OKLAHOMA MEDICARE CARRIER - 04312
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**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**421.46*400.39*460.45
#**G0186**363.92*345.72*397.58
**G0339**2423.13*2301.97*2647.27
**G0340**1822.37*1731.25*1990.94
**G0398**123.96*117.76*135.42
**G0398*TC*86.55*82.22*94.55
**G0398*26*37.41*35.54*40.87
**G0399**87.18*82.82*95.24
**G0399*TC*45.92*43.62*50.16
**G0399*26*41.56*39.48*45.40
**G0400**89.56*85.08*97.84
**G0400*TC*50.96*48.41*55.67
**G0400*26*38.60*36.67*42.17
**G0460**716.65*680.82*782.94
#**G0460**114.27*108.56*124.84
**G0465**716.65*680.82*782.94
#**G0465**114.27*108.56*124.84
**G0498**131.67*125.09*143.85
**G6017**72.09*68.49*78.76
**0042T**209.36*198.89*228.72
**0054T**215.64*204.86*235.59
**0055T**215.64*204.86*235.59
**0071T**539.11*512.15*588.97
**0072T**539.11*512.15*588.97
**0075T**913.81*868.12*998.34
**0075T*TC*913.81*868.12*998.34
**0075T*26*913.81*868.12*998.34
**0095T**582.84*553.70*636.76
**0098T**652.69*620.06*713.07
**0100T**1779.56*1690.58*1944.17
**0101T**290.83*276.29*317.73
#**0101T**212.23*201.62*231.86
**0102T**290.83*276.29*317.73
#**0102T**212.23*201.62*231.86
**0106T**30.09*28.59*32.88
**0107T**30.09*28.59*32.88
**0108T**30.09*28.59*32.88
**0109T**30.09*28.59*32.88
**0110T**30.09*28.59*32.88
**0164T**636.87*605.03*695.78
**0165T**652.57*619.94*712.93
**0184T**772.49*733.87*843.95
**0198T**77.79*73.90*84.99
#**0198T**30.34*28.82*33.14
**0200T**1605.84*1525.55*1754.38
#**0200T**382.10*363.00*417.45
**0201T**2408.76*2288.32*2631.57
#**0201T**573.15*544.49*626.16
**0207T**121.71*115.62*132.96
**0208T**33.79*32.10*36.92
**0209T**40.90*38.86*44.69
**0210T**25.78*24.49*28.16
**0211T**40.01*38.01*43.71
**0212T**34.45*32.73*37.64
#**0212T**30.00*28.50*32.78
**0213T**177.86*168.97*194.32
#**0213T**99.27*94.31*108.46
**0214T**90.50*85.98*98.88
#**0214T**56.10*53.30*61.30
**0215T**90.80*86.26*99.20
#**0215T**56.99*54.14*62.26
**0216T**163.21*155.05*178.31
#**0216T**85.21*80.95*93.09
**0217T**84.34*80.12*92.14
#**0217T**48.15*45.74*52.60
**0218T**84.34*80.12*92.14
#**0218T**49.04*46.59*53.58
**0219T**1224.71*1163.47*1337.99
**0220T**1204.45*1144.23*1315.86
**0221T**1485.29*1411.03*1622.68
**0222T**364.94*346.69*398.69
**0232T**716.65*680.82*782.94
#**0232T**114.27*108.56*124.84
**0234T**7649.55*7267.07*8357.13
#**0234T**552.40*524.78*603.50
**0235T**7649.55*7267.07*8357.13
#**0235T**552.40*524.78*603.50
**0236T**7789.50*7400.03*8510.03
#**0236T**640.46*608.44*699.71
**0237T**7789.50*7400.03*8510.03
#**0237T**640.46*608.44*699.71
**0238T**7789.50*7400.03*8510.03
#**0238T**640.46*608.44*699.71
**0266T**841.66*799.58*919.52
**0267T**149.42*141.95*163.24
**0268T**312.61*296.98*341.53
**0269T**796.18*756.37*869.83
**0270T**149.42*141.95*163.24
**0271T**312.61*296.98*341.53
**0272T**51.34*48.77*56.09
**0273T**66.38*63.06*72.52
**0274T**1032.02*980.42*1127.48
**0278T**13.63*12.95*14.89
**0308T**1304.98*1239.73*1425.69
**0329T**77.79*73.90*84.99
#**0329T**30.34*28.82*33.14
**0330T**38.21*36.30*41.75
**0331T**165.85*157.56*181.19
**0332T**283.25*269.09*309.45
**0347T**133.55*126.87*145.90
**0348T**30.04*28.54*32.82
**0349T**31.74*30.15*34.67
**0350T**32.34*30.72*35.33
**0351T**153.76*146.07*167.98
**0352T**40.79*38.75*44.56
**0353T**153.76*146.07*167.98
**0354T**40.79*38.75*44.56
**0358T**24.00*22.80*26.22
**0362T**85.43*81.16*93.33
#**0362T**62.59*59.46*68.38
**0378T**23.61*22.43*25.79
**0394T**226.02*214.72*246.93
**0395T**551.99*524.39*603.05
**0397T**44.69*42.46*48.83
**0398T*26*1746.88*1659.54*1908.47
**0408T**478.20*454.29*522.43
**0409T**330.09*313.59*360.63
**0410T**342.75*325.61*374.45
**0411T**342.75*325.61*374.45
**0412T**214.76*204.02*234.62
**0413T**446.83*424.49*488.16
**0414T**344.13*326.92*375.96
**0415T**286.89*272.55*313.43
**0416T**316.62*300.79*345.91
**0417T**77.13*73.27*84.26
**0418T**51.34*48.77*56.09
**0419T**416.11*395.30*454.60
#**0419T**336.62*319.79*367.76
**0420T**593.07*563.42*647.93
#**0420T**494.90*470.16*540.68
**0421T**1470.08*1396.58*1606.07
#**0421T**654.75*622.01*715.31
**0437T**200.33*190.31*218.86
**0439T**65.65*62.37*71.73
**0440T**227.90*216.51*248.99
#**0440T**112.23*106.62*122.61
**0441T**227.90*216.51*248.99
#**0441T**112.23*106.62*122.61
**0442T**227.90*216.51*248.99
#**0442T**112.23*106.62*122.61
**0449T**708.96*673.51*774.54
**0464T**61.13*58.07*66.78
**0472T**61.90*58.81*67.63
**0473T**51.34*48.77*56.09
**0479T**59.80*56.81*65.33
**0480T**142.55*135.42*155.73
#**0480T**29.90*28.41*32.67
**0483T**1118.45*1062.53*1221.91
**0484T**1450.84*1378.30*1585.05
**0485T**21.86*20.77*23.89
**0485T*TC*7.83*7.44*8.56
**0485T*26*14.30*13.59*15.63
**0486T**43.73*41.54*47.77
**0486T*TC*15.40*14.63*16.82
**0486T*26*28.33*26.91*30.95
**0488T**59.21*56.25*64.69
#**0488T**47.64*45.26*52.05
**0505T**9806.39*9316.07*10713.48
#**0505T**541.66*514.58*591.77
**0507T**20.89*19.85*22.83
**0507T*TC*18.07*17.17*19.75
**0507T*26*2.82*2.68*3.08
**0510T**556.00*528.20*607.43
#**0510T**395.84*376.05*432.46
**0512T**290.83*276.29*317.73
#**0512T**212.23*201.62*231.86
**0513T**87.25*82.89*95.32
#**0513T**63.67*60.49*69.56
**0515T**478.20*454.29*522.43
**0516T**441.31*419.24*482.13
**0517T**312.61*296.98*341.53
**0518T**214.76*204.02*234.62
**0519T**313.39*297.72*342.38
**0520T**441.31*419.24*482.13
**0521T**51.34*48.77*56.09
**0521T*TC*32.01*30.41*34.97
**0521T*26*19.33*18.36*21.11
**0522T**61.90*58.81*67.63
**0522T*TC*32.60*30.97*35.62
**0522T*26*29.30*27.84*32.02
**0523T**139.80*132.81*152.73
**0524T**1472.14*1398.53*1608.31
#**0524T**166.84*158.50*182.28
**0525T**441.60*419.52*482.45
**0526T**342.75*325.61*374.45
**0527T**298.44*283.52*326.05
**0528T**61.90*58.81*67.63
**0528T*TC*32.60*30.97*35.62
**0528T*26*29.30*27.84*32.02
**0529T**51.34*48.77*56.09
**0529T*TC*32.01*30.41*34.97
**0529T*26*19.33*18.36*21.11
**0530T**586.76*557.42*641.03
**0531T**446.83*424.49*488.16
**0532T**313.39*297.72*342.38
**0540T**167.26*158.90*182.74
**0543T**1450.84*1378.30*1585.05
**0544T**1664.94*1581.69*1818.94
**0545T**1664.94*1581.69*1818.94
**0546T**66.44*63.12*72.59
**0552T**6.12*5.81*6.68
**0553T**2208.54*2098.11*2412.83
#**0553T**369.38*350.91*403.55
**0565T**567.79*539.40*620.31
#**0565T**479.11*455.15*523.42
**0566T**92.28*87.67*100.82
#**0566T**55.80*53.01*60.96
**0569T**1664.94*1581.69*1818.94
**0570T**391.25*371.69*427.44
**0571T**517.05*491.20*564.88
**0572T**421.07*400.02*460.02
**0573T**320.75*304.71*350.42
**0574T**372.31*353.69*406.74
**0575T**61.90*58.81*67.63
**0576T**51.34*48.77*56.09
**0577T**179.53*170.55*196.13
**0578T**27.88*26.49*30.46
**0579T**18.96*18.01*20.71
**0580T**198.14*188.23*216.46
**0581T**2028.04*1926.64*2215.64
#**0581T**196.88*187.04*215.10
**0582T**1493.38*1418.71*1631.52
#**0582T**360.11*342.10*393.42
**0583T**1522.66*1446.53*1663.51
#**0583T**123.33*117.16*134.73
**0587T**410.19*389.68*448.13
#**0587T**278.50*264.58*304.27
**0588T**336.77*319.93*367.92
#**0588T**216.65*205.82*236.69
**0589T**45.36*43.09*49.55
#**0589T**36.76*34.92*40.16
**0590T**53.12*50.46*58.03
#**0590T**37.99*36.09*41.50
**0596T**672.69*639.06*734.92
#**0596T**126.38*120.06*138.07
**0597T**672.69*639.06*734.92
#**0597T**126.38*120.06*138.07
**0598T**135.54*128.76*148.07
**0599T**90.45*85.93*98.82
**0600T**3231.16*3069.60*3530.04
#**0600T**688.18*653.77*751.84
**0601T**1360.30*1292.29*1486.13
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**179.51*170.53*196.11
**0611T**36.13*34.32*39.47
**0614T**343.61*326.43*375.39
**0615T**44.17*41.96*48.25
**0616T**619.66*588.68*676.98
**0617T**690.90*656.36*754.81
**0618T**835.97*794.17*913.30
**0619T**605.54*575.26*661.55
#**0619T**447.32*424.95*488.69
**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**236.22*224.41*258.07
#**0627T**93.85*89.16*102.53
**0628T**70.87*67.33*77.43
#**0628T**28.16*26.75*30.76
**0629T**236.22*224.41*258.07
#**0629T**93.85*89.16*102.53
**0630T**70.87*67.33*77.43
#**0630T**28.16*26.75*30.76
**0631T**74.04*70.34*80.89
**0632T**535.34*508.57*584.86
**0633T**183.47*174.30*200.45
*C*0633T*TC*94.88*90.14*103.66
**0633T*26*56.28*53.47*61.49
**0634T**183.47*174.30*200.45
**0634T*TC*127.19*120.83*138.95
**0634T*26*56.28*53.47*61.49
**0635T**183.47*174.30*200.45
**0635T*TC*127.19*120.83*138.95
**0635T*26*56.28*53.47*61.49
**0636T**183.47*174.30*200.45
**0636T*TC*127.19*120.83*138.95
**0636T*26*56.28*53.47*61.49
**0637T**183.47*174.30*200.45
**0637T*TC*127.19*120.83*138.95
**0637T*26*56.28*53.47*61.49
**0638T**183.47*174.30*200.45
**0638T*TC*127.19*120.83*138.95
**0638T*26*56.28*53.47*61.49
**0639T**74.04*70.34*80.89
**0640T**20.89*19.85*22.83
**0640T*TC*18.17*17.26*19.85
**0640T*26*2.82*2.68*3.08
**0644T**1048.26*995.85*1145.23
#**0644T**225.81*214.52*246.70
**0646T**1664.94*1581.69*1818.94
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**54.90*52.16*59.98
**0652T**262.87*249.73*287.19
#**0652T**114.57*108.84*125.17
**0653T**342.45*325.33*374.13
#**0653T**129.50*123.03*141.48
**0654T**133.04*126.39*145.35
**0655T**1470.08*1396.58*1606.07
#**0655T**654.75*622.01*715.31
**0658T**84.50*80.28*92.32
**0659T**2419.99*2298.99*2643.84
#**0659T**407.32*386.95*444.99
**0671T**953.33*905.66*1041.51
**0673T**3074.89*2921.15*3359.32
#**0673T**343.58*326.40*375.36
**0699T**104.89*99.65*114.60
#**0699T**85.32*81.05*93.21
**0707T**340.18*323.17*371.65
#**0707T**258.02*245.12*281.89
**0714T**1268.98*1205.53*1386.36
#**0714T**335.90*319.11*366.98
**0730T**245.97*233.67*268.72
#**0730T**221.88*210.79*242.41
**0738T**67.09*63.74*73.30
**0739T**1470.08*1396.58*1606.07
#**0739T**654.75*622.01*715.31
**0740T**17.74*16.85*19.38
**0741T**42.09*39.99*45.99
**0742T**84.97*80.72*92.83
**0742T*TC*66.69*63.36*72.86
**0742T*26*18.28*17.37*19.98
**0743T**48.47*46.05*52.96
**0744T**831.18*789.62*908.06
**0745T**228.79*217.35*249.95
**0746T**213.81*203.12*233.59
**0747T**884.68*840.45*966.52
**0748T**172.07*163.47*187.99
**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**4.00*3.80*4.37
**0765T**7.71*7.32*8.42
**0771T**25.03*23.78*27.35
**0772T**25.03*23.78*27.35
**0773T**21.39*20.32*23.37
**0774T**21.39*20.32*23.37
**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**390.94*371.39*427.10
**0779T*TC*366.26*347.95*400.14
**0779T*26*24.67*23.44*26.96
**0780T**21.39*20.32*23.37
**0783T**12.73*12.09*13.90
**0784T**1907.39*1812.02*2083.82
#**0784T**306.39*291.07*334.73
**0785T**222.80*211.66*243.41
#**0785T**135.30*128.54*147.82
**0786T**670.32*636.80*732.32
#**0786T**286.53*272.20*313.03
**0787T**222.80*211.66*243.41
#**0787T**135.30*128.54*147.82
**0788T**17.80*16.91*19.45
#**0788T**17.21*16.35*18.80
**0789T**24.48*23.26*26.75
#**0789T**21.51*20.43*23.49
**0790T**1821.08*1730.03*1989.53
**0791T**8.50*8.08*9.29
**0793T**535.34*508.57*584.86
**0794T**130.35*123.83*142.40
**0795T**661.96*628.86*723.19
**0796T**441.31*419.24*482.13
**0797T**441.31*419.24*482.13
**0798T**700.99*665.94*765.83
**0799T**467.33*443.96*510.55
**0800T**467.33*443.96*510.55
**0801T**908.64*863.21*992.69
**0802T**454.32*431.60*496.34
**0803T**454.32*431.60*496.34
**0804T**72.41*68.79*79.11
**0804T*TC*37.64*35.76*41.12
**0804T*26*34.77*33.03*37.98
**0805T**2655.55*2522.77*2901.19
#**0805T**307.44*292.07*335.88
**0806T**3540.74*3363.70*3868.26
#**0806T**409.92*389.42*447.83
**0807T**38.95*37.00*42.55
**0807T*TC*24.89*23.65*27.20
**0807T*26*14.06*13.36*15.36
**0808T**38.95*37.00*42.55
**0808T*TC*24.89*23.65*27.20
**0808T*26*14.06*13.36*15.36
**0810T**1058.70*1005.77*1156.64
**0811T**17.74*16.85*19.38
**0813T**2322.91*2206.76*2537.77
#**0813T**169.06*160.61*184.70
**0814T**425.22*403.96*464.55
#**0814T**322.53*306.40*352.36
**0818T**336.77*319.93*367.92
#**0818T**216.65*205.82*236.69
**0820T**142.14*135.03*155.28
#**0820T**126.42*120.10*138.12
**0821T**142.14*135.03*155.28
#**0821T**126.42*120.10*138.12
**0822T**120.82*114.78*132.00
#**0822T**107.46*102.09*117.40
**0823T**661.96*628.86*723.19
**0824T**700.99*665.94*765.83
**0825T**908.64*863.21*992.69
**0826T**61.90*58.81*67.63
**0826T*TC*32.60*30.97*35.62
**0826T*26*29.30*27.84*32.02
**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**20.89*19.85*22.83
**0859T*TC*18.07*17.17*19.75
**0859T*26*2.82*2.68*3.08
**0864T**290.83*276.29*317.73
#**0864T**212.23*201.62*231.86
**10011**386.97*367.62*422.76
#**10011**102.54*97.41*112.02
**10012**214.54*203.81*234.38
#**10012**68.62*65.19*74.97
**15847**329.10*312.65*359.55
**21742**1086.19*1031.88*1186.66
**21743**1245.89*1183.60*1361.14
**32855**318.72*302.78*348.20
**32856**424.73*403.49*464.01
**33928**3120.79*2964.75*3409.46
**33929**1169.14*1110.68*1277.28
**33933**488.17*463.76*533.32
**33944**488.17*463.76*533.32
**34841**1933.03*1836.38*2111.84
**34842**2158.80*2050.86*2358.49
**34843**2384.58*2265.35*2605.15
**34844**2610.35*2479.83*2851.80
**34845**1933.03*1836.38*2111.84
**34846**2158.80*2050.86*2358.49
**34847**2384.58*2265.35*2605.15
**34848**2610.35*2479.83*2851.80
**43496**1882.70*1788.57*2056.86
**43647**442.49*420.37*483.43
**43648**477.31*453.44*521.46
#**43648**217.91*207.01*238.06
**43881**595.57*565.79*650.66
#**43881**546.88*519.54*597.47
**43882**629.04*597.59*687.23
#**43882**576.61*547.78*629.95
**47143**385.36*366.09*421.00
**47144**457.61*434.73*499.94
**47145**433.53*411.85*473.63
**48551**241.38*229.31*263.71
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**715.12*679.36*781.26
**53452**357.56*339.68*390.63
**53453**607.71*577.32*663.92
**53454**52.80*50.16*57.68
#**53454**33.53*31.85*36.63
**63043**531.86*505.27*581.06
**63044**459.74*436.75*502.26
**64596**1907.39*1812.02*2083.82
#**64596**306.39*291.07*334.73
**64597**572.22*543.61*625.15
#**64597**91.92*87.32*100.42
**64598**222.80*211.66*243.41
#**64598**135.30*128.54*147.82
**65757**111.74*106.15*122.07
**66983**619.66*588.68*676.98
**66987**722.24*686.13*789.05
**66988**598.43*568.51*653.79
*C*70170**225.23*213.97*246.07
*C*70170*TC*211.44*200.87*231.00
**70555**233.47*221.80*255.07
**70555*TC*120.76*114.72*131.93
*C*70557**619.65*588.67*676.97
*C*70557*TC*476.00*452.20*520.03
*C*70558**317.01*301.16*346.33
*C*70558*TC*158.65*150.72*173.33
*C*70559**307.80*292.41*336.27
*C*70559*TC*158.65*150.72*173.33
*C*74190**496.95*472.10*542.92
*C*74190*TC*476.00*452.20*520.03
**74235**132.11*125.50*144.33
**74235*TC*78.42*74.50*85.68
**74300**75.46*71.69*82.44
**74300*TC*62.97*59.82*68.79
**74301**23.20*22.04*25.35
**74301*TC*13.86*13.17*15.15
**74328**175.06*166.31*191.26
**74328*TC*153.24*145.58*167.42
**74329**126.86*120.52*138.60
**74329*TC*104.74*99.50*114.43
**74330**262.59*249.46*286.88
**74330*TC*236.91*225.06*258.82
**74340**86.58*82.25*94.59
**74340*TC*62.45*59.33*68.23
**74355**86.58*82.25*94.59
**74355*TC*52.19*49.58*57.02
**74360**86.58*82.25*94.59
**74360*TC*61.02*57.97*66.67
**74363**175.06*166.31*191.26
**74363*TC*135.81*129.02*148.37
*C*74445**145.78*138.49*159.26
*C*74445*TC*94.88*90.14*103.66
*C*74450**226.26*214.95*247.19
*C*74450*TC*211.44*200.87*231.00
*C*74470**499.54*474.56*545.74
*C*74470*TC*476.00*452.20*520.03
**74742**233.47*221.80*255.07
**74742*TC*205.83*195.54*224.87
*C*74775**239.42*227.45*261.57
*C*74775*TC*211.44*200.87*231.00
*C*75801**582.12*553.01*635.96
*C*75801*TC*542.14*515.03*592.28
*C*75803**1435.12*1363.36*1567.86
*C*75803*TC*1382.09*1312.99*1509.94
*C*75805**2787.51*2648.13*3045.35
*C*75805*TC*2750.86*2613.32*3005.32
*C*75807**2800.87*2660.83*3059.95
*C*75807*TC*2750.86*2613.32*3005.32
*C*75810**2796.85*2657.01*3055.56
*C*75810*TC*2750.86*2613.32*3005.32
**75894**797.42*757.55*871.18
**75894*TC*730.79*694.25*798.39
*C*75898**2835.70*2693.92*3098.01
*C*75898*TC*2750.86*2613.32*3005.32
**75970**389.94*370.44*426.01
**75970*TC*354.16*336.45*386.92
**76125**35.82*34.03*39.13
**76125*TC*23.33*22.16*25.48
**76390**184.61*175.38*201.69
**76390*TC*135.62*128.84*148.17
**76390*26*48.99*46.54*53.52
**76932**76.77*72.93*83.87
**76932*TC*43.13*40.97*47.12
**76940**144.77*137.53*158.16
**76940*TC*50.42*47.90*55.09
**76941**106.22*100.91*116.05
**76941*TC*45.38*43.11*49.58
**76945**75.92*72.12*82.94
**76945*TC*45.64*43.36*49.86
*C*76975**249.90*237.41*273.02
*C*76975*TC*211.44*200.87*231.00
**76998**175.06*166.31*191.26
**76998*TC*131.24*124.68*143.38
**77013**377.42*358.55*412.33
**77013*TC*204.32*194.10*223.22
**77022**426.54*405.21*465.99
**77022*TC*237.92*226.02*259.92
**77371**527.20*500.84*575.97
**77520**765.00*726.75*835.76
**77522**765.00*726.75*835.76
**77523**878.42*834.50*959.68
**77525**991.87*942.28*1083.62
*C*78282**370.58*352.05*404.86
*C*78282*TC*355.88*338.09*388.80
**78414**514.99*489.24*562.63
**78414*TC*494.99*470.24*540.78
*C*78429**1425.10*1353.85*1556.93
*C*78429*TC*1350.06*1282.56*1474.94
*C*78430**1421.54*1350.46*1553.03
*C*78430*TC*1350.06*1282.56*1474.94
*C*78431**2121.71*2015.62*2317.96
*C*78431*TC*2038.45*1936.53*2227.01
*C*78432**1765.20*1676.94*1928.48
*C*78432*TC*1676.01*1592.21*1831.04
*C*78433**1864.33*1771.11*2036.78
*C*78433*TC*1766.77*1678.43*1930.19
**78434**626.12*594.81*684.03
**78434*TC*598.68*568.75*654.06
*C*78459**1294.94*1230.19*1414.72
*C*78459*TC*1225.49*1164.22*1338.85
*C*78491**1418.17*1347.26*1549.35
*C*78491*TC*1350.06*1282.56*1474.94
*C*78492**1429.99*1358.49*1562.26
*C*78492*TC*1350.06*1282.56*1474.94
*C*78608**1415.55*1344.77*1546.49
*C*78608*TC*1350.06*1282.56*1474.94
*C*78811**1292.88*1228.24*1412.48
*C*78811*TC*1225.49*1164.22*1338.85
*C*78812**1435.13*1363.37*1567.88
*C*78812*TC*1350.06*1282.56*1474.94
*C*78813**1437.16*1365.30*1570.10
*C*78813*TC*1350.06*1282.56*1474.94
*C*78814**1446.46*1374.14*1580.26
*C*78814*TC*1350.06*1282.56*1474.94
*C*78815**1457.39*1384.52*1592.20
*C*78815*TC*1350.06*1282.56*1474.94
*C*78816**1458.53*1385.60*1593.44
*C*78816*TC*1350.06*1282.56*1474.94
**79300**237.04*225.19*258.97
**79300*TC*175.82*167.03*192.08
**79445**237.04*225.19*258.97
**79445*TC*133.49*126.82*145.84
**86485**17.28*16.42*18.88
**90867**273.41*259.74*298.70
#**90867**127.93*121.53*139.76
**90868**185.83*176.54*203.02
#**90868**100.59*95.56*109.89
**90869**257.13*244.27*280.91
#**90869**149.64*142.16*163.48
**92978**220.97*209.92*241.41
**92978*TC*133.46*126.79*145.81
**92979**135.36*128.59*147.88
**92979*TC*65.86*62.57*71.96
*C*93315**594.97*565.22*650.00
*C*93315*TC*476.00*452.20*520.03
**93317**193.65*183.97*211.57
**93317*TC*111.06*105.51*121.34
*C*93318**571.58*543.00*624.45
*C*93318*TC*476.00*452.20*520.03
**93571**220.10*209.10*240.47
**93571*TC*153.46*145.79*167.66
**93572**133.34*126.67*145.67
**93572*TC*84.83*80.59*92.68
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.91*3278.36*3770.11
**93602**3557.81*3379.92*3886.91
**93602*TC*3452.64*3280.01*3772.01
**93603**3557.81*3379.92*3886.91
**93603*TC*3452.64*3280.01*3772.01
**93609**2134.69*2027.96*2332.15
**93609*TC*1883.83*1789.64*2058.09
**93610**3557.81*3379.92*3886.91
**93610*TC*3409.15*3238.69*3724.49
**93612**3557.81*3379.92*3886.91
**93612*TC*3411.15*3240.59*3726.68
**93615**45.03*42.78*49.20
**93615*TC*11.81*11.22*12.90
**93619**7115.62*6759.84*7773.82
**93619*TC*6761.27*6423.21*7386.69
**93620**7115.62*6759.84*7773.82
**93620*TC*6547.15*6219.79*7152.76
**93621**7115.62*6759.84*7773.82
**93621*TC*7040.05*6688.05*7691.26
**93622**7115.62*6759.84*7773.82
**93622*TC*6959.68*6611.70*7603.46
**93623**2134.69*2027.96*2332.15
**93623*TC*2072.90*1969.26*2264.65
**93624**3557.81*3379.92*3886.91
**93624*TC*3336.86*3170.02*3645.52
**93631**7115.62*6759.84*7773.82
**93631*TC*6751.30*6413.74*7375.80
**93640**1133.95*1077.25*1238.84
**93640*TC*971.55*922.97*1061.42
**93641**1133.95*1077.25*1238.84
**93641*TC*850.19*807.68*928.83
**93662**377.49*358.62*412.41
**93662*TC*311.57*295.99*340.39
**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**884.81*840.57*966.66
**95965*TC*505.04*479.79*551.76
**95966**528.68*502.25*577.59
**95966*TC*345.30*328.04*377.25
**95967**444.52*422.29*485.63
**95967*TC*285.34*271.07*311.73
**96020**376.79*357.95*411.64
**96547**671.10*637.55*733.18
#**96547**126.26*119.95*137.94
**96548**335.55*318.77*366.59
#**96548**63.13*59.97*68.97
**97151**47.94*45.54*52.37
#**97151**42.90*40.76*46.87
**97152**40.75*38.71*44.52
#**97152**36.47*34.65*39.85
**97153**32.51*30.88*35.51
#**97153**28.81*27.37*31.48
**97154**4.39*4.17*4.80
#**97154**4.01*3.81*4.38
**97155**32.51*30.88*35.51
#**97155**28.81*27.37*31.48
**97156**34.33*32.61*37.50
#**97156**30.47*28.95*33.29
**97157**9.97*9.47*10.89
#**97157**9.08*8.63*9.92
**97158**5.12*4.86*5.59
#**97158**4.67*4.44*5.11
**98978**42.09*39.99*45.99
# - 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.