TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BRAZORIA
******
**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**458.19*435.28*500.57
#**G0186**393.22*373.56*429.59
**G0339**2794.17*2654.46*3052.63
**G0340**2101.45*1996.38*2295.84
**G0398**136.50*129.68*149.13
**G0398*TC*97.64*92.76*106.67
**G0398*26*38.86*36.92*42.46
**G0399**94.67*89.94*103.43
**G0399*TC*51.76*49.17*56.55
**G0399*26*43.24*41.08*47.24
**G0400**97.66*92.78*106.70
**G0400*TC*57.46*54.59*62.78
**G0400*26*40.20*38.19*43.92
**G0460**799.01*759.06*872.92
#**G0460**118.89*112.95*129.89
**G0465**799.01*759.06*872.92
#**G0465**118.89*112.95*129.89
**G0498**147.58*140.20*161.23
**G6017**78.08*74.18*85.31
**0042T**228.74*217.30*249.90
**0054T**223.58*212.40*244.26
**0055T**223.58*212.40*244.26
**0071T**568.35*539.93*620.92
**0072T**568.35*539.93*620.92
**0075T**950.35*902.83*1038.25
**0075T*TC*950.35*902.83*1038.25
**0075T*26*945.03*897.78*1032.45
**0095T**609.24*578.78*665.60
**0098T**681.53*647.45*744.57
**0100T**1895.38*1800.61*2070.70
**0101T**313.93*298.23*342.96
#**0101T**225.19*213.93*246.02
**0102T**313.93*298.23*342.96
#**0102T**225.19*213.93*246.02
**0106T**33.69*32.01*36.81
**0107T**33.69*32.01*36.81
**0108T**33.69*32.01*36.81
**0109T**33.69*32.01*36.81
**0110T**33.69*32.01*36.81
**0164T**666.36*633.04*728.00
**0165T**682.61*648.48*745.75
**0184T**816.94*776.09*892.50
**0198T**85.41*81.14*93.31
#**0198T**31.83*30.24*34.78
**0200T**1780.65*1691.62*1945.36
#**0200T**398.96*379.01*435.86
**0201T**2670.97*2537.42*2918.03
#**0201T**598.44*568.52*653.80
**0207T**121.71*115.62*132.96
**0208T**38.11*36.20*41.63
**0209T**46.14*43.83*50.40
**0210T**29.06*27.61*31.75
**0211T**45.14*42.88*49.31
**0212T**36.52*34.69*39.89
#**0212T**31.50*29.93*34.42
**0213T**193.11*183.45*210.97
#**0213T**104.37*99.15*114.02
**0214T**97.25*92.39*106.25
#**0214T**58.40*55.48*63.80
**0215T**97.58*92.70*106.61
#**0215T**59.41*56.44*64.91
**0216T**177.84*168.95*194.29
#**0216T**89.77*85.28*98.07
**0217T**90.98*86.43*99.39
#**0217T**50.13*47.62*54.76
**0218T**90.98*86.43*99.39
#**0218T**51.13*48.57*55.86
**0219T**1291.09*1226.54*1410.52
**0220T**1270.15*1206.64*1387.64
**0221T**1559.28*1481.32*1703.52
**0222T**378.90*359.96*413.95
**0232T**799.01*759.06*872.92
#**0232T**118.89*112.95*129.89
**0234T**8581.46*8152.39*9375.25
#**0234T**568.30*539.89*620.87
**0235T**8581.46*8152.39*9375.25
#**0235T**568.30*539.89*620.87
**0236T**8730.61*8294.08*9538.19
#**0236T**658.85*625.91*719.80
**0237T**8730.61*8294.08*9538.19
#**0237T**658.85*625.91*719.80
**0238T**8730.61*8294.08*9538.19
#**0238T**658.85*625.91*719.80
**0266T**879.22*835.26*960.55
**0267T**154.45*146.73*168.74
**0268T**327.78*311.39*358.10
**0269T**833.38*791.71*910.47
**0270T**154.45*146.73*168.74
**0271T**327.78*311.39*358.10
**0272T**56.23*53.42*61.43
**0273T**71.92*68.32*78.57
**0274T**1088.10*1033.70*1188.76
**0278T**14.40*13.68*15.73
**0308T**1391.46*1321.89*1520.17
**0329T**85.41*81.14*93.31
#**0329T**31.83*30.24*34.78
**0330T**38.21*36.30*41.75
**0331T**183.90*174.71*200.92
**0332T**314.11*298.40*343.16
**0347T**139.21*132.25*152.09
**0348T**33.07*31.42*36.13
**0349T**35.07*33.32*38.32
**0350T**35.74*33.95*39.04
**0351T**170.38*161.86*186.14
**0352T**42.87*40.73*46.84
**0353T**170.38*161.86*186.14
**0354T**42.87*40.73*46.84
**0358T**27.05*25.70*29.56
**0362T**91.06*86.51*99.49
#**0362T**65.28*62.02*71.32
**0378T**24.70*23.47*26.99
**0394T**250.80*238.26*274.00
**0395T**607.58*577.20*663.78
**0397T**46.77*44.43*51.09
**0398T*26*1746.88*1659.54*1908.47
**0408T**499.39*474.42*545.58
**0409T**346.32*329.00*378.35
**0410T**360.27*342.26*393.60
**0411T**360.27*342.26*393.60
**0412T**227.51*216.13*248.55
**0413T**468.09*444.69*511.39
**0414T**360.96*342.91*394.35
**0415T**300.45*285.43*328.24
**0416T**334.33*317.61*365.25
**0417T**83.66*79.48*91.40
**0418T**56.23*53.42*61.43
**0419T**449.30*426.84*490.87
#**0419T**359.55*341.57*392.81
**0420T**636.71*604.87*695.60
#**0420T**525.87*499.58*574.52
**0421T**1607.19*1526.83*1755.85
#**0421T**686.63*652.30*750.15
**0437T**209.30*198.84*228.67
**0439T**71.70*68.12*78.34
**0440T**248.87*236.43*271.89
#**0440T**118.27*112.36*129.21
**0441T**248.87*236.43*271.89
#**0441T**118.27*112.36*129.21
**0442T**248.87*236.43*271.89
#**0442T**118.27*112.36*129.21
**0449T**759.91*721.91*830.20
**0464T**67.60*64.22*73.85
**0472T**67.27*63.91*73.50
**0473T**56.23*53.42*61.43
**0479T**62.91*59.76*68.72
**0480T**156.34*148.52*170.80
#**0480T**31.46*29.89*34.37
**0483T**1155.30*1097.54*1262.17
**0484T**1497.93*1423.03*1636.48
**0485T**23.61*22.43*25.79
**0485T*TC*8.80*8.36*9.61
**0485T*26*15.07*14.32*16.47
**0486T**47.22*44.86*51.59
**0486T*TC*17.34*16.47*18.94
**0486T*26*29.88*28.39*32.65
**0488T**62.73*59.59*68.53
#**0488T**49.67*47.19*54.27
**0505T**10917.98*10372.08*11927.89
#**0505T**551.05*523.50*602.03
**0507T**23.31*22.14*25.46
**0507T*TC*20.36*19.34*22.24
**0507T*26*2.96*2.81*3.23
**0510T**600.60*570.57*656.16
#**0510T**419.76*398.77*458.59
**0512T**313.93*298.23*342.96
#**0512T**225.19*213.93*246.02
**0513T**94.18*89.47*102.89
#**0513T**67.56*64.18*73.81
**0515T**499.39*474.42*545.58
**0516T**461.15*438.09*503.80
**0517T**327.78*311.39*358.10
**0518T**227.51*216.13*248.55
**0519T**328.78*312.34*359.19
**0520T**461.15*438.09*503.80
**0521T**56.23*53.42*61.43
**0521T*TC*36.10*34.30*39.45
**0521T*26*20.14*19.13*22.00
**0522T**67.27*63.91*73.50
**0522T*TC*36.77*34.93*40.17
**0522T*26*30.51*28.98*33.33
**0523T**151.26*143.70*165.26
**0524T**1645.79*1563.50*1798.03
#**0524T**172.02*163.42*187.93
**0525T**461.48*438.41*504.17
**0526T**360.27*342.26*393.60
**0527T**313.06*297.41*342.02
**0528T**67.27*63.91*73.50
**0528T*TC*36.77*34.93*40.17
**0528T*26*30.51*28.98*33.33
**0529T**56.23*53.42*61.43
**0529T*TC*36.10*34.30*39.45
**0529T*26*20.14*19.13*22.00
**0530T**615.32*584.55*672.23
**0531T**468.09*444.69*511.39
**0532T**328.78*312.34*359.19
**0540T**176.54*167.71*192.87
**0543T**1497.93*1423.03*1636.48
**0544T**1725.94*1639.64*1885.59
**0545T**1725.94*1639.64*1885.59
**0546T**72.06*68.46*78.73
**0552T**6.64*6.31*7.26
**0553T**2456.22*2333.41*2683.42
#**0553T**379.67*360.69*414.79
**0565T**610.18*579.67*666.62
#**0565T**510.06*484.56*557.24
**0566T**99.37*94.40*108.56
#**0566T**58.18*55.27*63.56
**0569T**1725.94*1639.64*1885.59
**0570T**403.97*383.77*441.34
**0571T**540.49*513.47*590.49
**0572T**439.65*417.67*480.32
**0573T**336.31*319.49*367.41
**0574T**389.29*369.83*425.30
**0575T**67.27*63.91*73.50
**0576T**56.23*53.42*61.43
**0577T**190.65*181.12*208.29
**0578T**29.01*27.56*31.69
**0579T**21.36*20.29*23.33
**0580T**209.21*198.75*228.56
**0581T**2271.78*2158.19*2481.92
#**0581T**204.28*194.07*223.18
**0582T**1660.43*1577.41*1814.02
#**0582T**380.89*361.85*416.13
**0583T**1522.66*1446.53*1663.51
#**0583T**132.41*125.79*144.66
**0587T**440.61*418.58*481.37
#**0587T**291.92*277.32*318.92
**0588T**363.43*345.26*397.05
#**0588T**227.80*216.41*248.87
**0589T**47.94*45.54*52.37
#**0589T**38.23*36.32*41.77
**0590T**56.58*53.75*61.81
#**0590T**39.50*37.53*43.16
**0596T**672.69*639.06*734.92
#**0596T**130.16*123.65*142.20
**0597T**672.69*639.06*734.92
#**0597T**130.16*123.65*142.20
**0598T**151.96*144.36*166.01
**0599T**101.13*96.07*110.48
**0600T**3584.39*3405.17*3915.95
#**0600T**713.20*677.54*779.17
**0601T**1417.50*1346.63*1548.62
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**196.60*186.77*214.79
**0611T**40.71*38.67*44.47
**0614T**360.30*342.29*393.63
**0615T**47.18*44.82*51.54
**0616T**660.45*627.43*721.54
**0617T**737.58*700.70*805.81
**0618T**892.98*848.33*975.58
**0619T**650.90*618.36*711.11
#**0619T**472.40*448.78*516.10
**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**259.08*246.13*283.05
#**0627T**98.34*93.42*107.43
**0628T**77.72*73.83*84.90
#**0628T**29.50*28.03*32.23
**0629T**259.08*246.13*283.05
#**0629T**98.34*93.42*107.43
**0630T**77.72*73.83*84.90
#**0630T**29.50*28.03*32.23
**0631T**82.43*78.31*90.06
**0632T**555.71*527.92*607.11
**0633T**202.03*191.93*220.72
*C*0633T*TC*107.09*101.74*117.00
**0633T*26*58.51*55.58*63.92
**0634T**202.03*191.93*220.72
**0634T*TC*143.52*136.34*156.79
**0634T*26*58.51*55.58*63.92
**0635T**202.03*191.93*220.72
**0635T*TC*143.52*136.34*156.79
**0635T*26*58.51*55.58*63.92
**0636T**202.03*191.93*220.72
**0636T*TC*143.52*136.34*156.79
**0636T*26*58.51*55.58*63.92
**0637T**202.03*191.93*220.72
**0637T*TC*143.52*136.34*156.79
**0637T*26*58.51*55.58*63.92
**0638T**202.03*191.93*220.72
**0638T*TC*143.52*136.34*156.79
**0638T*26*58.51*55.58*63.92
**0639T**82.43*78.31*90.06
**0640T**23.31*22.14*25.46
**0640T*TC*20.46*19.44*22.36
**0640T*26*2.96*2.81*3.23
**0644T**1160.58*1102.55*1267.93
#**0644T**231.98*220.38*253.44
**0646T**1725.94*1639.64*1885.59
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**59.87*56.88*65.41
**0652T**287.73*273.34*314.34
#**0652T**120.29*114.28*131.42
**0653T**376.27*357.46*411.08
#**0653T**135.83*129.04*148.40
**0654T**139.33*132.36*152.21
**0655T**1607.19*1526.83*1755.85
#**0655T**686.63*652.30*750.15
**0658T**95.37*90.60*104.19
**0659T**2691.00*2556.45*2939.92
#**0659T**418.56*397.63*457.27
**0671T**1021.52*970.44*1116.01
**0673T**3440.45*3268.43*3758.69
#**0673T**356.62*338.79*389.61
**0699T**112.46*106.84*122.87
#**0699T**90.36*85.84*98.72
**0707T**371.62*353.04*406.00
#**0707T**278.86*264.92*304.66
**0714T**1409.30*1338.84*1539.67
#**0714T**355.79*338.00*388.70
**0730T**267.76*254.37*292.53
#**0730T**239.79*227.80*261.97
**0738T**70.44*66.92*76.96
**0739T**1607.19*1526.83*1755.85
#**0739T**686.63*652.30*750.15
**0740T**19.95*18.95*21.79
**0741T**47.48*45.11*51.88
**0742T**94.23*89.52*102.95
**0742T*TC*75.24*71.48*82.20
**0742T*26*18.99*18.04*20.75
**0743T**53.45*50.78*58.40
**0744T**856.78*813.94*936.03
**0745T**258.03*245.13*281.90
**0746T**224.24*213.03*244.98
**0747T**997.84*947.95*1090.14
**0748T**181.24*172.18*198.01
**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**25.97*24.67*28.37
**0772T**25.97*24.67*28.37
**0773T**23.42*22.25*25.59
**0774T**23.42*22.25*25.59
**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**439.28*417.32*479.92
**0779T*TC*413.50*392.83*451.75
**0779T*26*25.78*24.49*28.16
**0780T**23.42*22.25*25.59
**0783T**14.33*13.61*15.65
**0784T**2128.98*2022.53*2325.91
#**0784T**321.34*305.27*351.06
**0785T**242.24*230.13*264.65
#**0785T**143.45*136.28*156.72
**0786T**732.97*696.32*800.77
#**0786T**299.65*284.67*327.37
**0787T**242.24*230.13*264.65
#**0787T**143.45*136.28*156.72
**0788T**18.64*17.71*20.37
#**0788T**17.97*17.07*19.63
**0789T**25.48*24.21*27.84
#**0789T**22.46*21.34*24.54
**0790T**1903.09*1807.94*2079.13
**0791T**9.04*8.59*9.88
**0793T**555.71*527.92*607.11
**0794T**130.35*123.83*142.40
**0795T**691.72*657.13*755.70
**0796T**461.15*438.09*503.80
**0797T**461.15*438.09*503.80
**0798T**729.90*693.41*797.42
**0799T**486.60*462.27*531.61
**0800T**486.60*462.27*531.61
**0801T**947.75*900.36*1035.41
**0802T**473.87*450.18*517.71
**0803T**473.87*450.18*517.71
**0804T**78.69*74.76*85.97
**0804T*TC*42.46*40.34*46.39
**0804T*26*36.23*34.42*39.58
**0805T**2968.81*2820.37*3243.43
#**0805T**317.63*301.75*347.01
**0806T**3958.41*3760.49*4324.56
#**0806T**423.50*402.33*462.68
**0807T**42.66*40.53*46.61
**0807T*TC*28.06*26.66*30.66
**0807T*26*14.60*13.87*15.95
**0808T**42.66*40.53*46.61
**0808T*TC*28.06*26.66*30.66
**0808T*26*14.60*13.87*15.95
**0810T**1127.56*1071.18*1231.86
**0811T**19.95*18.95*21.79
**0813T**2607.99*2477.59*2849.23
#**0813T**176.14*167.33*192.43
**0814T**464.52*441.29*507.48
#**0814T**348.57*331.14*380.81
**0818T**363.43*345.26*397.05
#**0818T**227.80*216.41*248.87
**0820T**147.51*140.13*161.15
#**0820T**129.77*123.28*141.77
**0821T**147.51*140.13*161.15
#**0821T**129.77*123.28*141.77
**0822T**125.39*119.12*136.99
#**0822T**110.30*104.79*120.51
**0823T**691.72*657.13*755.70
**0824T**729.90*693.41*797.42
**0825T**947.75*900.36*1035.41
**0826T**67.27*63.91*73.50
**0826T*TC*36.77*34.93*40.17
**0826T*26*30.51*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**23.31*22.14*25.46
**0859T*TC*20.36*19.34*22.24
**0859T*26*2.96*2.81*3.23
**0864T**313.93*298.23*342.96
#**0864T**225.19*213.93*246.02
**10011**427.36*405.99*466.89
#**10011**106.22*100.91*116.05
**10012**235.05*223.30*256.80
#**10012**70.29*66.78*76.80
**15847**347.77*330.38*379.94
**21742**1131.21*1074.65*1235.85
**21743**1295.16*1230.40*1414.96
**32855**351.74*334.15*384.27
**32856**438.70*416.77*479.29
**33928**3210.70*3050.17*3507.70
**33929**1202.91*1142.76*1314.17
**33933**538.99*512.04*588.85
**33944**538.99*512.04*588.85
**34841**2112.81*2007.17*2308.25
**34842**2338.58*2221.65*2554.90
**34843**2564.36*2436.14*2801.56
**34844**2790.13*2650.62*3048.21
**34845**2112.81*2007.17*2308.25
**34846**2338.58*2221.65*2554.90
**34847**2564.36*2436.14*2801.56
**34848**2790.13*2650.62*3048.21
**43496**2102.68*1997.55*2297.18
**43647**442.49*420.37*483.43
**43648**532.30*505.69*581.54
#**43648**240.44*228.42*262.68
**43881**675.69*641.91*738.20
#**43881**619.52*588.54*676.82
**43882**716.29*680.48*782.55
#**43882**655.82*623.03*716.48
**47143**422.20*401.09*461.25
**47144**501.36*476.29*547.73
**47145**474.95*451.20*518.88
**48551**268.04*254.64*292.84
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**751.11*713.55*820.58
**53452**375.56*356.78*410.30
**53453**638.42*606.50*697.48
**53454**56.69*53.86*61.94
#**53454**34.93*33.18*38.16
**63043**558.11*530.20*609.73
**63044**515.91*490.11*563.63
**64596**2128.98*2022.53*2325.91
#**64596**321.34*305.27*351.06
**64597**638.69*606.76*697.77
#**64597**96.40*91.58*105.32
**64598**242.24*230.13*264.65
#**64598**143.45*136.28*156.72
**65757**118.79*112.85*129.78
**66983**660.45*627.43*721.54
**66987**760.93*722.88*831.31
**66988**634.13*602.42*692.78
*C*70170**253.03*240.38*276.44
*C*70170*TC*238.69*226.76*260.77
**70555**233.47*221.80*255.07
**70555*TC*116.43*110.61*127.20
*C*70557**687.95*653.55*751.58
*C*70557*TC*537.40*510.53*587.11
*C*70558**345.05*327.80*376.97
*C*70558*TC*179.09*170.14*195.66
*C*70559**334.16*317.45*365.07
*C*70559*TC*179.09*170.14*195.66
*C*74190**559.08*531.13*610.80
*C*74190*TC*537.40*510.53*587.11
**74235**144.22*137.01*157.56
**74235*TC*88.40*83.98*96.58
**74300**83.97*79.77*91.74
**74300*TC*70.98*67.43*77.54
**74301**25.74*24.45*28.12
**74301*TC*16.04*15.24*17.53
**74328**175.06*166.31*191.26
**74328*TC*152.30*144.69*166.39
**74329**139.99*132.99*152.94
**74329*TC*116.90*111.06*127.72
**74330**262.59*249.46*286.88
**74330*TC*235.86*224.07*257.68
**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*60.00*57.00*65.55
**74363**175.06*166.31*191.26
**74363*TC*134.32*127.60*146.74
*C*74445**160.02*152.02*174.82
*C*74445*TC*107.09*101.74*117.00
*C*74450**254.12*241.41*277.62
*C*74450*TC*238.69*226.76*260.77
*C*74470**561.78*533.69*613.74
*C*74470*TC*537.40*510.53*587.11
**74742**233.47*221.80*255.07
**74742*TC*204.72*194.48*223.65
*C*74775**267.78*254.39*292.55
*C*74775*TC*238.69*226.76*260.77
*C*75801**653.57*620.89*714.02
*C*75801*TC*612.08*581.48*668.70
*C*75803**1615.58*1534.80*1765.02
*C*75803*TC*1560.43*1482.41*1704.77
*C*75805**3143.98*2986.78*3434.80
*C*75805*TC*3105.87*2950.58*3393.17
*C*75807**3157.52*2999.64*3449.59
*C*75807*TC*3105.87*2950.58*3393.17
*C*75810**3153.02*2995.37*3444.68
*C*75810*TC*3105.87*2950.58*3393.17
**75894**890.35*845.83*972.70
**75894*TC*821.24*780.18*897.21
*C*75898**3193.86*3034.17*3489.30
*C*75898*TC*3105.87*2950.58*3393.17
**75970**434.81*413.07*475.03
**75970*TC*397.84*377.95*434.64
**76125**39.26*37.30*42.90
**76125*TC*26.27*24.96*28.70
**76390**204.29*194.08*223.19
**76390*TC*153.03*145.38*167.19
**76390*26*51.26*48.70*56.01
**76932**83.87*79.68*91.63
**76932*TC*48.83*46.39*53.35
**76940**154.09*146.39*168.35
**76940*TC*56.33*53.51*61.54
**76941**114.67*108.94*125.28
**76941*TC*51.23*48.67*55.97
**76945**82.95*78.80*90.62
**76945*TC*51.36*48.79*56.11
*C*76975**278.88*264.94*304.68
*C*76975*TC*238.69*226.76*260.77
**76998**175.06*166.31*191.26
**76998*TC*129.73*123.24*141.73
**77013**420.61*399.58*459.52
**77013*TC*241.48*229.41*263.82
**77022**470.85*447.31*514.41
**77022*TC*275.03*261.28*300.47
**77371**608.02*577.62*664.26
**77520**882.21*838.10*963.82
**77522**882.21*838.10*963.82
**77523**1013.00*962.35*1106.70
**77525**1143.78*1086.59*1249.58
*C*78282**416.88*396.04*455.45
*C*78282*TC*401.78*381.69*438.94
**78414**514.99*489.24*562.63
**78414*TC*494.18*469.47*539.89
*C*78429**1602.01*1521.91*1750.20
*C*78429*TC*1524.27*1448.06*1665.27
*C*78430**1598.37*1518.45*1746.22
**78430*TC*1450.17*1377.66*1584.31
*C*78431**2387.99*2268.59*2608.88
*C*78431*TC*2301.51*2186.43*2514.39
*C*78432**1984.78*1885.54*2168.37
*C*78432*TC*1892.29*1797.68*2067.33
*C*78433**2095.94*1991.14*2289.81
*C*78433*TC*1994.76*1895.02*2179.27
**78434**704.70*669.47*769.89
**78434*TC*676.21*642.40*738.76
*C*78459**1455.63*1382.85*1590.28
*C*78459*TC*1383.62*1314.44*1511.61
*C*78491**1594.99*1515.24*1742.53
*C*78491*TC*1524.27*1448.06*1665.27
*C*78492**1607.37*1527.00*1756.05
*C*78492*TC*1524.27*1448.06*1665.27
*C*78608**1592.23*1512.62*1739.51
*C*78608*TC*1524.27*1448.06*1665.27
*C*78811**1453.53*1380.85*1587.98
*C*78811*TC*1383.62*1314.44*1511.61
*C*78812**1612.56*1531.93*1761.72
*C*78812*TC*1524.27*1448.06*1665.27
*C*78813**1614.58*1533.85*1763.93
*C*78813*TC*1524.27*1448.06*1665.27
*C*78814**1624.28*1543.07*1774.53
*C*78814*TC*1524.27*1448.06*1665.27
*C*78815**1635.66*1553.88*1786.96
*C*78815*TC*1524.27*1448.06*1665.27
*C*78816**1636.75*1554.91*1788.15
*C*78816*TC*1524.27*1448.06*1665.27
**79300**237.04*225.19*258.97
**79300*TC*174.13*165.42*190.23
**79445**237.04*225.19*258.97
**79445*TC*129.89*123.40*141.91
**86485**17.28*16.42*18.88
**90867**299.22*284.26*326.90
#**90867**134.97*128.22*147.45
**90868**200.66*190.63*219.22
#**90868**105.28*100.02*115.02
**90869**277.13*263.27*302.76
#**90869**159.81*151.82*174.59
**92978**242.03*229.93*264.42
**92978*TC*151.51*143.93*165.52
**92979**147.06*139.71*160.67
**92979*TC*75.17*71.41*82.12
*C*93315**661.05*628.00*722.20
*C*93315*TC*537.40*510.53*587.11
**93317**211.08*200.53*230.61
**93317*TC*125.37*119.10*136.97
*C*93318**636.59*604.76*695.47
*C*93318*TC*537.40*510.53*587.11
**93571**241.04*228.99*263.34
**93571*TC*172.11*163.50*188.03
**93572**144.83*137.59*158.23
**93572*TC*94.66*89.93*103.42
**93600**3557.81*3379.92*3886.91
**93600*TC*3446.87*3274.53*3765.71
**93602**3557.81*3379.92*3886.91
**93602*TC*3448.74*3276.30*3767.75
**93603**3557.81*3379.92*3886.91
**93603*TC*3448.74*3276.30*3767.75
**93609**2134.69*2027.96*2332.15
**93609*TC*1874.41*1780.69*2047.79
**93610**3557.81*3379.92*3886.91
**93610*TC*3403.74*3233.55*3718.58
**93612**3557.81*3379.92*3886.91
**93612*TC*3405.88*3235.59*3720.93
**93615**49.35*46.88*53.91
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6748.62*6411.19*7372.87
**93620**7115.62*6759.84*7773.82
**93620*TC*6525.94*6199.64*7129.59
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.22*6685.36*7688.16
**93622**7115.62*6759.84*7773.82
**93622*TC*6953.85*6606.16*7597.08
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.46*1965.99*2260.89
**93624**3557.81*3379.92*3886.91
**93624*TC*3329.37*3162.90*3637.34
**93631**7115.62*6759.84*7773.82
**93631*TC*6739.65*6402.67*7363.07
**93640**1133.95*1077.25*1238.84
**93640*TC*965.58*917.30*1054.90
**93641**1133.95*1077.25*1238.84
**93641*TC*839.79*797.80*917.47
**93662**418.65*397.72*457.38
**93662*TC*349.90*332.41*382.27
**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**931.44*884.87*1017.60
**95965*TC*534.17*507.46*583.58
**95966**536.26*509.45*585.87
**95966*TC*345.30*328.04*377.25
**95967**450.95*428.40*492.66
**95967*TC*285.34*271.07*311.73
**96020**373.48*354.81*408.03
**96547**749.03*711.58*818.32
#**96547**133.87*127.18*146.26
**96548**374.51*355.78*409.15
#**96548**66.93*63.58*73.12
**97151**49.78*47.29*54.38
#**97151**44.08*41.88*48.16
**97152**42.31*40.19*46.22
#**97152**37.47*35.60*40.94
**97153**33.72*32.03*36.83
#**97153**29.53*28.05*32.26
**97154**4.56*4.33*4.98
#**97154**4.13*3.92*4.51
**97155**33.72*32.03*36.83
#**97155**29.53*28.05*32.26
**97156**35.57*33.79*38.86
#**97156**31.22*29.66*34.11
**97157**10.37*9.85*11.33
#**97157**9.36*8.89*10.22
**97158**5.32*5.05*5.81
#**97158**4.81*4.57*5.26
**98978**47.48*45.11*51.88
# - 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.