596T**133.77*127.08*146.14
**0597T**672.69*639.06*734.92
#**0597T**133.77*127.08*146.14
**0598T**151.94*144.34*165.99
**0599T**101.06*96.01*110.41
**0600T**3607.63*3427.25*3941.34
#**0600T**745.00*707.75*813.91
**0601T**1537.61*1460.73*1679.84
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**198.21*188.30*216.55
**0611T**41.00*38.95*44.79
**0614T**386.89*367.55*422.68
**0615T**47.73*45.34*52.14
**0616T**671.56*637.98*733.68
**0617T**752.62*714.99*822.24
**0618T**911.24*865.68*995.53
**0619T**668.60*635.17*730.45
#**0619T**490.63*466.10*536.02
**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**262.18*249.07*286.43
#**0627T**101.92*96.82*111.34
**0628T**78.65*74.72*85.93
#**0628T**30.58*29.05*33.41
**0629T**262.18*249.07*286.43
#**0629T**101.92*96.82*111.34
**0630T**78.65*74.72*85.93
#**0630T**30.58*29.05*33.41
**0631T**83.23*79.07*90.93
**0632T**602.69*572.56*658.44
**0633T**203.20*193.04*222.00
*C*0633T*TC*106.97*101.62*116.86
**0633T*26*59.70*56.72*65.23
**0634T**203.20*193.04*222.00
**0634T*TC*143.50*136.33*156.78
**0634T*26*59.70*56.72*65.23
**0635T**203.20*193.04*222.00
**0635T*TC*143.50*136.33*156.78
**0635T*26*59.70*56.72*65.23
**0636T**203.20*193.04*222.00
**0636T*TC*143.50*136.33*156.78
**0636T*26*59.70*56.72*65.23
**0637T**203.20*193.04*222.00
**0637T*TC*143.50*136.33*156.78
**0637T*26*59.70*56.72*65.23
**0638T**203.20*193.04*222.00
**0638T*TC*143.50*136.33*156.78
**0638T*26*59.70*56.72*65.23
**0639T**83.23*79.07*90.93
**0640T**23.66*22.48*25.85
**0640T*TC*20.69*19.66*22.61
**0640T*26*3.16*3.00*3.45
**0644T**1178.33*1119.41*1287.32
#**0644T**252.50*239.88*275.86
**0646T**1876.28*1782.47*2049.84
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**60.36*57.34*65.94
**0652T**292.41*277.79*319.46
#**0652T**125.48*119.21*137.09
**0653T**381.54*362.46*416.83
#**0653T**141.82*134.73*154.94
**0654T**145.93*138.63*159.42
**0655T**1634.19*1552.48*1785.35
#**0655T**716.37*680.55*782.63
**0658T**95.29*90.53*104.11
**0659T**2723.04*2586.89*2974.92
#**0659T**457.38*434.51*499.69
**0671T**1041.34*989.27*1137.66
**0673T**3453.06*3280.41*3772.47
#**0673T**378.42*359.50*413.43
**0699T**114.53*108.80*125.12
#**0699T**92.49*87.87*101.05
**0707T**378.19*359.28*413.17
#**0707T**285.70*271.42*312.13
**0714T**1419.18*1348.22*1550.45
#**0714T**368.82*350.38*402.94
**0730T**271.64*258.06*296.77
#**0730T**243.51*231.33*266.03
**0738T**72.00*68.40*78.66
**0739T**1634.19*1552.48*1785.35
#**0739T**716.37*680.55*782.63
**0740T**20.30*19.29*22.18
**0741T**47.55*45.17*51.95
**0742T**94.61*89.88*103.36
**0742T*TC*75.32*71.55*82.28
**0742T*26*19.28*18.32*21.07
**0743T**53.94*51.24*58.93
**0744T**941.89*894.80*1029.02
**0745T**258.70*245.77*282.64
**0746T**227.70*216.32*248.77
**0747T**999.99*949.99*1092.49
**0748T**190.84*181.30*208.50
**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**4.41*4.19*4.82
**0765T**8.21*7.80*8.97
**0771T**27.28*25.92*29.81
**0772T**27.28*25.92*29.81
**0773T**23.57*22.39*25.75
**0774T**23.57*22.39*25.75
**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**438.64*416.71*479.22
**0779T*TC*412.47*391.85*450.63
**0779T*26*26.17*24.86*28.59
**0780T**23.57*22.39*25.75
**0783T**14.49*13.77*15.84
**0784T**2135.93*2029.13*2333.50
#**0784T**333.68*317.00*364.55
**0785T**247.89*235.50*270.83
#**0785T**149.39*141.92*163.21
**0786T**746.51*709.18*815.56
#**0786T**314.48*298.76*343.57
**0787T**247.89*235.50*270.83
#**0787T**149.39*141.92*163.21
**0788T**19.23*18.27*21.01
#**0788T**18.56*17.63*20.27
**0789T**27.91*26.51*30.49
#**0789T**23.20*22.04*25.35
**0790T**1976.95*1878.10*2159.82
**0791T**9.23*8.77*10.09
**0793T**602.69*572.56*658.44
**0794T**130.35*123.83*142.40
**0795T**745.31*708.04*814.25
**0796T**496.87*472.03*542.83
**0797T**496.87*472.03*542.83
**0798T**790.27*750.76*863.37
**0799T**526.84*500.50*575.58
**0800T**526.84*500.50*575.58
**0801T**1023.71*972.52*1118.40
**0802T**511.86*486.27*559.21
**0803T**511.86*486.27*559.21
**0804T**79.15*75.19*86.47
**0804T*TC*42.54*40.41*46.47
**0804T*26*36.61*34.78*40.00
**0805T**2980.02*2831.02*3255.67
#**0805T**336.74*319.90*367.89
**0806T**3973.36*3774.69*4340.89
#**0806T**448.99*426.54*490.52
**0807T**43.39*41.22*47.40
**0807T*TC*28.18*26.77*30.79
**0807T*26*15.21*14.45*16.62
**0808T**43.39*41.22*47.40
**0808T*TC*28.18*26.77*30.79
**0808T*26*15.21*14.45*16.62
**0810T**1152.11*1094.50*1258.68
**0811T**20.30*19.29*22.18
**0813T**2614.68*2483.95*2856.54
#**0813T**190.09*180.59*207.68
**0814T**472.73*449.09*516.45
#**0814T**357.13*339.27*390.16
**0818T**374.21*355.50*408.83
#**0818T**238.99*227.04*261.10
**0820T**149.46*141.99*163.29
#**0820T**131.76*125.17*143.95
**0821T**149.46*141.99*163.29
#**0821T**131.76*125.17*143.95
**0822T**127.04*120.69*138.79
#**0822T**112.00*106.40*122.36
**0823T**745.31*708.04*814.25
**0824T**790.27*750.76*863.37
**0825T**1023.71*972.52*1118.40
**0826T**67.75*64.36*74.01
**0826T*TC*36.86*35.02*40.27
**0826T*26*30.89*29.35*33.75
**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**23.66*22.48*25.85
**0859T*TC*20.50*19.48*22.40
**0859T*26*3.16*3.00*3.45
**0864T**319.49*303.52*349.05
#**0864T**231.02*219.47*252.39
**10011**430.83*409.29*470.68
#**10011**110.64*105.11*120.88
**10012**238.82*226.88*260.91
#**10012**74.56*70.83*81.45
**15847**368.05*349.65*402.10
**21742**1218.92*1157.97*1331.67
**21743**1409.75*1339.26*1540.15
**32855**353.05*335.40*385.71
**32856**480.77*456.73*525.24
**33928**3521.82*3345.73*3847.59
**33929**1318.53*1252.60*1440.49
**33933**540.91*513.86*590.94
**33944**540.91*513.86*590.94
**34841**2120.10*2014.10*2316.22
**34842**2345.88*2228.59*2562.88
**34843**2571.65*2443.07*2809.53
**34844**2797.43*2657.56*3056.19
**34845**2120.10*2014.10*2316.22
**34846**2345.88*2228.59*2562.88
**34847**2571.65*2443.07*2809.53
**34848**2797.43*2657.56*3056.19
**43496**2116.94*2011.09*2312.75
**43647**442.49*420.37*483.43
**43648**536.22*509.41*585.82
#**43648**241.80*229.71*264.17
**43881**681.31*647.24*744.33
#**43881**624.29*593.08*682.04
**43882**722.94*686.79*789.81
#**43882**661.57*628.49*722.76
**47143**423.96*402.76*463.17
**47144**503.44*478.27*550.01
**47145**476.95*453.10*521.07
**48551**269.63*256.15*294.57
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**782.81*743.67*855.22
**53452**391.40*371.83*427.60
**53453**665.32*632.05*726.86
**53454**57.83*54.94*63.18
#**53454**36.12*34.31*39.46
**63043**628.79*597.35*686.95
**63044**518.94*492.99*566.94
**64596**2135.93*2029.13*2333.50
#**64596**333.68*317.00*364.55
**64597**640.78*608.74*700.05
#**64597**100.10*95.10*109.37
**64598**247.89*235.50*270.83
#**64598**149.39*141.92*163.21
**65757**123.12*116.96*134.50
**66983**671.56*637.98*733.68
**66987**782.55*743.42*854.93
**66988**646.40*614.08*706.19
*C*70170**252.92*240.27*276.31
*C*70170*TC*238.19*226.28*260.22
**70555**233.47*221.80*255.07
**70555*TC*114.06*108.36*124.61
*C*70557**689.06*654.61*752.80
*C*70557*TC*536.00*509.20*585.58
*C*70558**347.42*330.05*379.56
*C*70558*TC*178.76*169.82*195.29
*C*70559**339.03*322.08*370.39
*C*70559*TC*178.76*169.82*195.29
*C*74190**558.29*530.38*609.94
*C*74190*TC*536.00*509.20*585.58
**74235**147.94*140.54*161.62
**74235*TC*90.94*86.39*99.35
**74300**84.36*80.14*92.16
**74300*TC*70.97*67.42*77.53
**74301**26.28*24.97*28.72
**74301*TC*16.39*15.57*17.91
**74328**175.06*166.31*191.26
**74328*TC*151.91*144.31*165.96
**74329**143.68*136.50*156.98
**74329*TC*120.20*114.19*131.32
**74330**262.59*249.46*286.88
**74330*TC*235.27*223.51*257.04
**74340**86.58*82.25*94.59
**74340*TC*60.94*57.89*66.57
**74355**86.58*82.25*94.59
**74355*TC*50.04*47.54*54.67
**74360**86.58*82.25*94.59
**74360*TC*59.00*56.05*64.46
**74363**175.06*166.31*191.26
**74363*TC*133.33*126.66*145.66
*C*74445**160.68*152.65*175.55
*C*74445*TC*106.97*101.62*116.86
*C*74450**253.80*241.11*277.28
*C*74450*TC*238.19*226.28*260.22
*C*74470**560.98*532.93*612.87
*C*74470*TC*536.00*509.20*585.58
**74742**233.47*221.80*255.07
**74742*TC*204.13*193.92*223.01
*C*74775**267.87*254.48*292.65
*C*74775*TC*238.19*226.28*260.22
*C*75801**654.58*621.85*715.13
*C*75801*TC*610.46*579.94*666.93
*C*75803**1612.31*1531.69*1761.44
*C*75803*TC*1555.99*1478.19*1699.92
*C*75805**3135.71*2978.92*3425.76
*C*75805*TC*3096.81*2941.97*3383.27
*C*75807**3150.07*2992.57*3441.46
*C*75807*TC*3096.81*2941.97*3383.27
*C*75810**3145.99*2988.69*3436.99
*C*75810*TC*3096.81*2941.97*3383.27
**75894**915.07*869.32*999.72
**75894*TC*840.49*798.47*918.24
*C*75898**3192.09*3032.49*3487.36
*C*75898*TC*3096.81*2941.97*3383.27
**75970**446.51*424.18*487.81
**75970*TC*408.34*387.92*446.11
**76125**40.39*38.37*44.13
**76125*TC*27.00*25.65*29.50
**76390**205.41*195.14*224.41
**76390*TC*152.99*145.34*167.14
**76390*26*52.42*49.80*57.27
**76932**86.11*81.80*94.07
**76932*TC*49.26*46.80*53.82
**76940**165.94*157.64*181.29
**76940*TC*62.73*59.59*68.53
**76941**117.49*111.62*128.36
**76941*TC*53.49*50.82*58.44
**76945**84.99*80.74*92.85
**76945*TC*53.23*50.57*58.16
*C*76975**278.95*265.00*304.75
*C*76975*TC*238.19*226.28*260.22
**76998**175.06*166.31*191.26
**76998*TC*126.49*120.17*138.20
**77013**421.12*400.06*460.07
**77013*TC*236.99*225.14*258.91
**77022**471.36*447.79*514.96
**77022*TC*271.18*257.62*296.26
**77371**617.25*586.39*674.35
**77520**895.59*850.81*978.43
**77522**895.59*850.81*978.43
**77523**1028.37*976.95*1123.49
**77525**1161.13*1103.07*1268.53
*C*78282**416.08*395.28*454.57
*C*78282*TC*400.78*380.74*437.85
**78414**514.99*489.24*562.63
**78414*TC*493.99*469.29*539.68
*C*78429**1598.84*1518.90*1746.74
*C*78429*TC*1519.93*1443.93*1660.52
*C*78430**1595.00*1515.25*1742.54
*C*78430*TC*1519.93*1443.93*1660.52
*C*78431**2382.49*2263.37*2602.88
*C*78431*TC*2294.85*2180.11*2507.13
*C*78432**1980.71*1881.67*2163.92
*C*78432*TC*1886.86*1792.52*2061.40
*C*78433**2091.76*1987.17*2285.25
*C*78433*TC*1989.02*1889.57*2173.01
**78434**703.08*667.93*768.12
**78434*TC*674.20*640.49*736.56
*C*78459**1452.88*1380.24*1587.28
*C*78459*TC*1379.70*1310.72*1507.33
*C*78491**1591.62*1512.04*1738.85
*C*78491*TC*1519.93*1443.93*1660.52
*C*78492**1604.20*1523.99*1752.59
*C*78492*TC*1519.93*1443.93*1660.52
*C*78608**1589.06*1509.61*1736.05
*C*78608*TC*1519.93*1443.93*1660.52
*C*78811**1450.99*1378.44*1585.21
*C*78811*TC*1379.70*1310.72*1507.33
*C*78812**1609.99*1529.49*1758.91
*C*78812*TC*1519.93*1443.93*1660.52
*C*78813**1612.02*1531.42*1761.13
*C*78813*TC*1519.93*1443.93*1660.52
*C*78814**1621.91*1540.81*1771.93
*C*78814*TC*1519.93*1443.93*1660.52
*C*78815**1633.49*1551.82*1784.59
*C*78815*TC*1519.93*1443.93*1660.52
*C*78816**1634.38*1552.66*1785.56
*C*78816*TC*1519.93*1443.93*1660.52
**79300**237.04*225.19*258.97
**79300*TC*173.75*165.06*189.82
**79445**237.04*225.19*258.97
**79445*TC*127.10*120.75*138.86
**86485**17.28*16.42*18.88
**90867**305.52*290.24*333.78
#**90867**141.75*134.66*154.86
**90868**205.61*195.33*224.63
#**90868**106.24*100.93*116.07
**90869**281.95*267.85*308.03
#**90869**164.88*156.64*180.14
**92978**247.54*235.16*270.43
**92978*TC*150.14*142.63*164.02
**92979**150.60*143.07*164.53
**92979*TC*73.44*69.77*80.24
*C*93315**661.40*628.33*722.58
*C*93315*TC*536.00*509.20*585.58
**93317**216.69*205.86*236.74
**93317*TC*128.59*122.16*140.48
*C*93318**637.57*605.69*696.54
*C*93318*TC*536.00*509.20*585.58
**93571**246.56*234.23*269.36
**93571*TC*172.56*163.93*188.52
**93572**148.17*140.76*161.87
**93572*TC*94.15*89.44*102.86
**93600**3557.81*3379.92*3886.91
**93600*TC*3438.78*3266.84*3756.87
**93602**3557.81*3379.92*3886.91
**93602*TC*3441.05*3269.00*3759.35
**93603**3557.81*3379.92*3886.91
**93603*TC*3441.05*3269.00*3759.35
**93609**2134.69*2027.96*2332.15
**93609*TC*1855.40*1762.63*2027.02
**93610**3557.81*3379.92*3886.91
**93610*TC*3392.82*3223.18*3706.66
**93612**3557.81*3379.92*3886.91
**93612*TC*3395.56*3225.78*3709.65
**93615**49.73*47.24*54.33
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6721.12*6385.06*7342.82
**93620**7115.62*6759.84*7773.82
**93620*TC*6482.45*6158.33*7082.08
**93621**7115.62*6759.84*7773.82
**93621*TC*7031.36*6679.79*7681.76
**93622**7115.62*6759.84*7773.82
**93622*TC*6941.91*6594.81*7584.03
**93623**2134.69*2027.96*2332.15
**93623*TC*2065.66*1962.38*2256.74
**93624**3557.81*3379.92*3886.91
**93624*TC*3311.54*3145.96*3617.85
**93631**7115.62*6759.84*7773.82
**93631*TC*6708.41*6372.99*7328.94
**93640**1133.95*1077.25*1238.84
**93640*TC*953.24*905.58*1041.42
**93641**1133.95*1077.25*1238.84
**93641*TC*817.52*776.64*893.14
**93662**426.68*405.35*466.15
**93662*TC*357.17*339.31*390.21
**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**938.11*891.20*1024.88
**95965*TC*534.17*507.46*583.58
**95966**541.34*514.27*591.41
**95966*TC*345.30*328.04*377.25
**95967**455.64*432.86*497.79
**95967*TC*285.34*271.07*311.73
**96020**375.58*356.80*410.32
**96547**749.88*712.39*819.25
#**96547**136.55*129.72*149.18
**96548**374.94*356.19*409.62
#**96548**68.28*64.87*74.60
**97151**50.46*47.94*55.13
#**97151**44.78*42.54*48.92
**97152**42.89*40.75*46.86
#**97152**38.06*36.16*41.58
**97153**34.10*32.40*37.26
#**97153**29.93*28.43*32.69
**97154**4.76*4.52*5.20
#**97154**4.33*4.11*4.73
**97155**34.10*32.40*37.26
#**97155**29.93*28.43*32.69
**97156**35.96*34.16*39.28
#**97156**31.62*30.04*34.55
**97157**10.57*10.04*11.55
#**97157**9.56*9.08*10.44
**97158**5.52*5.24*6.03
#**97158**5.02*4.77*5.49
**98978**47.55*45.17*51.95
# - 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.