NEW MEXICO MEDICARE CARRIER - 04212
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**430.69*409.16*470.53
#**G0186**372.05*353.45*406.47
**G0339**2593.52*2463.84*2833.42
**G0340**1950.66*1853.13*2131.10
**G0398**126.36*120.04*138.05
**G0398*TC*88.43*84.01*96.61
**G0398*26*37.93*36.03*41.43
**G0399**88.82*84.38*97.04
**G0399*TC*47.02*44.67*51.37
**G0399*26*42.10*40.00*46.00
**G0400**91.30*86.74*99.75
**G0400*TC*52.16*49.55*56.98
**G0400*26*39.14*37.18*42.76
**G0460**733.13*696.47*800.94
#**G0460**119.25*113.29*130.28
**G0465**733.13*696.47*800.94
#**G0465**119.25*113.29*130.28
**G0498**134.85*128.11*147.33
**G6017**73.76*70.07*80.58
**0042T**212.93*202.28*232.62
**0054T**232.81*221.17*254.35
**0055T**232.81*221.17*254.35
**0071T**561.12*533.06*613.02
**0072T**561.12*533.06*613.02
**0075T**972.34*923.72*1062.28
**0075T*TC*972.34*923.72*1062.28
**0075T*26*972.34*923.72*1062.28
**0095T**630.38*598.86*688.69
**0098T**706.46*671.14*771.81
**0100T**1820.79*1729.75*1989.21
**0101T**297.62*282.74*325.15
#**0101T**217.52*206.64*237.64
**0102T**297.62*282.74*325.15
#**0102T**217.52*206.64*237.64
**0106T**30.86*29.32*33.72
**0107T**30.86*29.32*33.72
**0108T**30.86*29.32*33.72
**0109T**30.86*29.32*33.72
**0110T**30.86*29.32*33.72
**0164T**688.32*653.90*751.99
**0165T**705.46*670.19*770.72
**0184T**804.11*763.90*878.49
**0198T**79.12*75.16*86.43
#**0198T**30.76*29.22*33.60
**0200T**1644.05*1561.85*1796.13
#**0200T**396.97*377.12*433.69
**0201T**2466.08*2342.78*2694.20
#**0201T**595.45*565.68*650.53
**0207T**121.71*115.62*132.96
**0208T**34.54*32.81*37.73
**0209T**41.80*39.71*45.67
**0210T**26.38*25.06*28.82
**0211T**40.89*38.85*44.68
**0212T**34.96*33.21*38.19
#**0212T**30.42*28.90*33.24
**0213T**182.16*173.05*199.01
#**0213T**102.06*96.96*111.50
**0214T**92.86*88.22*101.45
#**0214T**57.80*54.91*63.15
**0215T**93.17*88.51*101.79
#**0215T**58.71*55.77*64.14
**0216T**167.07*158.72*182.53
#**0216T**87.58*83.20*95.68
**0217T**86.46*82.14*94.46
#**0217T**49.58*47.10*54.17
**0218T**86.46*82.14*94.46
#**0218T**50.49*47.97*55.17
**0219T**1307.00*1241.65*1427.90
**0220T**1282.31*1218.19*1400.92
**0221T**1575.75*1496.96*1721.50
**0222T**391.60*372.02*427.82
**0232T**733.13*696.47*800.94
#**0232T**119.25*113.29*130.28
**0234T**7817.08*7426.23*8540.16
#**0234T**584.52*555.29*638.58
**0235T**7817.08*7426.23*8540.16
#**0235T**584.52*555.29*638.58
**0236T**7961.26*7563.20*8697.68
#**0236T**675.81*642.02*738.32
**0237T**7961.26*7563.20*8697.68
#**0237T**675.81*642.02*738.32
**0238T**7961.26*7563.20*8697.68
#**0238T**675.81*642.02*738.32
**0266T**887.11*842.75*969.16
**0267T**157.54*149.66*172.11
**0268T**329.05*312.60*359.49
**0269T**838.77*796.83*916.35
**0270T**157.54*149.66*172.11
**0271T**329.05*312.60*359.49
**0272T**52.27*49.66*57.11
**0273T**67.63*64.25*73.89
**0274T**1098.15*1043.24*1199.73
**0278T**13.85*13.16*15.13
**0308T**1335.06*1268.31*1458.56
**0329T**79.12*75.16*86.43
#**0329T**30.76*29.22*33.60
**0330T**38.21*36.30*41.75
**0331T**169.30*160.84*184.97
**0332T**288.92*274.47*315.64
**0347T**140.12*133.11*153.08
**0348T**30.71*29.17*33.55
**0349T**32.46*30.84*35.47
**0350T**33.07*31.42*36.13
**0351T**156.65*148.82*171.14
**0352T**41.40*39.33*45.23
**0353T**156.65*148.82*171.14
**0354T**41.40*39.33*45.23
**0358T**24.57*23.34*26.84
**0362T**87.37*83.00*95.45
#**0362T**64.10*60.90*70.04
**0378T**24.10*22.90*26.34
**0394T**230.69*219.16*252.03
**0395T**563.20*535.04*615.30
**0397T**45.54*43.26*49.75
**0398T*26*1746.88*1659.54*1908.47
**0408T**503.98*478.78*550.60
**0409T**347.16*329.80*379.27
**0410T**360.24*342.23*393.56
**0411T**360.24*342.23*393.56
**0412T**225.10*213.85*245.93
**0413T**470.28*446.77*513.79
**0414T**362.11*344.00*395.60
**0415T**302.16*287.05*330.11
**0416T**332.39*315.77*363.14
**0417T**78.52*74.59*85.78
**0418T**52.27*49.66*57.11
**0419T**427.06*405.71*466.57
#**0419T**346.06*328.76*378.07
**0420T**611.40*580.83*667.95
#**0420T**511.36*485.79*558.66
**0421T**1507.45*1432.08*1646.89
#**0421T**676.57*642.74*739.15
**0437T**209.95*199.45*229.37
**0439T**67.71*64.32*73.97
**0440T**233.39*221.72*254.98
#**0440T**115.51*109.73*126.19
**0441T**233.39*221.72*254.98
#**0441T**115.51*109.73*126.19
**0442T**233.39*221.72*254.98
#**0442T**115.51*109.73*126.19
**0449T**725.18*688.92*792.26
**0464T**62.30*59.19*68.07
**0472T**63.01*59.86*68.84
**0473T**52.27*49.66*57.11
**0479T**60.78*57.74*66.40
**0480T**145.11*137.85*158.53
#**0480T**30.39*28.87*33.20
**0483T**1185.43*1126.16*1295.08
**0484T**1537.40*1460.53*1679.61
**0485T**22.22*21.11*24.28
**0485T*TC*8.10*7.70*8.86
**0485T*26*14.52*13.79*15.86
**0486T**44.45*42.23*48.56
**0486T*TC*15.80*15.01*17.26
**0486T*26*28.64*27.21*31.29
**0488T**60.50*57.48*66.10
#**0488T**48.71*46.27*53.21
**0505T**10144.72*9637.48*11083.10
#**0505T**568.03*539.63*620.57
**0507T**21.49*20.42*23.48
**0507T*TC*18.53*17.60*20.24
**0507T*26*2.96*2.81*3.23
**0510T**574.94*546.19*628.12
#**0510T**411.73*391.14*449.81
**0512T**297.62*282.74*325.15
#**0512T**217.52*206.64*237.64
**0513T**89.29*84.83*97.55
#**0513T**65.26*62.00*71.30
**0515T**503.98*478.78*550.60
**0516T**465.01*441.76*508.02
**0517T**329.05*312.60*359.49
**0518T**225.10*213.85*245.93
**0519T**329.87*313.38*360.39
**0520T**465.01*441.76*508.02
**0521T**52.27*49.66*57.11
**0521T*TC*32.73*31.09*35.75
**0521T*26*19.54*18.56*21.34
**0522T**63.01*59.86*68.84
**0522T*TC*33.34*31.67*36.42
**0522T*26*29.67*28.19*32.42
**0523T**144.52*137.29*157.88
**0524T**1506.23*1430.92*1645.56
#**0524T**176.03*167.23*192.31
**0525T**465.31*442.04*508.35
**0526T**360.24*342.23*393.56
**0527T**314.10*298.40*343.16
**0528T**63.01*59.86*68.84
**0528T*TC*33.34*31.67*36.42
**0528T*26*29.67*28.19*32.42
**0529T**52.27*49.66*57.11
**0529T*TC*32.73*31.09*35.75
**0529T*26*19.54*18.56*21.34
**0530T**617.50*586.63*674.62
**0531T**470.28*446.77*513.79
**0532T**329.87*313.38*360.39
**0540T**170.84*162.30*186.65
**0543T**1537.40*1460.53*1679.61
**0544T**1761.06*1673.01*1923.96
**0545T**1761.06*1673.01*1923.96
**0546T**67.46*64.09*73.70
**0552T**6.32*6.00*6.90
**0553T**2265.56*2152.28*2475.12
#**0553T**391.30*371.74*427.50
**0565T**588.64*559.21*643.09
#**0565T**498.27*473.36*544.36
**0566T**95.06*90.31*103.86
#**0566T**57.88*54.99*63.24
**0569T**1761.06*1673.01*1923.96
**0570T**414.38*393.66*452.71
**0571T**544.68*517.45*595.07
**0572T**444.01*421.81*485.08
**0573T**337.60*320.72*368.83
**0574T**392.55*372.92*428.86
**0575T**63.01*59.86*68.84
**0576T**52.27*49.66*57.11
**0577T**182.17*173.06*199.02
**0578T**28.48*27.06*31.12
**0579T**19.43*18.46*21.23
**0580T**207.99*197.59*227.23
**0581T**2075.25*1971.49*2267.21
#**0581T**209.16*198.70*228.51
**0582T**1526.46*1450.14*1667.66
#**0582T**371.56*352.98*405.93
**0583T**1522.66*1446.53*1663.51
#**0583T**127.34*120.97*139.12
**0587T**423.12*401.96*462.25
#**0587T**288.92*274.47*315.64
**0588T**347.19*329.83*379.30
#**0588T**224.78*213.54*245.57
**0589T**46.53*44.20*50.83
#**0589T**37.76*35.87*41.25
**0590T**54.54*51.81*59.58
#**0590T**39.12*37.16*42.73
**0596T**672.69*639.06*734.92
#**0596T**128.89*122.45*140.82
**0597T**672.69*639.06*734.92
#**0597T**128.89*122.45*140.82
**0598T**138.19*131.28*150.97
**0599T**92.13*87.52*100.65
**0600T**3301.37*3136.30*3606.75
#**0600T**709.87*674.38*775.54
**0601T**1438.58*1366.65*1571.65
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**183.13*173.97*200.07
**0611T**37.05*35.20*40.48
**0614T**361.57*343.49*395.01
**0615T**44.93*42.68*49.08
**0616T**632.13*600.52*690.60
**0617T**706.61*671.28*771.97
**0618T**855.11*812.35*934.20
**0619T**622.80*591.66*680.41
#**0619T**461.58*438.50*504.28
**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**241.64*229.56*263.99
#**0627T**96.56*91.73*105.49
**0628T**72.49*68.87*79.20
#**0628T**28.97*27.52*31.65
**0629T**241.64*229.56*263.99
#**0629T**96.56*91.73*105.49
**0630T**72.49*68.87*79.20
#**0630T**28.97*27.52*31.65
**0631T**75.86*72.07*82.88
**0632T**565.57*537.29*617.88
**0633T**187.09*177.74*204.40
*C*0633T*TC*96.81*91.97*105.77
**0633T*26*57.25*54.39*62.55
**0634T**187.09*177.74*204.40
**0634T*TC*129.84*123.35*141.85
**0634T*26*57.25*54.39*62.55
**0635T**187.09*177.74*204.40
**0635T*TC*129.84*123.35*141.85
**0635T*26*57.25*54.39*62.55
**0636T**187.09*177.74*204.40
**0636T*TC*129.84*123.35*141.85
**0636T*26*57.25*54.39*62.55
**0637T**187.09*177.74*204.40
**0637T*TC*129.84*123.35*141.85
**0637T*26*57.25*54.39*62.55
**0638T**187.09*177.74*204.40
**0638T*TC*129.84*123.35*141.85
**0638T*26*57.25*54.39*62.55
**0639T**75.86*72.07*82.88
**0640T**21.49*20.42*23.48
**0640T*TC*18.68*17.75*20.41
**0640T*26*2.96*2.81*3.23
**0644T**1076.68*1022.85*1176.28
#**0644T**238.54*226.61*260.60
**0646T**1761.06*1673.01*1923.96
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**55.96*53.16*61.13
**0652T**269.53*256.05*294.46
#**0652T**118.40*112.48*129.35
**0653T**350.89*333.35*383.35
#**0653T**133.88*127.19*146.27
**0654T**137.77*130.88*150.51
**0655T**1507.45*1432.08*1646.89
#**0655T**676.57*642.74*739.15
**0658T**86.23*81.92*94.21
**0659T**2482.44*2358.32*2712.07
#**0659T**431.37*409.80*471.27
**0671T**975.14*926.38*1065.34
**0673T**3141.45*2984.38*3432.04
#**0673T**358.02*340.12*391.14
**0699T**107.24*101.88*117.16
#**0699T**87.29*82.93*95.37
**0707T**348.96*331.51*381.24
#**0707T**265.24*251.98*289.78
**0714T**1297.29*1232.43*1417.29
#**0714T**346.41*329.09*378.45
**0730T**251.42*238.85*274.68
#**0730T**226.92*215.57*247.91
**0738T**68.46*65.04*74.80
**0739T**1507.45*1432.08*1646.89
#**0739T**676.57*642.74*739.15
**0740T**18.31*17.39*20.00
**0741T**43.01*40.86*46.99
**0742T**86.68*82.35*94.70
**0742T*TC*68.14*64.73*74.44
**0742T*26*18.54*17.61*20.25
**0743T**49.54*47.06*54.12
**0744T**884.25*840.04*966.05
**0745T**233.95*222.25*255.59
**0746T**217.23*206.37*237.33
**0747T**904.41*859.19*988.07
**0748T**179.00*170.05*195.56
**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**4.11*3.90*4.49
**0765T**7.86*7.47*8.59
**0771T**25.91*24.61*28.30
**0772T**25.91*24.61*28.30
**0773T**21.80*20.71*23.82
**0774T**21.80*20.71*23.82
**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**398.41*378.49*435.26
**0779T*TC*373.37*354.70*407.91
**0779T*26*25.04*23.79*27.36
**0780T**21.80*20.71*23.82
**0783T**13.08*12.43*14.29
**0784T**1947.21*1849.85*2127.33
#**0784T**315.67*299.89*344.87
**0785T**229.14*217.68*250.33
#**0785T**139.97*132.97*152.92
**0786T**688.11*653.70*751.76
#**0786T**297.00*282.15*324.47
**0787T**229.14*217.68*250.33
#**0787T**139.97*132.97*152.92
**0788T**18.26*17.35*19.95
#**0788T**17.66*16.78*19.30
**0789T**26.05*24.75*28.46
#**0789T**22.07*20.97*24.12
**0790T**1875.26*1781.50*2048.73
**0791T**8.69*8.26*9.50
**0793T**565.57*537.29*617.88
**0794T**130.35*123.83*142.40
**0795T**697.52*662.64*762.04
**0796T**465.01*441.76*508.02
**0797T**465.01*441.76*508.02
**0798T**740.31*703.29*808.78
**0799T**493.54*468.86*539.19
**0800T**493.54*468.86*539.19
**0801T**958.55*910.62*1047.21
**0802T**479.28*455.32*523.62
**0803T**479.28*455.32*523.62
**0804T**73.65*69.97*80.47
**0804T*TC*38.47*36.55*42.03
**0804T*26*35.18*33.42*38.43
**0805T**2712.78*2577.14*2963.71
#**0805T**319.86*303.87*349.45
**0806T**3617.04*3436.19*3951.62
#**0806T**426.48*405.16*465.93
**0807T**39.96*37.96*43.65
**0807T*TC*25.48*24.21*27.84
**0807T*26*14.48*13.76*15.82
**0808T**39.96*37.96*43.65
**0808T*TC*25.48*24.21*27.84
**0808T*26*14.48*13.76*15.82
**0810T**1083.17*1029.01*1183.36
**0811T**18.31*17.39*20.00
**0813T**2373.14*2254.48*2592.65
#**0813T**178.20*169.29*194.68
**0814T**436.20*414.39*476.55
#**0814T**331.55*314.97*362.22
**0818T**347.19*329.83*379.30
#**0818T**224.78*213.54*245.57
**0820T**143.91*136.71*157.22
#**0820T**127.89*121.50*139.73
**0821T**143.91*136.71*157.22
#**0821T**127.89*121.50*139.73
**0822T**122.33*116.21*133.64
#**0822T**108.71*103.27*118.76
**0823T**697.52*662.64*762.04
**0824T**740.31*703.29*808.78
**0825T**958.55*910.62*1047.21
**0826T**63.01*59.86*68.84
**0826T*TC*33.34*31.67*36.42
**0826T*26*29.67*28.19*32.42
**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**21.49*20.42*23.48
**0859T*TC*18.53*17.60*20.24
**0859T*26*2.96*2.81*3.23
**0864T**297.62*282.74*325.15
#**0864T**217.52*206.64*237.64
**10011**395.43*375.66*432.01
#**10011**105.57*100.29*115.33
**10012**219.99*208.99*240.34
#**10012**71.28*67.72*77.88
**15847**343.72*326.53*375.51
**21742**1143.70*1086.52*1249.50
**21743**1319.72*1253.73*1441.79
**32855**344.68*327.45*376.57
**32856**451.17*428.61*492.90
**33928**3313.90*3148.21*3620.44
**33929**1240.94*1178.89*1355.72
**33933**529.04*502.59*577.98
**33944**529.04*502.59*577.98
**34841**2081.49*1977.42*2274.03
**34842**2307.25*2191.89*2520.67
**34843**2533.03*2406.38*2767.34
**34844**2758.81*2620.87*3014.00
**34845**2081.49*1977.42*2274.03
**34846**2307.25*2191.89*2520.67
**34847**2533.03*2406.38*2767.34
**34848**2758.81*2620.87*3014.00
**43496**2032.41*1930.79*2220.41
**43647**442.49*420.37*483.43
**43648**511.84*486.25*559.19
#**43648**232.48*220.86*253.99
**43881**652.36*619.74*712.70
#**43881**600.24*570.23*655.76
**43882**688.41*653.99*752.09
#**43882**632.30*600.69*690.79
**47143**414.19*393.48*452.50
**47144**491.86*467.27*537.36
**47145**465.96*442.66*509.06
**48551**259.86*246.87*283.90
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**738.68*701.75*807.01
**53452**369.34*350.87*403.50
**53453**627.75*596.36*685.81
**53454**54.05*51.35*59.05
#**53454**34.41*32.69*37.59
**63043**577.25*548.39*630.65
**63044**503.36*478.19*549.92
**64596**1947.21*1849.85*2127.33
#**64596**315.67*299.89*344.87
**64597**584.16*554.95*638.19
#**64597**94.70*89.97*103.47
**64598**229.14*217.68*250.33
#**64598**139.97*132.97*152.92
**65757**115.31*109.54*125.97
**66983**632.13*600.52*690.60
**66987**740.30*703.29*808.78
**66988**610.71*580.17*667.20
*C*70170**229.68*218.20*250.93
*C*70170*TC*215.59*204.81*235.53
**70555**233.47*221.80*255.07
**70555*TC*118.85*112.91*129.85
*C*70557**631.24*599.68*689.63
*C*70557*TC*485.20*460.94*530.08
*C*70558**322.74*306.60*352.59
*C*70558*TC*161.79*153.70*176.76
*C*70559**314.73*298.99*343.84
*C*70559*TC*161.79*153.70*176.76
*C*74190**506.58*481.25*553.44
*C*74190*TC*485.20*460.94*530.08
**74235**136.13*129.32*148.72
**74235*TC*81.48*77.41*89.02
**74300**77.04*73.19*84.17
**74300*TC*64.25*61.04*70.20
**74301**23.92*22.72*26.13
**74301*TC*14.42*13.70*15.76
**74328**175.06*166.31*191.26
**74328*TC*152.89*145.25*167.04
**74329**131.09*124.54*143.22
**74329*TC*108.62*103.19*118.67
**74330**262.59*249.46*286.88
**74330*TC*236.43*224.61*258.30
**74340**86.58*82.25*94.59
**74340*TC*61.99*58.89*67.72
**74355**86.58*82.25*94.59
**74355*TC*51.56*48.98*56.33
**74360**86.58*82.25*94.59
**74360*TC*60.31*57.29*65.88
**74363**175.06*166.31*191.26
**74363*TC*135.05*128.30*147.55
*C*74445**148.41*140.99*162.14
*C*74445*TC*96.81*91.97*105.77
*C*74450**230.59*219.06*251.92
*C*74450*TC*215.59*204.81*235.53
*C*74470**509.18*483.72*556.28
*C*74470*TC*485.20*460.94*530.08
**74742**233.47*221.80*255.07
**74742*TC*205.34*195.07*224.33
*C*74775**244.05*231.85*266.63
*C*74775*TC*215.59*204.81*235.53
*C*75801**594.31*564.59*649.28
*C*75801*TC*552.60*524.97*603.72
*C*75803**1462.56*1389.43*1597.84
*C*75803*TC*1408.58*1338.15*1538.87
*C*75805**2840.75*2698.71*3103.52
*C*75805*TC*2803.46*2663.29*3062.78
*C*75807**2854.60*2711.87*3118.65
*C*75807*TC*2803.46*2663.29*3062.78
*C*75810**2850.75*2708.21*3114.44
*C*75810*TC*2803.46*2663.29*3062.78
**75894**827.00*785.65*903.50
**75894*TC*756.84*719.00*826.85
*C*75898**2892.98*2748.33*3160.58
*C*75898*TC*2803.46*2663.29*3062.78
**75970**404.06*383.86*441.44
**75970*TC*367.44*349.07*401.43
**76125**37.01*35.16*40.43
**76125*TC*24.22*23.01*26.46
**76390**188.34*178.92*205.76
**76390*TC*138.42*131.50*151.23
**76390*26*49.92*47.42*54.53
**76932**79.17*75.21*86.49
**76932*TC*44.29*42.08*48.39
**76940**153.03*145.38*167.19
**76940*TC*55.07*52.32*60.17
**76941**109.10*103.65*119.20
**76941*TC*47.61*45.23*52.01
**76945**78.19*74.28*85.42
**76945*TC*47.64*45.26*52.05
*C*76975**254.61*241.88*278.16
*C*76975*TC*215.59*204.81*235.53
**76998**175.06*166.31*191.26
**76998*TC*129.16*122.70*141.11
**77013**384.59*365.36*420.16
**77013*TC*207.87*197.48*227.10
**77022**433.70*412.02*473.82
**77022*TC*241.66*229.58*264.02
**77371**564.54*536.31*616.76
**77520**818.99*778.04*894.75
**77522**818.99*778.04*894.75
**77523**940.38*893.36*1027.36
**77525**1061.74*1008.65*1159.95
*C*78282**377.64*358.76*412.57
*C*78282*TC*362.79*344.65*396.35
**78414**514.99*489.24*562.63
**78414*TC*494.78*470.04*540.55
*C*78429**1451.97*1379.37*1586.28
*C*78429*TC*1375.93*1307.13*1503.20
*C*78430**1448.28*1375.87*1582.25
*C*78430*TC*1375.93*1307.13*1503.20
*C*78431**2161.78*2053.69*2361.74
*C*78431*TC*2077.46*1973.59*2269.63
*C*78432**1798.48*1708.56*1964.84
*C*78432*TC*1708.11*1622.70*1866.11
*C*78433**1899.50*1804.53*2075.21
*C*78433*TC*1800.59*1710.56*1967.14
**78434**637.95*606.05*696.96
**78434*TC*610.15*579.64*666.59
*C*78459**1319.43*1253.46*1441.48
*C*78459*TC*1248.99*1186.54*1364.52
*C*78491**1444.92*1372.67*1578.57
*C*78491*TC*1375.93*1307.13*1503.20
*C*78492**1456.93*1384.08*1591.69
*C*78492*TC*1375.93*1307.13*1503.20
*C*78608**1442.41*1370.29*1575.83
*C*78608*TC*1375.93*1307.13*1503.20
*C*78811**1317.49*1251.62*1439.36
*C*78811*TC*1248.99*1186.54*1364.52
*C*78812**1462.43*1389.31*1597.71
*C*78812*TC*1375.93*1307.13*1503.20
*C*78813**1464.46*1391.24*1599.93
*C*78813*TC*1375.93*1307.13*1503.20
*C*78814**1473.92*1400.22*1610.25
*C*78814*TC*1375.93*1307.13*1503.20
*C*78815**1485.02*1410.77*1622.39
*C*78815*TC*1375.93*1307.13*1503.20
*C*78816**1486.02*1411.72*1623.48
*C*78816*TC*1375.93*1307.13*1503.20
**79300**237.04*225.19*258.97
**79300*TC*175.44*166.67*191.67
**79445**237.04*225.19*258.97
**79445*TC*131.44*124.87*143.60
**86485**17.28*16.42*18.88
**90867**281.17*267.11*307.18
#**90867**132.92*126.27*145.21
**90868**191.00*181.45*208.67
#**90868**101.76*96.67*111.17
**90869**263.00*249.85*287.33
#**90869**154.13*146.42*168.38
**92978**227.44*216.07*248.48
**92978*TC*135.52*128.74*148.05
**92979**139.18*132.22*152.05
**92979*TC*66.29*62.98*72.43
*C*93315**605.76*575.47*661.79
*C*93315*TC*485.20*460.94*530.08
**93317**199.58*189.60*218.04
**93317*TC*115.21*109.45*125.87
*C*93318**582.61*553.48*636.50
*C*93318*TC*485.20*460.94*530.08
**93571**226.54*215.21*247.49
**93571*TC*156.64*148.81*171.13
**93572**137.01*130.16*149.68
**93572*TC*86.03*81.73*93.99
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.64*3273.36*3764.36
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.63*3275.25*3766.54
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.63*3275.25*3766.54
**93609**2134.69*2027.96*2332.15
**93609*TC*1871.46*1777.89*2044.57
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.06*3231.96*3716.75
**93612**3557.81*3379.92*3886.91
**93612*TC*3404.44*3234.22*3719.35
**93615**46.29*43.98*50.58
**93615*TC*12.67*12.04*13.85
**93619**7115.62*6759.84*7773.82
**93619*TC*6743.79*6406.60*7367.59
**93620**7115.62*6759.84*7773.82
**93620*TC*6518.91*6192.96*7121.90
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.24*6684.43*7687.09
**93622**7115.62*6759.84*7773.82
**93622*TC*6951.93*6604.33*7594.98
**93623**2134.69*2027.96*2332.15
**93623*TC*2070.17*1966.66*2261.66
**93624**3557.81*3379.92*3886.91
**93624*TC*3325.47*3159.20*3633.08
**93631**7115.62*6759.84*7773.82
**93631*TC*6731.56*6394.98*7354.23
**93640**1133.95*1077.25*1238.84
**93640*TC*963.55*915.37*1052.68
**93641**1133.95*1077.25*1238.84
**93641*TC*835.80*794.01*913.11
**93662**388.34*368.92*424.26
**93662*TC*321.62*305.54*351.37
**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**909.00*863.55*993.08
**95965*TC*523.04*496.89*571.42
**95966**532.61*505.98*581.88
**95966*TC*345.30*328.04*377.25
**95967**448.07*425.67*489.52
**95967*TC*285.34*271.07*311.73
**96020**373.48*354.81*408.03
**96547**684.16*649.95*747.44
#**96547**128.93*122.48*140.85
**96548**342.08*324.98*373.73
#**96548**64.46*61.24*70.43
**97151**48.56*46.13*53.05
#**97151**43.42*41.25*47.44
**97152**41.28*39.22*45.10
#**97152**36.91*35.06*40.32
**97153**32.88*31.24*35.93
#**97153**29.10*27.65*31.80
**97154**4.53*4.30*4.95
#**97154**4.14*3.93*4.52
**97155**32.88*31.24*35.93
#**97155**29.10*27.65*31.80
**97156**34.69*32.96*37.90
#**97156**30.77*29.23*33.61
**97157**10.13*9.62*11.06
#**97157**9.22*8.76*10.07
**97158**5.26*5.00*5.75
#**97158**4.81*4.57*5.26
**98978**43.01*40.86*46.99
# - 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.