ARKANSAS MEDICARE CARRIER - 07102
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**408.70*388.27*446.51
#**G0186**353.16*335.50*385.83
**G0339**2447.88*2325.49*2674.31
**G0340**1840.79*1748.75*2011.06
**G0398**120.19*114.18*131.31
**G0398*TC*83.36*79.19*91.07
**G0398*26*36.83*34.99*40.24
**G0399**84.78*80.54*92.62
**G0399*TC*44.14*41.93*48.22
**G0399*26*40.92*38.87*44.70
**G0400**86.98*82.63*95.02
**G0400*TC*49.01*46.56*53.54
**G0400*26*37.97*36.07*41.48
**G0460**691.04*656.49*754.96
#**G0460**109.62*104.14*119.76
**G0465**691.04*656.49*754.96
#**G0465**109.62*104.14*119.76
**G0498**126.71*120.37*138.43
**G6017**69.87*66.38*76.34
**0042T**203.67*193.49*222.51
**0054T**200.49*190.47*219.04
**0055T**200.49*190.47*219.04
**0071T**517.18*491.32*565.02
**0072T**517.18*491.32*565.02
**0075T**861.91*818.81*941.63
**0075T*TC*861.91*818.81*941.63
**0075T*26*861.91*818.81*941.63
**0095T**540.15*513.14*590.11
**0098T**604.55*574.32*660.47
**0100T**1730.22*1643.71*1890.27
**0101T**282.04*267.94*308.13
#**0101T**206.18*195.87*225.25
**0102T**282.04*267.94*308.13
#**0102T**206.18*195.87*225.25
**0106T**28.92*27.47*31.59
**0107T**28.92*27.47*31.59
**0108T**28.92*27.47*31.59
**0109T**28.92*27.47*31.59
**0110T**28.92*27.47*31.59
**0164T**590.53*561.00*645.15
**0165T**604.98*574.73*660.94
**0184T**740.58*703.55*809.08
**0198T**75.61*71.83*82.60
#**0198T**29.81*28.32*32.57
**0200T**1548.96*1471.51*1692.24
#**0200T**367.80*349.41*401.82
**0201T**2323.43*2207.26*2538.35
#**0201T**551.69*524.11*602.73
**0207T**121.71*115.62*132.96
**0208T**32.52*30.89*35.52
**0209T**39.39*37.42*43.03
**0210T**24.79*23.55*27.08
**0211T**38.53*36.60*42.09
**0212T**33.77*32.08*36.89
#**0212T**29.48*28.01*32.21
**0213T**172.18*163.57*188.11
#**0213T**96.32*91.50*105.23
**0214T**87.63*83.25*95.74
#**0214T**54.42*51.70*59.46
**0215T**87.92*83.52*96.05
#**0215T**55.28*52.52*60.40
**0216T**157.96*150.06*172.57
#**0216T**82.67*78.54*90.32
**0217T**81.67*77.59*89.23
#**0217T**46.75*44.41*51.07
**0218T**81.67*77.59*89.23
#**0218T**47.61*45.23*52.01
**0219T**1147.92*1090.52*1254.10
**0220T**1131.42*1074.85*1236.08
**0221T**1401.02*1330.97*1530.62
**0222T**341.22*324.16*372.78
**0232T**691.04*656.49*754.96
#**0232T**109.62*104.14*119.76
**0234T**7374.46*7005.74*8056.60
#**0234T**524.24*498.03*572.73
**0235T**7374.46*7005.74*8056.60
#**0235T**524.24*498.03*572.73
**0236T**7509.70*7134.22*8204.35
#**0236T**609.39*578.92*665.76
**0237T**7509.70*7134.22*8204.35
#**0237T**609.39*578.92*665.76
**0238T**7509.70*7134.22*8204.35
#**0238T**609.39*578.92*665.76
**0266T**799.47*759.50*873.43
**0267T**142.16*135.05*155.31
**0268T**297.10*282.25*324.59
**0269T**756.33*718.51*826.29
**0270T**142.16*135.05*155.31
**0271T**297.10*282.25*324.59
**0272T**49.87*47.38*54.49
**0273T**64.59*61.36*70.56
**0274T**969.97*921.47*1059.69
**0278T**13.36*12.69*14.59
**0308T**1268.68*1205.25*1386.04
**0329T**75.61*71.83*82.60
#**0329T**29.81*28.32*32.57
**0330T**38.21*36.30*41.75
**0331T**160.38*152.36*175.21
**0332T**274.10*260.40*299.46
**0347T**127.45*121.08*139.24
**0348T**29.05*27.60*31.74
**0349T**30.67*29.14*33.51
**0350T**31.24*29.68*34.13
**0351T**148.99*141.54*162.77
**0352T**40.03*38.03*43.73
**0353T**148.99*141.54*162.77
**0354T**40.03*38.03*43.73
**0358T**23.07*21.92*25.21
**0362T**83.07*78.92*90.76
#**0362T**61.03*57.98*66.68
**0378T**23.08*21.93*25.22
**0394T**218.57*207.64*238.79
**0395T**534.79*508.05*584.26
**0397T**43.75*41.56*47.79
**0398T*26*1746.88*1659.54*1908.47
**0408T**454.30*431.59*496.33
**0409T**313.94*298.24*342.98
**0410T**326.06*309.76*356.22
**0411T**326.06*309.76*356.22
**0412T**204.54*194.31*223.46
**0413T**424.80*403.56*464.09
**0414T**327.14*310.78*357.40
**0415T**272.58*258.95*297.79
**0416T**301.28*286.22*329.15
**0417T**75.07*71.32*82.02
**0418T**49.87*47.38*54.49
**0419T**402.47*382.35*439.70
#**0419T**325.75*309.46*355.88
**0420T**571.96*543.36*624.86
#**0420T**477.21*453.35*521.35
**0421T**1419.78*1348.79*1551.11
#**0421T**632.82*601.18*691.36
**0437T**191.28*181.72*208.98
**0439T**63.09*59.94*68.93
**0440T**220.40*209.38*240.79
#**0440T**108.75*103.31*118.81
**0441T**220.40*209.38*240.79
#**0441T**108.75*103.31*118.81
**0442T**220.40*209.38*240.79
#**0442T**108.75*103.31*118.81
**0449T**688.70*654.27*752.41
**0464T**59.23*56.27*64.71
**0472T**60.23*57.22*65.80
**0473T**49.87*47.38*54.49
**0479T**58.61*55.68*64.03
**0480T**138.48*131.56*151.29
#**0480T**29.30*27.84*32.02
**0483T**1059.04*1006.09*1157.00
**0484T**1374.16*1305.45*1501.27
**0485T**21.33*20.26*23.30
**0485T*TC*7.47*7.10*8.17
**0485T*26*14.03*13.33*15.33
**0486T**42.65*40.52*46.60
**0486T*TC*14.77*14.03*16.13
**0486T*26*27.88*26.49*30.46
**0488T**57.68*54.80*63.02
#**0488T**46.52*44.19*50.82
**0505T**9576.86*9098.02*10462.72
#**0505T**509.69*484.21*556.84
**0507T**20.04*19.04*21.90
**0507T*TC*17.35*16.48*18.95
**0507T*26*2.70*2.57*2.96
**0510T**534.15*507.44*583.56
#**0510T**379.56*360.58*414.67
**0512T**282.04*267.94*308.13
#**0512T**206.18*195.87*225.25
**0513T**84.61*80.38*92.44
#**0513T**61.85*58.76*67.57
**0515T**454.30*431.59*496.33
**0516T**419.27*398.31*458.06
**0517T**297.10*282.25*324.59
**0518T**204.54*194.31*223.46
**0519T**297.82*282.93*325.37
**0520T**419.27*398.31*458.06
**0521T**49.87*47.38*54.49
**0521T*TC*30.80*29.26*33.65
**0521T*26*19.07*18.12*20.84
**0522T**60.23*57.22*65.80
**0522T*TC*31.38*29.81*34.28
**0522T*26*28.85*27.41*31.52
**0523T**134.29*127.58*146.72
**0524T**1418.58*1347.65*1549.80
#**0524T**158.69*150.76*173.37
**0525T**419.56*398.58*458.37
**0526T**326.06*309.76*356.22
**0527T**283.65*269.47*309.89
**0528T**60.23*57.22*65.80
**0528T*TC*31.38*29.81*34.28
**0528T*26*28.85*27.41*31.52
**0529T**49.87*47.38*54.49
**0529T*TC*30.80*29.26*33.65
**0529T*26*19.07*18.12*20.84
**0530T**557.74*529.85*609.33
**0531T**424.80*403.56*464.09
**0532T**297.82*282.93*325.37
**0540T**163.14*154.98*178.23
**0543T**1374.16*1305.45*1501.27
**0544T**1578.49*1499.57*1724.51
**0545T**1578.49*1499.57*1724.51
**0546T**64.82*61.58*70.82
**0552T**5.89*5.60*6.44
**0553T**2125.40*2019.13*2322.00
#**0553T**350.23*332.72*382.63
**0565T**544.73*517.49*595.11
#**0565T**459.14*436.18*501.61
**0566T**89.01*84.56*97.24
#**0566T**53.80*51.11*58.78
**0569T**1578.49*1499.57*1724.51
**0570T**370.76*352.22*405.05
**0571T**491.31*466.74*536.75
**0572T**399.83*379.84*436.82
**0573T**304.86*289.62*333.06
**0574T**353.48*335.81*386.18
**0575T**60.23*57.22*65.80
**0576T**49.87*47.38*54.49
**0577T**175.92*167.12*192.19
**0578T**27.25*25.89*29.77
**0579T**18.21*17.30*19.90
**0580T**188.55*179.12*205.99
**0581T**1953.32*1855.65*2134.00
#**0581T**185.87*176.58*203.07
**0582T**1441.81*1369.72*1575.18
#**0582T**347.97*330.57*380.16
**0583T**1522.66*1446.53*1663.51
#**0583T**118.78*112.84*129.77
**0587T**395.34*375.57*431.91
#**0587T**268.24*254.83*293.05
**0588T**324.47*308.25*354.49
#**0588T**208.53*198.10*227.82
**0589T**44.06*41.86*48.14
#**0589T**35.76*33.97*39.07
**0590T**51.48*48.91*56.25
#**0590T**36.88*35.04*40.30
**0596T**672.69*639.06*734.92
#**0596T**123.95*117.75*135.41
**0597T**672.69*639.06*734.92
#**0597T**123.95*117.75*135.41
**0598T**130.95*124.40*143.06
**0599T**87.51*83.13*95.60
**0600T**3122.05*2965.95*3410.84
#**0600T**667.55*634.17*729.30
**0601T**1288.68*1224.25*1407.89
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**174.09*165.39*190.20
**0611T**34.70*32.97*37.92
**0614T**326.66*310.33*356.88
**0615T**43.15*40.99*47.14
**0616T**603.98*573.78*659.85
**0617T**671.72*638.13*733.85
**0618T**812.56*771.93*887.72
**0619T**585.09*555.84*639.22
#**0619T**432.32*410.70*472.31
**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**228.49*217.07*249.63
#**0627T**91.08*86.53*99.51
**0628T**68.55*65.12*74.89
#**0628T**27.32*25.95*29.84
**0629T**228.49*217.07*249.63
#**0629T**91.08*86.53*99.51
**0630T**68.55*65.12*74.89
#**0630T**27.32*25.95*29.84
**0631T**71.31*67.74*77.90
**0632T**507.97*482.57*554.96
**0633T**177.82*168.93*194.27
*C*0633T*TC*91.49*86.92*99.96
**0633T*26*55.24*52.48*60.35
**0634T**177.82*168.93*194.27
**0634T*TC*122.58*116.45*133.92
**0634T*26*55.24*52.48*60.35
**0635T**177.82*168.93*194.27
**0635T*TC*122.58*116.45*133.92
**0635T*26*55.24*52.48*60.35
**0636T**177.82*168.93*194.27
**0636T*TC*122.58*116.45*133.92
**0636T*26*55.24*52.48*60.35
**0637T**177.82*168.93*194.27
**0637T*TC*122.58*116.45*133.92
**0637T*26*55.24*52.48*60.35
**0638T**177.82*168.93*194.27
**0638T*TC*122.58*116.45*133.92
**0638T*26*55.24*52.48*60.35
**0639T**71.31*67.74*77.90
**0640T**20.04*19.04*21.90
**0640T*TC*17.42*16.55*19.03
**0640T*26*2.70*2.57*2.96
**0644T**1008.52*958.09*1101.80
#**0644T**214.68*203.95*234.54
**0646T**1578.49*1499.57*1724.51
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**53.32*50.65*58.25
**0652T**253.83*241.14*277.31
#**0652T**110.70*105.17*120.95
**0653T**330.64*314.11*361.23
#**0653T**125.09*118.84*136.67
**0654T**128.37*121.95*140.24
**0655T**1419.78*1348.79*1551.11
#**0655T**632.82*601.18*691.36
**0658T**81.47*77.40*89.01
**0659T**2328.97*2212.52*2544.40
#**0659T**386.32*367.00*422.05
**0671T**926.13*879.82*1011.79
**0673T**2966.45*2818.13*3240.85
#**0673T**330.17*313.66*360.71
**0699T**101.93*96.83*111.35
#**0699T**83.04*78.89*90.72
**0707T**328.47*312.05*358.86
#**0707T**249.17*236.71*272.22
**0714T**1225.24*1163.98*1338.58
#**0714T**324.63*308.40*354.66
**0730T**238.40*226.48*260.45
#**0730T**215.24*204.48*235.15
**0738T**65.55*62.27*71.61
**0739T**1419.78*1348.79*1551.11
#**0739T**632.82*601.18*691.36
**0740T**16.95*16.10*18.52
**0741T**40.54*38.51*44.29
**0742T**82.23*78.12*89.84
**0742T*TC*64.24*61.03*70.18
**0742T*26*17.99*17.09*19.65
**0743T**46.86*44.52*51.20
**0744T**784.58*745.35*857.15
**0745T**220.21*209.20*240.58
**0746T**209.75*199.26*229.15
**0747T**851.68*809.10*930.47
**0748T**165.17*156.91*180.45
**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**3.86*3.67*4.22
**0765T**7.55*7.17*8.25
**0771T**24.19*22.98*26.43
**0772T**24.19*22.98*26.43
**0773T**20.76*19.72*22.68
**0774T**20.76*19.72*22.68
**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**377.67*358.79*412.61
**0779T*TC*353.43*335.76*386.12
**0779T*26*24.24*23.03*26.48
**0780T**20.76*19.72*22.68
**0783T**12.20*11.59*13.33
**0784T**1842.20*1750.09*2012.60
#**0784T**296.90*282.06*324.37
**0785T**214.82*204.08*234.69
#**0785T**130.37*123.85*142.43
**0786T**646.73*614.39*706.55
#**0786T**276.29*262.48*301.85
**0787T**214.82*204.08*234.69
#**0787T**130.37*123.85*142.43
**0788T**17.32*16.45*18.92
#**0788T**16.75*15.91*18.30
**0789T**23.07*21.92*25.21
#**0789T**20.94*19.89*22.87
**0790T**1766.56*1678.23*1929.96
**0791T**8.27*7.86*9.04
**0793T**507.97*482.57*554.96
**0794T**130.35*123.83*142.40
**0795T**628.91*597.46*687.08
**0796T**419.27*398.31*458.06
**0797T**419.27*398.31*458.06
**0798T**665.03*631.78*726.55
**0799T**443.35*421.18*484.36
**0800T**443.35*421.18*484.36
**0801T**862.62*819.49*942.41
**0802T**431.31*409.74*471.20
**0803T**431.31*409.74*471.20
**0804T**70.52*66.99*77.04
**0804T*TC*36.24*34.43*39.59
**0804T*26*34.28*32.57*37.46
**0805T**2562.52*2434.39*2799.55
#**0805T**296.10*281.30*323.50
**0806T**3416.69*3245.86*3732.74
#**0806T**394.80*375.06*431.32
**0807T**37.59*35.71*41.07
**0807T*TC*23.93*22.73*26.14
**0807T*26*13.65*12.97*14.92
**0808T**37.59*35.71*41.07
**0808T*TC*23.93*22.73*26.14
**0808T*26*13.65*12.97*14.92
**0810T**1029.42*977.95*1124.64
**0811T**16.95*16.10*18.52
**0813T**2239.56*2127.58*2446.72
#**0813T**160.65*152.62*175.51
**0814T**410.59*390.06*448.57
#**0814T**311.47*295.90*340.29
**0818T**324.47*308.25*354.49
#**0818T**208.53*198.10*227.82
**0820T**140.11*133.10*153.07
#**0820T**124.93*118.68*136.48
**0821T**140.11*133.10*153.07
#**0821T**124.93*118.68*136.48
**0822T**119.09*113.14*130.11
#**0822T**106.19*100.88*116.01
**0823T**628.91*597.46*687.08
**0824T**665.03*631.78*726.55
**0825T**862.62*819.49*942.41
**0826T**60.23*57.22*65.80
**0826T*TC*31.38*29.81*34.28
**0826T*26*28.85*27.41*31.52
**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**20.04*19.04*21.90
**0859T*TC*17.35*16.48*18.95
**0859T*26*2.70*2.57*2.96
**0864T**282.04*267.94*308.13
#**0864T**206.18*195.87*225.25
**10011**374.17*355.46*408.78
#**10011**99.63*94.65*108.85
**10012**207.12*196.76*226.27
#**10012**66.27*62.96*72.40
**15847**314.60*298.87*343.70
**21742**1033.27*981.61*1128.85
**21743**1179.01*1120.06*1288.07
**32855**315.04*299.29*344.18
**32856**401.33*381.26*438.45
**33928**2951.95*2804.35*3225.00
**33929**1106.32*1051.00*1208.65
**33933**481.02*456.97*525.52
**33944**453.77*431.08*495.74
**34841**1863.16*1770.00*2035.50
**34842**2088.94*1984.49*2282.16
**34843**2314.72*2198.98*2528.83
**34844**2540.49*2413.47*2775.49
**34845**1863.16*1770.00*2035.50
**34846**2088.94*1984.49*2282.16
**34847**2314.72*2198.98*2528.83
**34848**2540.49*2413.47*2775.49
**43496**1869.17*1775.71*2042.07
**43647**553.90*526.21*605.14
**43648**478.68*454.75*522.96
#**43648**219.95*208.95*240.29
**43881**579.14*550.18*632.71
#**43881**529.92*503.42*578.93
**43882**612.89*582.25*669.59
#**43882**559.91*531.91*611.70
**47143**372.81*354.17*407.30
**47144**442.71*420.57*483.66
**47145**419.40*398.43*458.19
**48551**240.49*228.47*262.74
**50323**145.43*138.16*158.88
**50325**212.01*201.41*231.62
**53451**691.18*656.62*755.11
**53452**345.59*328.31*377.56
**53453**587.35*557.98*641.68
**53454**51.25*48.69*55.99
#**53454**32.64*31.01*35.66
**63043**490.87*466.33*536.28
**63044**446.68*424.35*488.00
**64596**1842.20*1750.09*2012.60
#**64596**296.90*282.06*324.37
**64597**552.66*525.03*603.78
#**64597**89.07*84.62*97.31
**64598**214.82*204.08*234.69
#**64598**130.37*123.85*142.43
**65757**107.86*102.47*117.84
**66983**603.98*573.78*659.85
**66987**702.47*667.35*767.45
**66988**583.69*554.51*637.69
*C*70170**217.48*206.61*237.60
*C*70170*TC*204.00*193.80*222.87
**70555**233.47*221.80*255.07
**70555*TC*124.61*118.38*136.14
*C*70557**600.21*570.20*655.73
*C*70557*TC*459.35*436.38*501.84
*C*70558**308.35*292.93*336.87
*C*70558*TC*153.04*145.39*167.20
*C*70559**298.40*283.48*326.00
*C*70559*TC*153.04*145.39*167.20
*C*74190**479.86*455.87*524.25
*C*74190*TC*459.35*436.38*501.84
**74235**127.12*120.76*138.87
**74235*TC*75.31*71.54*82.27
**74300**72.94*69.29*79.68
**74300*TC*60.94*57.89*66.57
**74301**22.24*21.13*24.30
**74301*TC*13.22*12.56*14.44
**74328**175.06*166.31*191.26
**74328*TC*153.98*146.28*168.22
**74329**121.49*115.42*132.73
**74329*TC*100.13*95.12*109.39
**74330**262.59*249.46*286.88
**74330*TC*237.83*225.94*259.83
**74340**86.58*82.25*94.59
**74340*TC*63.32*60.15*69.17
**74355**86.58*82.25*94.59
**74355*TC*53.41*50.74*58.35
**74360**86.58*82.25*94.59
**74360*TC*62.14*59.03*67.88
**74363**175.06*166.31*191.26
**74363*TC*137.23*130.37*149.93
*C*74445**141.58*134.50*154.68
*C*74445*TC*91.49*86.92*99.96
*C*74450**218.59*207.66*238.81
*C*74450*TC*204.00*193.80*222.87
*C*74470**482.43*458.31*527.06
*C*74470*TC*459.35*436.38*501.84
**74742**233.47*221.80*255.07
**74742*TC*206.79*196.45*225.92
*C*74775**231.45*219.88*252.86
*C*74775*TC*204.00*193.80*222.87
*C*75801**561.56*533.48*613.50
*C*75801*TC*523.19*497.03*571.58
*C*75803**1385.92*1316.62*1514.11
*C*75803*TC*1333.92*1267.22*1457.30
*C*75805**2691.02*2556.47*2939.94
*C*75805*TC*2655.06*2522.31*2900.66
*C*75807**2703.98*2568.78*2954.10
*C*75807*TC*2655.06*2522.31*2900.66
*C*75810**2699.89*2564.90*2949.64
*C*75810*TC*2655.06*2522.31*2900.66
**75894**759.37*721.40*829.61
**75894*TC*696.97*662.12*761.44
*C*75898**2735.66*2598.88*2988.71
*C*75898*TC*2655.06*2522.31*2900.66
**75970**371.73*353.14*406.11
**75970*TC*337.34*320.47*368.54
**76125**34.36*32.64*37.54
**76125*TC*22.36*21.24*24.43
**76390**178.74*169.80*195.27
**76390*TC*130.72*124.18*142.81
**76390*26*48.02*45.62*52.46
**76932**73.82*70.13*80.65
**76932*TC*41.91*39.81*45.78
**76940**136.77*129.93*149.42
**76940*TC*47.27*44.91*51.65
**76941**102.74*97.60*112.24
**76941*TC*43.71*41.52*47.75
**76945**73.08*69.43*79.84
**76945*TC*43.65*41.47*47.69
*C*76975**241.78*229.69*264.14
*C*76975*TC*204.00*193.80*222.87
**76998**175.06*166.31*191.26
**76998*TC*133.82*127.13*146.20
**77013**365.30*347.04*399.10
**77013*TC*198.59*188.66*216.96
**77022**414.42*393.70*452.76
**77022*TC*232.43*220.81*253.93
**77371**532.23*505.62*581.46
**77520**772.52*733.89*843.97
**77522**772.52*733.89*843.97
**77523**887.13*842.77*969.19
**77525**1001.75*951.66*1094.41
*C*78282**357.95*340.05*391.06
*C*78282*TC*343.41*326.24*375.18
**78414**514.99*489.24*562.63
**78414*TC*495.58*470.80*541.42
*C*78429**1376.93*1308.08*1504.29
*C*78429*TC*1303.00*1237.85*1423.53
*C*78430**1373.48*1304.81*1500.53
*C*78430*TC*1303.00*1237.85*1423.53
*C*78431**2049.47*1947.00*2239.05
*C*78431*TC*1967.44*1869.07*2149.43
*C*78432**1705.47*1620.20*1863.23
*C*78432*TC*1617.61*1536.73*1767.24
*C*78433**1801.29*1711.23*1967.91
*C*78433*TC*1705.21*1619.95*1862.94
**78434**604.81*574.57*660.76
**78434*TC*578.21*549.30*631.70
*C*78459**1251.13*1188.57*1366.86
*C*78459*TC*1182.76*1123.62*1292.16
*C*78491**1370.10*1301.60*1496.84
*C*78491*TC*1303.00*1237.85*1423.53
*C*78492**1381.70*1312.62*1509.51
*C*78492*TC*1303.00*1237.85*1423.53
*C*78608**1367.42*1299.05*1493.91
*C*78608*TC*1303.00*1237.85*1423.53
*C*78811**1248.97*1186.52*1364.50
*C*78811*TC*1182.76*1123.62*1292.16
*C*78812**1386.54*1317.21*1514.79
*C*78812*TC*1303.00*1237.85*1423.53
*C*78813**1388.59*1319.16*1517.03
*C*78813*TC*1303.00*1237.85*1423.53
*C*78814**1397.71*1327.82*1526.99
*C*78814*TC*1303.00*1237.85*1423.53
*C*78815**1408.45*1338.03*1538.73
*C*78815*TC*1303.00*1237.85*1423.53
*C*78816**1409.70*1339.22*1540.10
*C*78816*TC*1303.00*1237.85*1423.53
**79300**237.04*225.19*258.97
**79300*TC*177.27*168.41*193.67
**79445**237.04*225.19*258.97
**79445*TC*137.21*130.35*149.90
**90867**263.32*250.15*287.67
#**90867**122.90*116.76*134.27
**90868**179.50*170.53*196.11
#**90868**99.07*94.12*108.24
**90869**249.54*237.06*272.62
#**90869**144.57*137.34*157.94
**92978**212.74*202.10*232.42
**92978*TC*130.57*124.04*142.65
**92979**130.63*124.10*142.72
**92979*TC*65.27*62.01*71.31
*C*93315**576.50*547.68*629.83
*C*93315*TC*459.35*436.38*501.84
**93317**186.38*177.06*203.62
**93317*TC*106.92*101.57*116.81
*C*93318**553.03*525.38*604.19
*C*93318*TC*459.35*436.38*501.84
**93571**211.87*201.28*231.47
**93571*TC*149.21*141.75*163.01
**93572**128.77*122.33*140.68
**93572*TC*83.23*79.07*90.93
**93600**3557.81*3379.92*3886.91
**93600*TC*3452.71*3280.07*3772.08
**93602**3557.81*3379.92*3886.91
**93602*TC*3454.94*3282.19*3774.52
**93603**3557.81*3379.92*3886.91
**93603*TC*3454.94*3282.19*3774.52
**93609**2134.69*2027.96*2332.15
**93609*TC*1888.85*1794.41*2063.57
**93610**3557.81*3379.92*3886.91
**93610*TC*3412.36*3241.74*3728.00
**93612**3557.81*3379.92*3886.91
**93612*TC*3414.30*3243.59*3730.13
**93615**44.25*42.04*48.35
**93615*TC*11.51*10.93*12.57
**93619**7115.62*6759.84*7773.82
**93619*TC*6769.76*6431.27*7395.96
**93620**7115.62*6759.84*7773.82
**93620*TC*6559.58*6231.60*7166.34
**93621**7115.62*6759.84*7773.82
**93621*TC*7041.79*6689.70*7693.16
**93622**7115.62*6759.84*7773.82
**93622*TC*6963.32*6615.15*7607.42
**93623**2134.69*2027.96*2332.15
**93623*TC*2061.60*1958.52*2252.30
**93624**3557.81*3379.92*3886.91
**93624*TC*3341.39*3174.32*3650.47
**93631**7115.62*6759.84*7773.82
**93631*TC*6761.77*6423.68*7387.23
**93640**1133.95*1077.25*1238.84
**93640*TC*975.77*926.98*1066.03
**93641**1133.95*1077.25*1238.84
**93641*TC*857.08*814.23*936.36
**93662**362.16*344.05*395.66
**93662*TC*293.04*278.39*320.15
**94642**29.42*27.95*32.14
**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**901.98*856.88*985.41
**95965*TC*529.38*502.91*578.35
**96020**377.70*358.82*412.64
**96547**648.96*616.51*708.99
#**96547**123.08*116.93*134.47
**96548**324.48*308.26*354.50
#**96548**61.54*58.46*67.23
**97151**47.24*44.88*51.61
#**97151**42.37*40.25*46.29
**97152**40.15*38.14*43.86
#**97152**36.02*34.22*39.35
**97153**32.08*30.48*35.05
#**97153**28.51*27.08*31.14
**97154**4.26*4.05*4.66
#**97154**3.89*3.70*4.26
**97155**32.08*30.48*35.05
#**97155**28.51*27.08*31.14
**97156**33.89*32.20*37.03
#**97156**30.17*28.66*32.96
**97157**9.79*9.30*10.70
#**97157**8.93*8.48*9.75
**97158**4.98*4.73*5.44
#**97158**4.55*4.32*4.97
**98978**40.54*38.51*44.29
# - 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.