LOUISIANA MEDICARE CARRIER - 07202
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
NEW ORLEANS
******
**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**438.72*416.78*479.30
#**G0186**378.34*359.42*413.33
**G0339**2763.05*2624.90*3018.64
**G0340**2078.06*1974.16*2270.28
**G0398**129.19*122.73*141.14
**G0398*TC*91.03*86.48*99.45
**G0398*26*38.16*36.25*41.69
**G0399**90.46*85.94*98.83
**G0399*TC*48.39*45.97*52.87
**G0399*26*42.38*40.26*46.30
**G0400**93.09*88.44*101.71
**G0400*TC*53.68*51.00*58.65
**G0400*26*39.41*37.44*43.06
**G0460**752.07*714.47*821.64
#**G0460**119.95*113.95*131.04
**G0465**752.07*714.47*821.64
#**G0465**119.95*113.95*131.04
**G0498**138.54*131.61*151.35
**G6017**75.05*71.30*82.00
**0042T**217.24*206.38*237.34
**0054T**233.73*222.04*255.35
**0055T**233.73*222.04*255.35
**0071T**566.41*538.09*618.80
**0072T**566.41*538.09*618.80
**0075T**975.93*927.13*1066.20
**0075T*TC*975.93*927.13*1066.20
**0075T*26*975.93*927.13*1066.20
**0095T**634.17*602.46*692.83
**0098T**710.51*674.98*776.23
**0100T**1844.14*1751.93*2014.72
**0101T**302.55*287.42*330.53
#**0101T**220.07*209.07*240.43
**0102T**302.55*287.42*330.53
#**0102T**220.07*209.07*240.43
**0106T**31.69*30.11*34.63
**0107T**31.69*30.11*34.63
**0108T**31.69*30.11*34.63
**0109T**31.69*30.11*34.63
**0110T**31.69*30.11*34.63
**0164T**692.65*658.02*756.72
**0165T**709.84*674.35*775.50
**0184T**812.38*771.76*887.52
**0198T**80.83*76.79*88.31
#**0198T**31.03*29.48*33.90
**0200T**1683.88*1599.69*1839.64
#**0200T**399.71*379.72*436.68
**0201T**2525.81*2399.52*2759.45
#**0201T**599.56*569.58*655.02
**0207T**121.71*115.62*132.96
**0208T**35.55*33.77*38.84
**0209T**43.02*40.87*47.00
**0210T**27.15*25.79*29.66
**0211T**42.09*39.99*45.99
**0212T**35.37*33.60*38.64
#**0212T**30.70*29.17*33.55
**0213T**185.47*176.20*202.63
#**0213T**102.99*97.84*112.52
**0214T**94.27*89.56*102.99
#**0214T**58.17*55.26*63.55
**0215T**94.59*89.86*103.34
#**0215T**59.10*56.15*64.57
**0216T**170.28*161.77*186.04
#**0216T**88.43*84.01*96.61
**0217T**87.87*83.48*96.00
#**0217T**49.90*47.41*54.52
**0218T**87.87*83.48*96.00
#**0218T**50.83*48.29*55.53
**0219T**1318.29*1252.38*1440.24
**0220T**1293.59*1228.91*1413.25
**0221T**1587.90*1508.51*1734.79
**0222T**393.36*373.69*429.74
**0232T**752.07*714.47*821.64
#**0232T**119.95*113.95*131.04
**0234T**8033.59*7631.91*8776.70
#**0234T**585.97*556.67*640.17
**0235T**8033.59*7631.91*8776.70
#**0235T**585.97*556.67*640.17
**0236T**8179.61*7770.63*8936.22
#**0236T**677.53*643.65*740.20
**0237T**8179.61*7770.63*8936.22
#**0237T**677.53*643.65*740.20
**0238T**8179.61*7770.63*8936.22
#**0238T**677.53*643.65*740.20
**0266T**892.97*848.32*975.57
**0267T**158.14*150.23*172.76
**0268T**331.56*314.98*362.23
**0269T**844.77*802.53*922.91
**0270T**158.14*150.23*172.76
**0271T**331.56*314.98*362.23
**0272T**53.37*50.70*58.31
**0273T**68.83*65.39*75.20
**0274T**1107.77*1052.38*1210.24
**0278T**14.00*13.30*15.30
**0308T**1352.60*1284.97*1477.72
**0329T**80.83*76.79*88.31
#**0329T**31.03*29.48*33.90
**0330T**38.21*36.30*41.75
**0331T**173.43*164.76*189.47
**0332T**295.97*281.17*323.35
**0347T**140.98*133.93*154.02
**0348T**31.39*29.82*34.29
**0349T**33.22*31.56*36.29
**0350T**33.84*32.15*36.97
**0351T**160.45*152.43*175.29
**0352T**41.79*39.70*45.66
**0353T**160.45*152.43*175.29
**0354T**41.79*39.70*45.66
**0358T**25.28*24.02*27.62
**0362T**88.52*84.09*96.70
#**0362T**64.55*61.32*70.52
**0378T**24.29*23.08*26.54
**0394T**236.36*224.54*258.22
**0395T**575.73*546.94*628.98
**0397T**45.91*43.61*50.15
**0398T*26*1746.88*1659.54*1908.47
**0408T**507.27*481.91*554.20
**0409T**349.87*332.38*382.24
**0410T**363.24*345.08*396.84
**0411T**363.24*345.08*396.84
**0412T**227.47*216.10*248.52
**0413T**473.75*450.06*517.57
**0414T**364.91*346.66*398.66
**0415T**304.36*289.14*332.51
**0416T**335.57*318.79*366.61
**0417T**79.94*75.94*87.33
**0418T**53.37*50.70*58.31
**0419T**434.12*412.41*474.27
#**0419T**350.71*333.17*383.15
**0420T**620.43*589.41*677.82
#**0420T**517.41*491.54*565.27
**0421T**1537.73*1460.84*1679.97
#**0421T**682.14*648.03*745.23
**0437T**211.38*200.81*230.93
**0439T**69.04*65.59*75.43
**0440T**238.01*226.11*260.03
#**0440T**116.63*110.80*127.42
**0441T**238.01*226.11*260.03
#**0441T**116.63*110.80*127.42
**0442T**238.01*226.11*260.03
#**0442T**116.63*110.80*127.42
**0449T**735.77*698.98*803.83
**0464T**63.77*60.58*69.67
**0472T**64.19*60.98*70.13
**0473T**53.37*50.70*58.31
**0479T**61.37*58.30*67.05
**0480T**148.20*140.79*161.91
#**0480T**30.68*29.15*33.52
**0483T**1189.57*1130.09*1299.60
**0484T**1542.59*1465.46*1685.28
**0485T**22.60*21.47*24.69
**0485T*TC*8.32*7.90*9.09
**0485T*26*14.66*13.93*16.02
**0486T**45.20*42.94*49.38
**0486T*TC*16.26*15.45*17.77
**0486T*26*28.94*27.49*31.61
**0488T**61.19*58.13*66.85
#**0488T**49.05*46.60*53.59
**0505T**10619.39*10088.42*11601.68
#**0505T**574.78*546.04*627.95
**0507T**22.04*20.94*24.08
**0507T*TC*19.06*18.11*20.83
**0507T*26*2.98*2.83*3.25
**0510T**584.35*555.13*638.40
#**0510T**416.28*395.47*454.79
**0512T**302.55*287.42*330.53
#**0512T**220.07*209.07*240.43
**0513T**90.76*86.22*99.15
#**0513T**66.02*62.72*72.13
**0515T**507.27*481.91*554.20
**0516T**468.12*444.71*511.42
**0517T**331.56*314.98*362.23
**0518T**227.47*216.10*248.52
**0519T**332.43*315.81*363.18
**0520T**468.12*444.71*511.42
**0521T**53.37*50.70*58.31
**0521T*TC*33.69*32.01*36.81
**0521T*26*19.68*18.70*21.51
**0522T**64.19*60.98*70.13
**0522T*TC*34.31*32.59*37.48
**0522T*26*29.88*28.39*32.65
**0523T**146.95*139.60*160.54
**0524T**1546.34*1469.02*1689.37
#**0524T**176.58*167.75*192.91
**0525T**468.43*445.01*511.76
**0526T**363.24*345.08*396.84
**0527T**316.53*300.70*345.81
**0528T**64.19*60.98*70.13
**0528T*TC*34.31*32.59*37.48
**0528T*26*29.88*28.39*32.65
**0529T**53.37*50.70*58.31
**0529T*TC*33.69*32.01*36.81
**0529T*26*19.68*18.70*21.51
**0530T**622.24*591.13*679.80
**0531T**473.75*450.06*517.57
**0532T**332.43*315.81*363.18
**0540T**172.61*163.98*188.58
**0543T**1542.59*1465.46*1685.28
**0544T**1768.95*1680.50*1932.58
**0545T**1768.95*1680.50*1932.58
**0546T**68.69*65.26*75.05
**0552T**6.43*6.11*7.03
**0553T**2322.16*2206.05*2536.96
#**0553T**392.17*372.56*428.44
**0565T**597.37*567.50*652.63
#**0565T**504.31*479.09*550.95
**0566T**96.54*91.71*105.47
#**0566T**58.26*55.35*63.65
**0569T**1768.95*1680.50*1932.58
**0570T**415.79*395.00*454.25
**0571T**548.39*520.97*599.12
**0572T**446.87*424.53*488.21
**0573T**340.18*323.17*371.65
**0574T**395.23*375.47*431.79
**0575T**64.19*60.98*70.13
**0576T**53.37*50.70*58.31
**0577T**184.41*175.19*201.47
**0578T**28.67*27.24*31.33
**0579T**19.99*18.99*21.84
**0580T**209.99*199.49*229.41
**0581T**2131.70*2025.12*2328.89
#**0581T**210.12*199.61*229.55
**0582T**1564.74*1486.50*1709.48
#**0582T**375.50*356.73*410.24
**0583T**1522.66*1446.53*1663.51
#**0583T**129.21*122.75*141.16
**0587T**429.42*407.95*469.14
#**0587T**291.23*276.67*318.17
**0588T**352.81*335.17*385.45
#**0588T**226.76*215.42*247.73
**0589T**47.02*44.67*51.37
#**0589T**38.00*36.10*41.52
**0590T**55.23*52.47*60.34
#**0590T**39.36*37.39*43.00
**0596T**672.69*639.06*734.92
#**0596T**129.37*122.90*141.34
**0597T**672.69*639.06*734.92
#**0597T**129.37*122.90*141.34
**0598T**142.01*134.91*155.15
**0599T**94.61*89.88*103.36
**0600T**3382.04*3212.94*3694.88
#**0600T**713.49*677.82*779.49
**0601T**1446.99*1374.64*1580.84
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**186.95*177.60*204.24
**0611T**38.12*36.21*41.64
**0614T**364.33*346.11*398.03
**0615T**45.55*43.27*49.76
**0616T**640.43*608.41*699.67
**0617T**716.14*680.33*782.38
**0618T**866.77*823.43*946.94
**0619T**632.26*600.65*690.75
#**0619T**466.29*442.98*509.43
**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**246.74*234.40*269.56
#**0627T**97.35*92.48*106.35
**0628T**74.02*70.32*80.87
#**0628T**29.20*27.74*31.90
**0629T**246.74*234.40*269.56
#**0629T**97.35*92.48*106.35
**0630T**74.02*70.32*80.87
#**0630T**29.20*27.74*31.90
**0631T**77.78*73.89*84.97
**0632T**568.33*539.91*620.90
**0633T**191.28*181.72*208.98
*C*0633T*TC*99.67*94.69*108.89
**0633T*26*57.61*54.73*62.94
**0634T**191.28*181.72*208.98
**0634T*TC*133.67*126.99*146.04
**0634T*26*57.61*54.73*62.94
**0635T**191.28*181.72*208.98
**0635T*TC*133.67*126.99*146.04
**0635T*26*57.61*54.73*62.94
**0636T**191.28*181.72*208.98
**0636T*TC*133.67*126.99*146.04
**0636T*26*57.61*54.73*62.94
**0637T**191.28*181.72*208.98
**0637T*TC*133.67*126.99*146.04
**0637T*26*57.61*54.73*62.94
**0638T**191.28*181.72*208.98
**0638T*TC*133.67*126.99*146.04
**0638T*26*57.61*54.73*62.94
**0639T**77.78*73.89*84.97
**0640T**22.04*20.94*24.08
**0640T*TC*19.21*18.25*20.99
**0640T*26*2.98*2.83*3.25
**0644T**1102.12*1047.01*1204.06
#**0644T**239.05*227.10*261.17
**0646T**1768.95*1680.50*1932.58
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**57.06*54.21*62.34
**0652T**275.03*261.28*300.47
#**0652T**119.41*113.44*130.46
**0653T**358.45*340.53*391.61
#**0653T**134.99*128.24*147.48
**0654T**138.85*131.91*151.70
**0655T**1537.73*1460.84*1679.97
#**0655T**682.14*648.03*745.23
**0658T**88.78*84.34*96.99
**0659T**2544.36*2417.14*2779.71
#**0659T**432.30*410.69*472.29
**0671T**989.30*939.84*1080.82
**0673T**3226.09*3064.79*3524.51
#**0673T**359.89*341.90*393.19
**0699T**108.81*103.37*118.88
#**0699T**88.27*83.86*96.44
**0707T**355.89*338.10*388.82
#**0707T**269.68*256.20*294.63
**0714T**1329.38*1262.91*1452.35
#**0714T**350.23*332.72*382.63
**0730T**258.95*246.00*282.90
#**0730T**233.60*221.92*255.21
**0738T**69.07*65.62*75.46
**0739T**1537.73*1460.84*1679.97
#**0739T**682.14*648.03*745.23
**0740T**18.82*17.88*20.56
**0741T**44.27*42.06*48.37
**0742T**88.79*84.35*97.00
**0742T*TC*70.14*66.63*76.62
**0742T*26*18.65*17.72*20.38
**0743T**50.67*48.14*55.36
**0744T**886.77*842.43*968.79
**0745T**240.79*228.75*263.06
**0746T**219.14*208.18*239.41
**0747T**930.88*884.34*1016.99
**0748T**180.65*171.62*197.36
**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**4.17*3.96*4.55
**0765T**7.91*7.51*8.64
**0771T**26.05*24.75*28.46
**0772T**26.05*24.75*28.46
**0773T**22.25*21.14*24.31
**0774T**22.25*21.14*24.31
**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**409.69*389.21*447.59
**0779T*TC*384.45*365.23*420.01
**0779T*26*25.24*23.98*27.58
**0780T**22.25*21.14*24.31
**0783T**13.46*12.79*14.71
**0784T**1998.37*1898.45*2183.22
#**0784T**318.30*302.39*347.75
**0785T**233.35*221.68*254.93
#**0785T**141.54*134.46*154.63
**0786T**701.94*666.84*766.87
#**0786T**299.20*284.24*326.88
**0787T**233.35*221.68*254.93
#**0787T**141.54*134.46*154.63
**0788T**18.41*17.49*20.11
#**0788T**17.78*16.89*19.42
**0789T**26.18*24.87*28.60
#**0789T**22.23*21.12*24.29
**0790T**1889.13*1794.67*2063.87
**0791T**8.80*8.36*9.61
**0793T**568.33*539.91*620.90
**0794T**130.35*123.83*142.40
**0795T**702.18*667.07*767.13
**0796T**468.12*444.71*511.42
**0797T**468.12*444.71*511.42
**0798T**744.52*707.29*813.38
**0799T**496.35*471.53*542.26
**0800T**496.35*471.53*542.26
**0801T**964.47*916.25*1053.69
**0802T**482.23*458.12*526.84
**0803T**482.23*458.12*526.84
**0804T**75.03*71.28*81.97
**0804T*TC*39.60*37.62*43.26
**0804T*26*35.43*33.66*38.71
**0805T**2785.22*2645.96*3042.85
#**0805T**321.15*305.09*350.85
**0806T**3713.63*3527.95*4057.14
#**0806T**428.20*406.79*467.81
**0807T**40.78*38.74*44.55
**0807T*TC*26.22*24.91*28.65
**0807T*26*14.56*13.83*15.90
**0808T**40.78*38.74*44.55
**0808T*TC*26.22*24.91*28.65
**0808T*26*14.56*13.83*15.90
**0810T**1097.05*1042.20*1198.53
**0811T**18.82*17.88*20.56
**0813T**2439.46*2317.49*2665.11
#**0813T**179.25*170.29*195.83
**0814T**444.86*422.62*486.01
#**0814T**337.09*320.24*368.28
**0818T**352.81*335.17*385.45
#**0818T**226.76*215.42*247.73
**0820T**144.78*137.54*158.17
#**0820T**128.28*121.87*140.15
**0821T**144.78*137.54*158.17
#**0821T**128.28*121.87*140.15
**0822T**123.06*116.91*134.45
#**0822T**109.04*103.59*119.13
**0823T**702.18*667.07*767.13
**0824T**744.52*707.29*813.38
**0825T**964.47*916.25*1053.69
**0826T**64.19*60.98*70.13
**0826T*TC*34.31*32.59*37.48
**0826T*26*29.88*28.39*32.65
**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**22.04*20.94*24.08
**0859T*TC*19.06*18.11*20.83
**0859T*26*2.98*2.83*3.25
**0864T**302.55*287.42*330.53
#**0864T**220.07*209.07*240.43
**10011**404.58*384.35*442.00
#**10011**106.10*100.80*115.92
**10012**224.54*213.31*245.31
#**10012**71.41*67.84*78.02
**15847**347.14*329.78*379.25
**21742**1150.36*1092.84*1256.77
**21743**1326.55*1260.22*1449.25
**32855**348.71*331.27*380.96
**32856**452.71*430.07*494.58
**33928**3321.86*3155.77*3629.14
**33929**1243.96*1181.76*1359.02
**33933**534.43*507.71*583.87
**33944**567.86*539.47*620.39
**34841**2132.10*2025.50*2329.33
**34842**2357.86*2239.97*2575.97
**34843**2583.65*2454.47*2822.64
**34844**2809.42*2668.95*3069.29
**34845**2132.10*2025.50*2329.33
**34846**2357.86*2239.97*2575.97
**34847**2583.65*2454.47*2822.64
**34848**2809.42*2668.95*3069.29
**43496**2083.27*1979.11*2275.98
**43647**693.16*658.50*757.28
**43648**527.22*500.86*575.99
#**43648**238.19*226.28*260.22
**43881**669.48*636.01*731.41
#**43881**613.95*583.25*670.74
**43882**709.55*674.07*775.18
#**43882**649.76*617.27*709.86
**47143**425.19*403.93*464.52
**47144**504.90*479.66*551.61
**47145**478.34*454.42*522.58
**48551**265.61*252.33*290.18
**50323**160.15*152.14*174.96
**50325**265.30*252.04*289.85
**53451**745.09*707.84*814.02
**53452**372.55*353.92*407.01
**53453**633.22*601.56*691.79
**53454**54.87*52.13*59.95
#**53454**34.64*32.91*37.85
**63043**581.24*552.18*635.01
**63044**511.42*485.85*558.73
**64596**1998.37*1898.45*2183.22
#**64596**318.30*302.39*347.75
**64597**599.51*569.53*654.96
#**64597**95.49*90.72*104.33
**64598**233.35*221.68*254.93
#**64598**141.54*134.46*154.63
**65757**116.70*110.87*127.50
**66983**640.43*608.41*699.67
**66987**747.53*710.15*816.67
**66988**617.73*586.84*674.87
*C*70170**236.17*224.36*258.01
*C*70170*TC*221.99*210.89*242.52
**70555**233.47*221.80*255.07
**70555*TC*118.16*112.25*129.09
*C*70557**646.90*614.56*706.74
*C*70557*TC*499.61*474.63*545.82
*C*70558**328.91*312.46*359.33
*C*70558*TC*166.59*158.26*182.00
*C*70559**320.46*304.44*350.11
*C*70559*TC*166.59*158.26*182.00
*C*74190**521.10*495.05*569.31
*C*74190*TC*499.61*474.63*545.82
**74235**138.69*131.76*151.52
**74235*TC*83.70*79.52*91.45
**74300**78.97*75.02*86.27
**74300*TC*66.10*62.80*72.22
**74301**24.49*23.27*26.76
**74301*TC*14.94*14.19*16.32
**74328**175.06*166.31*191.26
**74328*TC*152.73*145.09*166.85
**74329**133.97*127.27*146.36
**74329*TC*111.33*105.76*121.62
**74330**262.59*249.46*286.88
**74330*TC*236.26*224.45*258.12
**74340**86.58*82.25*94.59
**74340*TC*61.85*58.76*67.57
**74355**86.58*82.25*94.59
**74355*TC*51.34*48.77*56.09
**74360**86.58*82.25*94.59
**74360*TC*60.14*57.13*65.70
**74363**175.06*166.31*191.26
**74363*TC*134.82*128.08*147.29
*C*74445**151.61*144.03*165.63
*C*74445*TC*99.67*94.69*108.89
*C*74450**237.09*225.24*259.03
*C*74450*TC*221.99*210.89*242.52
*C*74470**523.72*497.53*572.16
*C*74470*TC*499.61*474.63*545.82
**74742**233.47*221.80*255.07
**74742*TC*205.16*194.90*224.14
*C*74775**250.63*238.10*273.82
*C*74775*TC*221.99*210.89*242.52
*C*75801**610.94*580.39*667.45
*C*75801*TC*569.02*540.57*621.66
*C*75803**1504.77*1429.53*1643.96
*C*75803*TC*1450.44*1377.92*1584.61
*C*75805**2924.34*2778.12*3194.84
*C*75805*TC*2886.81*2742.47*3153.84
*C*75807**2938.17*2791.26*3209.95
*C*75807*TC*2886.81*2742.47*3153.84
*C*75810**2934.21*2787.50*3205.63
*C*75810*TC*2886.81*2742.47*3153.84
**75894**848.06*805.66*926.51
**75894*TC*777.57*738.69*849.49
*C*75898**2976.75*2827.91*3252.10
*C*75898*TC*2886.81*2742.47*3153.84
**75970**414.20*393.49*452.51
**75970*TC*377.42*358.55*412.33
**76125**37.75*35.86*41.24
**76125*TC*24.88*23.64*27.19
**76390**192.74*183.10*210.57
**76390*TC*142.51*135.38*155.69
**76390*26*50.23*47.72*54.88
**76932**80.67*76.64*88.14
**76932*TC*45.57*43.29*49.78
**76940**154.64*146.91*168.95
**76940*TC*56.20*53.39*61.40
**76941**110.79*105.25*121.04
**76941*TC*48.85*46.41*53.37
**76945**79.68*75.70*87.06
**76945*TC*48.90*46.46*53.43
*C*76975**261.31*248.24*285.48
*C*76975*TC*221.99*210.89*242.52
**76998**175.06*166.31*191.26
**76998*TC*128.96*122.51*140.89
**77013**394.43*374.71*430.92
**77013*TC*216.82*205.98*236.88
**77022**443.55*421.37*484.58
**77022*TC*250.37*237.85*273.53
**77371**601.27*571.21*656.89
**77520**872.41*828.79*953.11
**77522**872.41*828.79*953.11
**77523**1001.73*951.64*1094.39
**77525**1131.05*1074.50*1235.68
*C*78282**388.46*369.04*424.40
*C*78282*TC*373.56*354.88*408.11
**78414**514.99*489.24*562.63
**78414*TC*494.65*469.92*540.41
*C*78429**1493.29*1418.63*1631.42
*C*78429*TC*1416.83*1345.99*1547.89
*C*78430**1489.59*1415.11*1627.38
*C*78430*TC*1416.83*1345.99*1547.89
*C*78431**2224.07*2112.87*2429.80
*C*78431*TC*2139.21*2032.25*2337.09
*C*78432**1849.78*1757.29*2020.88
*C*78432*TC*1758.88*1670.94*1921.58
*C*78433**1953.59*1855.91*2134.30
*C*78433*TC*1854.12*1761.41*2025.62
**78434**656.33*623.51*717.04
**78434*TC*628.36*596.94*686.48
*C*78459**1356.95*1289.10*1482.47
*C*78459*TC*1286.11*1221.80*1405.07
*C*78491**1486.24*1411.93*1623.72
*C*78491*TC*1416.83*1345.99*1547.89
*C*78492**1498.35*1423.43*1636.94
*C*78492*TC*1416.83*1345.99*1547.89
*C*78608**1483.70*1409.52*1620.95
*C*78608*TC*1416.83*1345.99*1547.89
*C*78811**1355.01*1287.26*1480.35
*C*78811*TC*1286.11*1221.80*1405.07
*C*78812**1503.83*1428.64*1642.94
*C*78812*TC*1416.83*1345.99*1547.89
*C*78813**1505.85*1430.56*1645.14
*C*78813*TC*1416.83*1345.99*1547.89
*C*78814**1515.39*1439.62*1655.56
*C*78814*TC*1416.83*1345.99*1547.89
*C*78815**1526.56*1450.23*1667.76
*C*78815*TC*1416.83*1345.99*1547.89
*C*78816**1527.55*1451.17*1668.85
*C*78816*TC*1416.83*1345.99*1547.89
**79300**237.04*225.19*258.97
**79300*TC*175.23*166.47*191.44
**79445**237.04*225.19*258.97
**79445*TC*130.91*124.36*143.01
**86485**15.20*14.44*16.61
**90867**286.87*272.53*313.41
#**90867**134.21*127.50*146.63
**90868**194.15*184.44*212.11
#**90868**102.61*97.48*112.10
**90869**267.24*253.88*291.96
#**90869**156.18*148.37*170.63
**92978**231.95*220.35*253.40
**92978*TC*139.65*132.67*152.57
**92979**141.60*134.52*154.70
**92979*TC*68.41*64.99*74.74
*C*93315**620.94*589.89*678.37
*C*93315*TC*499.61*474.63*545.82
**93317**203.23*193.07*222.03
**93317*TC*118.38*112.46*129.33
*C*93318**597.58*567.70*652.86
*C*93318*TC*499.61*474.63*545.82
**93571**231.03*219.48*252.40
**93571*TC*160.84*152.80*175.72
**93572**139.38*132.41*152.27
**93572*TC*88.20*83.79*96.36
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.08*3272.83*3763.75
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.10*3274.75*3765.96
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.10*3274.75*3765.96
**93609**2134.69*2027.96*2332.15
**93609*TC*1870.17*1776.66*2043.16
**93610**3557.81*3379.92*3886.91
**93610*TC*3401.33*3231.26*3715.95
**93612**3557.81*3379.92*3886.91
**93612*TC*3403.73*3233.54*3718.57
**93615**47.57*45.19*51.97
**93615*TC*13.70*13.02*14.97
**93619**7115.62*6759.84*7773.82
**93619*TC*6741.97*6404.87*7365.60
**93620**7115.62*6759.84*7773.82
**93620*TC*6516.02*6190.22*7118.75
**93621**7115.62*6759.84*7773.82
**93621*TC*7035.86*6684.07*7686.68
**93622**7115.62*6759.84*7773.82
**93622*TC*6951.13*6603.57*7594.11
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.55*1966.07*2260.98
**93624**3557.81*3379.92*3886.91
**93624*TC*3324.56*3158.33*3632.08
**93631**7115.62*6759.84*7773.82
**93631*TC*6730.26*6393.75*7352.81
**93640**1133.95*1077.25*1238.84
**93640*TC*962.74*914.60*1051.79
**93641**1133.95*1077.25*1238.84
**93641*TC*834.41*792.69*911.59
**93662**400.34*380.32*437.37
**93662*TC*333.13*316.47*363.94
**94642**36.81*34.97*40.22
**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**918.45*872.53*1003.41
**95965*TC*529.38*502.91*578.35
**96020**370.86*352.32*405.17
**96547**702.17*667.06*767.12
#**96547**130.42*123.90*142.49
**96548**351.08*333.53*383.56
#**96548**65.21*61.95*71.24
**97151**48.86*46.42*53.38
#**97151**43.57*41.39*47.60
**97152**41.53*39.45*45.37
#**97152**37.03*35.18*40.46
**97153**33.07*31.42*36.13
#**97153**29.18*27.72*31.88
**97154**4.56*4.33*4.98
#**97154**4.16*3.95*4.54
**97155**33.07*31.42*36.13
#**97155**29.18*27.72*31.88
**97156**34.89*33.15*38.12
#**97156**30.84*29.30*33.70
**97157**10.20*9.69*11.14
#**97157**9.26*8.80*10.12
**97158**5.29*5.03*5.78
#**97158**4.82*4.58*5.27
**98978**44.27*42.06*48.37
# - 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.