LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**420.33*399.31*459.21
#**G0186**363.44*345.27*397.06
**G0339**2482.57*2358.44*2712.21
**G0340**1867.06*1773.71*2039.77
**G0398**123.19*117.03*134.58
**G0398*TC*85.70*81.42*93.63
**G0398*26*37.49*35.62*40.96
**G0399**86.85*82.51*94.89
**G0399*TC*45.52*43.24*49.73
**G0399*26*41.62*39.54*45.47
**G0400**89.17*84.71*97.42
**G0400*TC*50.51*47.98*55.18
**G0400*26*38.66*36.73*42.24
**G0460**711.64*676.06*777.47
#**G0460**116.02*110.22*126.75
**G0465**711.64*676.06*777.47
#**G0465**116.02*110.22*126.75
**G0498**130.69*124.16*142.78
**G6017**71.99*68.39*78.65
**0042T**208.14*197.73*227.39
**0054T**222.62*211.49*243.21
**0055T**222.62*211.49*243.21
**0071T**545.40*518.13*595.85
**0072T**545.40*518.13*595.85
**0075T**937.35*890.48*1024.05
**0075T*TC*937.35*890.48*1024.05
**0075T*26*937.35*890.48*1024.05
**0095T**601.38*571.31*657.01
**0098T**673.83*640.14*736.16
**0100T**1782.64*1693.51*1947.54
**0101T**290.64*276.11*317.53
#**0101T**212.92*202.27*232.61
**0102T**290.64*276.11*317.53
#**0102T**212.92*202.27*232.61
**0106T**29.88*28.39*32.65
**0107T**29.88*28.39*32.65
**0108T**29.88*28.39*32.65
**0109T**29.88*28.39*32.65
**0110T**29.88*28.39*32.65
**0164T**656.80*623.96*717.55
**0165T**673.10*639.45*735.37
**0184T**781.10*742.05*853.36
**0198T**77.27*73.41*84.42
#**0198T**30.34*28.82*33.14
**0200T**1596.90*1517.06*1744.62
#**0200T**386.89*367.55*422.68
**0201T**2395.35*2275.58*2616.92
#**0201T**580.34*551.32*634.02
**0207T**121.71*115.62*132.96
**0208T**33.47*31.80*36.57
**0209T**40.50*38.48*44.25
**0210T**25.55*24.27*27.91
**0211T**39.62*37.64*43.29
**0212T**34.41*32.69*37.59
#**0212T**30.01*28.51*32.79
**0213T**177.61*168.73*194.04
#**0213T**99.90*94.91*109.15
**0214T**90.63*86.10*99.02
#**0214T**56.61*53.78*61.85
**0215T**90.92*86.37*99.33
#**0215T**57.49*54.62*62.81
**0216T**162.83*154.69*177.89
#**0216T**85.71*81.42*93.63
**0217T**84.36*80.14*92.16
#**0217T**48.58*46.15*53.07
**0218T**84.36*80.14*92.16
#**0218T**49.46*46.99*54.04
**0219T**1253.75*1191.06*1369.72
**0220T**1231.54*1169.96*1345.45
**0221T**1517.37*1441.50*1657.73
**0222T**375.58*356.80*410.32
**0232T**711.64*676.06*777.47
#**0232T**116.02*110.22*126.75
**0234T**7583.14*7203.98*8284.58
#**0234T**565.65*537.37*617.98
**0235T**7583.14*7203.98*8284.58
#**0235T**565.65*537.37*617.98
**0236T**7723.78*7337.59*8438.23
#**0236T**654.97*622.22*715.55
**0237T**7723.78*7337.59*8438.23
#**0237T**654.97*622.22*715.55
**0238T**7723.78*7337.59*8438.23
#**0238T**654.97*622.22*715.55
**0266T**857.94*815.04*937.30
**0267T**152.62*144.99*166.74
**0268T**318.25*302.34*347.69
**0269T**811.11*770.55*886.13
**0270T**152.62*144.99*166.74
**0271T**318.25*302.34*347.69
**0272T**51.04*48.49*55.76
**0273T**66.16*62.85*72.28
**0274T**1055.00*1002.25*1152.59
**0278T**13.63*12.95*14.89
**0308T**1306.90*1241.56*1427.79
**0329T**77.27*73.41*84.42
#**0329T**30.34*28.82*33.14
**0330T**38.21*36.30*41.75
**0331T**164.70*156.47*179.94
**0332T**281.18*267.12*307.19
**0347T**135.89*129.10*148.47
**0348T**29.89*28.40*32.66
**0349T**31.57*29.99*34.49
**0350T**32.16*30.55*35.13
**0351T**152.57*144.94*166.68
**0352T**40.81*38.77*44.59
**0353T**152.57*144.94*166.68
**0354T**40.81*38.77*44.59
**0358T**23.79*22.60*25.99
**0362T**85.55*81.27*93.46
#**0362T**62.97*59.82*68.79
**0378T**23.70*22.52*25.90
**0394T**224.41*213.19*245.17
**0395T**548.82*521.38*599.59
**0397T**44.83*42.59*48.98
**0398T*26*1746.88*1659.54*1908.47
**0408T**487.46*463.09*532.55
**0409T**335.87*319.08*366.94
**0410T**348.53*331.10*380.77
**0411T**348.53*331.10*380.77
**0412T**217.80*206.91*237.95
**0413T**454.94*432.19*497.02
**0414T**350.26*332.75*382.66
**0415T**292.21*277.60*319.24
**0416T**321.52*305.44*351.26
**0417T**76.82*72.98*83.93
**0418T**51.04*48.49*55.76
**0419T**416.37*395.55*454.88
#**0419T**337.77*320.88*369.01
**0420T**595.32*565.55*650.38
#**0420T**498.25*473.34*544.34
**0421T**1466.96*1393.61*1602.65
#**0421T**660.78*627.74*721.90
**0437T**203.65*193.47*222.49
**0439T**65.70*62.42*71.78
**0440T**227.32*215.95*248.34
#**0440T**112.95*107.30*123.40
**0441T**227.32*215.95*248.34
#**0441T**112.95*107.30*123.40
**0442T**227.32*215.95*248.34
#**0442T**112.95*107.30*123.40
**0449T**709.26*673.80*774.87
**0464T**60.69*57.66*66.31
**0472T**61.62*58.54*67.32
**0473T**51.04*48.49*55.76
**0479T**59.86*56.87*65.40
**0480T**141.68*134.60*154.79
#**0480T**29.93*28.43*32.69
**0483T**1145.36*1088.09*1251.30
**0484T**1485.72*1411.43*1623.14
**0485T**21.78*20.69*23.79
**0485T*TC*7.81*7.42*8.53
**0485T*26*14.30*13.59*15.63
**0486T**43.56*41.38*47.59
**0486T*TC*15.28*14.52*16.70
**0486T*26*28.27*26.86*30.89
**0488T**59.33*56.36*64.81
#**0488T**47.89*45.50*52.33
**0505T**9783.83*9294.64*10688.84
#**0505T**560.69*532.66*612.56
**0507T**20.79*19.75*22.71
**0507T*TC*17.92*17.02*19.57
**0507T*26*2.87*2.73*3.14
**0510T**558.27*530.36*609.91
#**0510T**399.91*379.91*436.90
**0512T**290.64*276.11*317.53
#**0512T**212.92*202.27*232.61
**0513T**87.19*82.83*95.25
#**0513T**63.88*60.69*69.79
**0515T**487.46*463.09*532.55
**0516T**449.76*427.27*491.36
**0517T**318.25*302.34*347.69
**0518T**217.80*206.91*237.95
**0519T**319.01*303.06*348.52
**0520T**449.76*427.27*491.36
**0521T**51.04*48.49*55.76
**0521T*TC*31.71*30.12*34.64
**0521T*26*19.33*18.36*21.11
**0522T**61.62*58.54*67.32
**0522T*TC*32.29*30.68*35.28
**0522T*26*29.33*27.86*32.04
**0523T**140.31*133.29*153.28
**0524T**1461.19*1388.13*1596.35
#**0524T**170.54*162.01*186.31
**0525T**450.06*427.56*491.69
**0526T**348.53*331.10*380.77
**0527T**303.78*288.59*331.88
**0528T**61.62*58.54*67.32
**0528T*TC*32.29*30.68*35.28
**0528T*26*29.33*27.86*32.04
**0529T**51.04*48.49*55.76
**0529T*TC*31.71*30.12*34.64
**0529T*26*19.33*18.36*21.11
**0530T**597.27*567.41*652.52
**0531T**454.94*432.19*497.02
**0532T**319.01*303.06*348.52
**0540T**167.69*159.31*183.21
**0543T**1485.72*1411.43*1623.14
**0544T**1702.30*1617.19*1859.77
**0545T**1702.30*1617.19*1859.77
**0546T**66.09*62.79*72.21
**0552T**6.14*5.83*6.70
**0553T**2197.02*2087.17*2400.25
#**0553T**378.50*359.58*413.52
**0565T**571.34*542.77*624.19
#**0565T**483.66*459.48*528.40
**0566T**92.55*87.92*101.11
#**0566T**56.48*53.66*61.71
**0569T**1702.30*1617.19*1859.77
**0570T**400.56*380.53*437.61
**0571T**526.86*500.52*575.60
**0572T**429.34*407.87*469.05
**0573T**326.53*310.20*356.73
**0574T**379.51*360.53*414.61
**0575T**61.62*58.54*67.32
**0576T**51.04*48.49*55.76
**0577T**179.24*170.28*195.82
**0578T**28.03*26.63*30.62
**0579T**18.80*17.86*20.54
**0580T**201.20*191.14*219.81
**0581T**2012.29*1911.68*2198.43
#**0581T**201.69*191.61*220.35
**0582T**1483.17*1409.01*1620.36
#**0582T**362.61*344.48*396.15
**0583T**1522.66*1446.53*1663.51
#**0583T**123.89*117.70*135.36
**0587T**411.82*391.23*449.91
#**0587T**281.61*267.53*307.66
**0588T**337.73*320.84*368.97
#**0588T**218.95*208.00*239.20
**0589T**45.55*43.27*49.76
#**0589T**37.05*35.20*40.48
**0590T**53.29*50.63*58.22
#**0590T**38.34*36.42*41.88
**0596T**672.69*639.06*734.92
#**0596T**127.18*120.82*138.94
**0597T**672.69*639.06*734.92
#**0597T**127.18*120.82*138.94
**0598T**134.24*127.53*146.66
**0599T**89.59*85.11*97.88
**0600T**3209.86*3049.37*3506.78
#**0600T**695.42*660.65*759.75
**0601T**1389.43*1319.96*1517.95
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**178.64*169.71*195.17
**0611T**35.85*34.06*39.17
**0614T**349.75*332.26*382.10
**0615T**44.10*41.90*48.19
**0616T**619.79*588.80*677.12
**0617T**691.66*657.08*755.64
**0618T**836.86*795.02*914.27
**0619T**607.03*576.68*663.18
#**0619T**450.57*428.04*492.25
**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**235.31*223.54*257.07
#**0627T**94.54*89.81*103.28
**0628T**70.59*67.06*77.12
#**0628T**28.36*26.94*30.98
**0629T**235.31*223.54*257.07
#**0629T**94.54*89.81*103.28
**0630T**70.59*67.06*77.12
#**0630T**28.36*26.94*30.98
**0631T**73.59*69.91*80.40
**0632T**546.91*519.56*597.49
**0633T**182.35*173.23*199.21
*C*0633T*TC*93.88*89.19*102.57
**0633T*26*56.47*53.65*61.70
**0634T**182.35*173.23*199.21
**0634T*TC*125.88*119.59*137.53
**0634T*26*56.47*53.65*61.70
**0635T**182.35*173.23*199.21
**0635T*TC*125.88*119.59*137.53
**0635T*26*56.47*53.65*61.70
**0636T**182.35*173.23*199.21
**0636T*TC*125.88*119.59*137.53
**0636T*26*56.47*53.65*61.70
**0637T**182.35*173.23*199.21
**0637T*TC*125.88*119.59*137.53
**0637T*26*56.47*53.65*61.70
**0638T**182.35*173.23*199.21
**0638T*TC*125.88*119.59*137.53
**0638T*26*56.47*53.65*61.70
**0639T**73.59*69.91*80.40
**0640T**20.79*19.75*22.71
**0640T*TC*18.05*17.15*19.72
**0640T*26*2.87*2.73*3.14
**0644T**1044.32*992.10*1140.92
#**0644T**231.10*219.55*252.48
**0646T**1702.30*1617.19*1859.77
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**54.65*51.92*59.71
**0652T**262.24*249.13*286.50
#**0652T**115.61*109.83*126.30
**0653T**341.28*324.22*372.85
#**0653T**130.71*124.17*142.80
**0654T**134.44*127.72*146.88
**0655T**1466.96*1393.61*1602.65
#**0655T**660.78*627.74*721.90
**0658T**83.61*79.43*91.34
**0659T**2407.42*2287.05*2630.11
#**0659T**417.34*396.47*455.94
**0671T**953.79*906.10*1042.02
**0673T**3049.41*2896.94*3331.48
#**0673T**348.75*331.31*381.01
**0699T**104.90*99.66*114.61
#**0699T**85.55*81.27*93.46
**0707T**339.57*322.59*370.98
#**0707T**258.33*245.41*282.22
**0714T**1260.67*1197.64*1377.29
#**0714T**338.07*321.17*369.35
**0730T**249.23*236.77*272.29
#**0730T**225.39*214.12*246.24
**0738T**67.30*63.94*73.53
**0739T**1466.96*1393.61*1602.65
#**0739T**660.78*627.74*721.90
**0740T**17.66*16.78*19.30
**0741T**41.68*39.60*45.54
**0742T**84.35*80.13*92.15
**0742T*TC*66.03*62.73*72.14
**0742T*26*18.32*17.40*20.01
**0743T**48.21*45.80*52.67
**0744T**852.99*810.34*931.89
**0745T**226.63*215.30*247.60
**0746T**214.08*203.38*233.89
**0747T**876.23*832.42*957.28
**0748T**174.06*165.36*190.16
**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**4.01*3.81*4.38
**0765T**7.75*7.36*8.46
**0771T**25.33*24.06*27.67
**0772T**25.33*24.06*27.67
**0773T**21.28*20.22*23.25
**0774T**21.28*20.22*23.25
**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**386.92*367.57*422.71
**0779T*TC*362.21*344.10*395.72
**0779T*26*24.71*23.47*26.99
**0780T**21.28*20.22*23.25
**0783T**12.64*12.01*13.81
**0784T**1891.81*1797.22*2066.80
#**0784T**308.78*293.34*337.34
**0785T**222.86*211.72*243.48
#**0785T**136.35*129.53*148.96
**0786T**669.22*635.76*731.12
#**0786T**289.73*275.24*316.53
**0787T**222.86*211.72*243.48
#**0787T**136.35*129.53*148.96
**0788T**17.91*17.01*19.56
#**0788T**17.32*16.45*18.92
**0789T**25.08*23.83*27.40
#**0789T**21.65*20.57*23.66
**0790T**1836.03*1744.23*2005.86
**0791T**8.52*8.09*9.30
**0793T**546.91*519.56*597.49
**0794T**130.35*123.83*142.40
**0795T**674.64*640.91*737.05
**0796T**449.76*427.27*491.36
**0797T**449.76*427.27*491.36
**0798T**715.64*679.86*781.84
**0799T**477.09*453.24*521.23
**0800T**477.09*453.24*521.23
**0801T**926.85*880.51*1012.59
**0802T**463.43*440.26*506.30
**0803T**463.43*440.26*506.30
**0804T**72.07*68.47*78.74
**0804T*TC*37.28*35.42*40.73
**0804T*26*34.79*33.05*38.01
**0805T**2633.85*2502.16*2877.48
#**0805T**312.09*296.49*340.96
**0806T**3511.80*3336.21*3836.64
#**0806T**416.12*395.31*454.61
**0807T**38.86*36.92*42.46
**0807T*TC*24.67*23.44*26.96
**0807T*26*14.19*13.48*15.50
**0808T**38.86*36.92*42.46
**0808T*TC*24.67*23.44*26.96
**0808T*26*14.19*13.48*15.50
**0810T**1060.51*1007.48*1158.60
**0811T**17.66*16.78*19.30
**0813T**2302.09*2186.99*2515.04
#**0813T**172.41*163.79*188.36
**0814T**424.46*403.24*463.73
#**0814T**322.92*306.77*352.79
**0818T**337.73*320.84*368.97
#**0818T**218.95*208.00*239.20
**0820T**142.36*135.24*155.53
#**0820T**126.82*120.48*138.55
**0821T**142.36*135.24*155.53
#**0821T**126.82*120.48*138.55
**0822T**121.01*114.96*132.20
#**0822T**107.80*102.41*117.77
**0823T**674.64*640.91*737.05
**0824T**715.64*679.86*781.84
**0825T**926.85*880.51*1012.59
**0826T**61.62*58.54*67.32
**0826T*TC*32.29*30.68*35.28
**0826T*26*29.33*27.86*32.04
**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**20.79*19.75*22.71
**0859T*TC*17.92*17.02*19.57
**0859T*26*2.87*2.73*3.14
**0864T**290.64*276.11*317.53
#**0864T**212.92*202.27*232.61
**10011**384.78*365.54*420.37
#**10011**103.54*98.36*113.11
**10012**213.99*203.29*233.78
#**10012**69.71*66.22*76.15
**15847**333.34*316.67*364.17
**21742**1107.28*1051.92*1209.71
**21743**1274.08*1210.38*1391.94
**32855**331.01*314.46*361.63
**32856**435.41*413.64*475.69
**33928**3200.95*3040.90*3497.04
**33929**1198.91*1138.96*1309.80
**33933**507.00*481.65*553.90
**33944**513.77*488.08*561.29
**34841**2014.32*1913.60*2200.64
**34842**2240.11*2128.10*2447.32
**34843**2465.88*2342.59*2693.98
**34844**2691.67*2557.09*2940.65
**34845**2014.32*1913.60*2200.64
**34846**2240.11*2128.10*2447.32
**34847**2465.88*2342.59*2693.98
**34848**2691.67*2557.09*2940.65
**43496**1948.34*1850.92*2128.56
**43647**627.11*595.75*685.11
**43648**493.98*469.28*539.67
#**43648**226.14*214.83*247.05
**43881**614.08*583.38*670.89
#**43881**564.16*535.95*616.34
**43882**647.84*615.45*707.77
#**43882**594.12*564.41*649.07
**47143**400.79*380.75*437.86
**47144**475.96*452.16*519.98
**47145**450.90*428.36*492.61
**48551**250.17*237.66*273.31
**50323**151.40*143.83*165.40
**50325**240.02*228.02*262.22
**53451**721.38*685.31*788.11
**53452**360.69*342.66*394.06
**53453**613.02*582.37*669.73
**53454**52.83*50.19*57.72
#**53454**33.77*32.08*36.89
**63043**549.33*521.86*600.14
**63044**475.51*451.73*519.49
**64596**1891.81*1797.22*2066.80
#**64596**308.78*293.34*337.34
**64597**567.54*539.16*620.03
#**64597**92.63*88.00*101.20
**64598**222.86*211.72*243.48
#**64598**136.35*129.53*148.96
**65757**112.42*106.80*122.82
**66983**619.79*588.80*677.12
**66987**725.54*689.26*792.65
**66988**599.30*569.34*654.74
*C*70170**223.00*211.85*243.63
*C*70170*TC*209.13*198.67*228.47
**70555**233.47*221.80*255.07
**70555*TC*120.36*114.34*131.49
*C*70557**614.61*583.88*671.46
*C*70557*TC*470.72*447.18*514.26
*C*70558**315.53*299.75*344.71
*C*70558*TC*156.93*149.08*171.44
*C*70559**307.14*291.78*335.55
*C*70559*TC*156.93*149.08*171.44
*C*74190**491.78*467.19*537.27
*C*74190*TC*470.72*447.18*514.26
**74235**132.23*125.62*144.46
**74235*TC*78.34*74.42*85.58
**74300**74.91*71.16*81.83
**74300*TC*62.34*59.22*68.10
**74301**23.15*21.99*25.29
**74301*TC*13.78*13.09*15.05
**74328**175.06*166.31*191.26
**74328*TC*153.19*145.53*167.36
**74329**126.86*120.52*138.60
**74329*TC*104.70*99.47*114.39
**74330**262.59*249.46*286.88
**74330*TC*236.81*224.97*258.72
**74340**86.58*82.25*94.59
**74340*TC*62.35*59.23*68.11
**74355**86.58*82.25*94.59
**74355*TC*52.06*49.46*56.88
**74360**86.58*82.25*94.59
**74360*TC*60.81*57.77*66.44
**74363**175.06*166.31*191.26
**74363*TC*135.63*128.85*148.18
*C*74445**144.86*137.62*158.26
*C*74445*TC*93.88*89.19*102.57
*C*74450**223.96*212.76*244.67
*C*74450*TC*209.13*198.67*228.47
*C*74470**494.37*469.65*540.10
*C*74470*TC*470.72*447.18*514.26
**74742**233.47*221.80*255.07
**74742*TC*205.73*195.44*224.76
*C*74775**237.20*225.34*259.14
*C*74775*TC*209.13*198.67*228.47
*C*75801**576.71*547.87*630.05
*C*75801*TC*536.12*509.31*585.71
*C*75803**1419.86*1348.87*1551.20
*C*75803*TC*1366.64*1298.31*1493.06
*C*75805**2756.82*2618.98*3011.83
*C*75805*TC*2720.05*2584.05*2971.66
*C*75807**2770.41*2631.89*3026.67
*C*75807*TC*2720.05*2584.05*2971.66
*C*75810**2766.54*2628.21*3022.44
*C*75810*TC*2720.05*2584.05*2971.66
**75894**796.82*756.98*870.53
**75894*TC*728.84*692.40*796.26
*C*75898**2806.68*2666.35*3066.30
*C*75898*TC*2720.05*2584.05*2971.66
**75970**389.60*370.12*425.64
**75970*TC*353.56*335.88*386.26
**76125**35.87*34.08*39.19
**76125*TC*23.30*22.14*25.46
**76390**183.41*174.24*200.38
**76390*TC*134.21*127.50*146.63
**76390*26*49.20*46.74*53.75
**76932**76.86*73.02*83.97
**76932*TC*42.82*40.68*46.78
**76940**147.38*140.01*161.01
**76940*TC*51.74*49.15*56.52
**76941**106.40*101.08*116.24
**76941*TC*45.56*43.28*49.77
**76945**75.96*72.16*82.98
**76945*TC*45.71*43.42*49.93
*C*76975**247.63*235.25*270.54
*C*76975*TC*209.13*198.67*228.47
**76998**175.06*166.31*191.26
**76998*TC*130.45*123.93*142.52
**77013**374.21*355.50*408.83
**77013*TC*200.08*190.08*218.59
**77022**423.32*402.15*462.47
**77022*TC*233.93*222.23*255.56
**77371**540.13*513.12*590.09
**77520**783.77*744.58*856.27
**77522**783.77*744.58*856.27
**77523**899.97*854.97*983.22
**77525**1016.17*965.36*1110.16
*C*78282**366.68*348.35*400.60
*C*78282*TC*351.95*334.35*384.50
**78414**514.99*489.24*562.63
**78414*TC*494.99*470.24*540.78
*C*78429**1410.18*1339.67*1540.62
*C*78429*TC*1334.97*1268.22*1458.45
*C*78430**1406.56*1336.23*1536.66
*C*78430*TC*1334.97*1268.22*1458.45
*C*78431**2099.02*1994.07*2293.18
*C*78431*TC*2015.63*1914.85*2202.08
*C*78432**1746.64*1659.31*1908.21
*C*78432*TC*1657.26*1574.40*1810.56
*C*78433**1844.79*1752.55*2015.43
*C*78433*TC*1747.00*1659.65*1908.60
**78434**619.38*588.41*676.67
**78434*TC*591.89*562.30*646.65
*C*78459**1281.43*1217.36*1399.96
*C*78459*TC*1211.80*1151.21*1323.89
*C*78491**1403.19*1333.03*1532.98
*C*78491*TC*1334.97*1268.22*1458.45
*C*78492**1415.03*1344.28*1545.92
*C*78492*TC*1334.97*1268.22*1458.45
*C*78608**1400.64*1330.61*1530.20
*C*78608*TC*1334.97*1268.22*1458.45
*C*78811**1279.42*1215.45*1397.77
*C*78811*TC*1211.80*1151.21*1323.89
*C*78812**1420.34*1349.32*1551.72
*C*78812*TC*1334.97*1268.22*1458.45
*C*78813**1422.37*1351.25*1553.94
*C*78813*TC*1334.97*1268.22*1458.45
*C*78814**1431.70*1360.12*1564.14
*C*78814*TC*1334.97*1268.22*1458.45
*C*78815**1442.66*1370.53*1576.11
*C*78815*TC*1334.97*1268.22*1458.45
*C*78816**1443.74*1371.55*1577.28
*C*78816*TC*1334.97*1268.22*1458.45
**79300**237.04*225.19*258.97
**79300*TC*175.79*167.00*192.05
**79445**237.04*225.19*258.97
**79445*TC*132.93*126.28*145.22
**86485**15.20*14.44*16.61
**90867**273.14*259.48*298.40
#**90867**129.30*122.84*141.27
**90868**186.07*176.77*203.29
#**90868**100.56*95.53*109.86
**90869**256.97*244.12*280.74
#**90869**150.29*142.78*164.20
**92978**220.90*209.86*241.34
**92978*TC*131.69*125.11*143.88
**92979**135.48*128.71*148.02
**92979*TC*64.68*61.45*70.67
*C*93315**589.89*560.40*644.46
*C*93315*TC*470.72*447.18*514.26
**93317**193.90*184.21*211.84
**93317*TC*110.84*105.30*121.10
*C*93318**566.74*538.40*619.16
*C*93318*TC*470.72*447.18*514.26
**93571**220.04*209.04*240.40
**93571*TC*152.15*144.54*166.22
**93572**133.42*126.75*145.76
**93572*TC*83.95*79.75*91.71
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.94*3276.49*3767.96
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.77*3278.23*3769.96
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.77*3278.23*3769.96
**93609**2134.69*2027.96*2332.15
**93609*TC*1879.21*1785.25*2053.04
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.49*3236.17*3721.60
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.65*3238.22*3723.95
**93615**45.50*43.23*49.71
**93615*TC*12.26*11.65*13.40
**93619**7115.62*6759.84*7773.82
**93619*TC*6754.73*6416.99*7379.54
**93620**7115.62*6759.84*7773.82
**93620*TC*6536.56*6209.73*7141.19
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.61*6686.68*7689.68
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.78*6608.94*7600.28
**93623**2134.69*2027.96*2332.15
**93623*TC*2072.10*1968.50*2263.78
**93624**3557.81*3379.92*3886.91
**93624*TC*3332.42*3165.80*3640.67
**93631**7115.62*6759.84*7773.82
**93631*TC*6743.42*6406.25*7367.19
**93640**1133.95*1077.25*1238.84
**93640*TC*968.54*920.11*1058.13
**93641**1133.95*1077.25*1238.84
**93641*TC*844.73*802.49*922.86
**93662**379.58*360.60*414.69
**93662*TC*313.62*297.94*342.63
**94642**33.33*31.66*36.41
**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**909.86*864.37*994.03
**95965*TC*529.38*502.91*578.35
**96020**374.35*355.63*408.97
**96547**665.19*631.93*726.72
#**96547**126.47*120.15*138.17
**96548**332.60*315.97*363.37
#**96548**63.23*60.07*69.08
**97151**48.02*45.62*52.46
#**97151**43.04*40.89*47.02
**97152**40.82*38.78*44.60
#**97152**36.58*34.75*39.96
**97153**32.55*30.92*35.56
#**97153**28.88*27.44*31.56
**97154**4.44*4.22*4.85
#**97154**4.06*3.86*4.44
**97155**32.55*30.92*35.56
#**97155**28.88*27.44*31.56
**97156**34.36*32.64*37.54
#**97156**30.55*29.02*33.37
**97157**10.00*9.50*10.93
#**97157**9.12*8.66*9.96
**97158**5.16*4.90*5.64
#**97158**4.72*4.48*5.15
**98978**41.68*39.60*45.54
# - 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.