State prevailing rates

Please note that the CHAMPUS Maximum Allowable Charges (CMAC) take precedence over the state prevailing rates listed below.

Latest update: 08-01-2018
CPT code State Provider class Modifier Current pricing Effective date Past pricing Past effective date
0298T TX 04 00 $424.00 02/29/16
0298T TX 01 00 $424.00 02/29/16
0359T TX 04 00 $500.00 02/29/16
0359T TX 01 00 $500.00 02/29/16
0360T TX 04 00 $62.50 02/29/16
0360T TX 01 00 $62.50 02/29/16
0361T TX 04 00 $62.50 02/29/16
0361T TX 01 00 $62.50 02/29/16
0365T TX 04 00 $62.50 02/29/16
0365T TX 01 00 $62.50 02/29/16
0368T TX 01 00 $62.50 02/29/16
0368T TX 04 00 $62.50 02/29/16
0369T TX 01 00 $62.50 02/29/16
0369T TX 04 00 $62.50 02/29/16
0370T TX 01 00 $125.00 02/29/16
0370T TX 04 00 $125.00 02/29/16
0500F TX 01 00 $6.00 02/29/16
0500F TX 04 00 $6.00 02/29/16
36468 TX 04 00 $307.00 02/29/16
58974 TX 01 00 $800.00 02/29/16
58974 TX 04 00 $800.00 02/29/16
69090 TX 04 00 $7.00 02/29/16
69090 TX 01 00 $7.00 02/29/16
76998 TX 01 TC $1,817.00 02/29/16
76998 TX 04 00 $1,203.00 02/29/16
76998 TX 04 TC $1,817.00 02/29/16
76998 TX 01 00 $1,203.00 02/29/16
77385 TX 01 00 $2,030.00 02/29/16
77385 TX 04 00 $2,030.00 02/29/16
80300 TX 04 QW $150.00 02/29/16
80300 TX 01 00 $150.00 02/29/16
80300 TX 01 QW $150.00 02/29/16
80300 TX 04 00 $150.00 02/29/16
80301 TX 01 00 $350.00 03/04/16
80301 TX 04 59 $45.00 03/04/16
80301 TX 04 00 $350.00 03/04/16
80301 TX 01 59 $45.00 03/04/16
80302 TX 01 00 $200.00 03/04/16
80302 TX 04 00 $200.00 03/04/16
80303 TX 01 00 $70.00 03/04/16
80303 TX 04 00 $70.00 03/04/16
80304 TX 01 00 $45.00 03/04/16
80304 TX 04 00 $45.00 03/04/16
80320 TX 04 00 $22.00 03/04/16
80320 TX 01 00 $22.00 03/04/16
80321 TX 01 90 $59.00 03/04/16
80321 TX 04 90 $59.00 03/04/16
80324 TX 04 59 $40.00 03/04/16
80324 TX 01 59 $40.00 03/04/16
80324 TX 01 00 $65.00 03/04/16
80324 TX 04 00 $65.00 03/04/16
80335 TX 01 00 $37.00 03/04/16
80335 TX 04 00 $37.00 03/04/16
80336 TX 04 90 $156.00 02/23/16
80336 TX 01 90 $156.00 02/23/16
80337 TX 01 00 $535.50 03/04/16
80337 TX 04 00 $535.50 03/04/16
80345 TX 04 00 $60.00 03/04/16
80345 TX 01 00 $60.00 03/04/16
80346 TX 04 00 $480.00 03/04/16
80346 TX 01 59 $50.00 03/04/16
80346 TX 01 00 $480.00 03/04/16
80346 TX 04 59 $50.00 03/04/16
80347 TX 01 00 $80.00 03/04/16
80347 TX 04 00 $80.00 03/04/16
80348 TX 01 00 $105.00 03/04/16
80348 TX 04 00 $105.00 03/04/16
80349 TX 04 00 $60.00 03/04/16
80349 TX 01 00 $60.00 03/04/16
80351 TX 01 00 $67.00 02/23/16
80351 TX 04 00 $67.00 02/23/16
80353 TX 04 00 $45.00 03/04/16
80353 TX 01 91 $31.00 03/04/16
80353 TX 04 91 $31.00 03/04/16
80353 TX 01 00 $45.00 03/04/16
80354 TX 04 59 $50.00 03/04/16
80354 TX 01 59 $50.00 03/04/16
80354 TX 01 00 $148.00 03/04/16
80354 TX 04 00 $148.00 03/04/16
80355 TX 04 00 $105.00 03/04/16
80355 TX 01 00 $105.00 03/04/16
80356 TX 04 00 $74.00 03/04/16
80356 TX 01 00 $74.00 03/04/16
80357 TX 04 00 $168.00 03/04/16
80357 TX 01 00 $168.00 03/04/16
80358 TX 04 00 $60.00 03/04/16
80358 TX 04 91 $33.00 03/04/16
80358 TX 01 00 $60.00 03/04/16
80358 TX 04 59 $40.00 03/04/16
80358 TX 01 59 $40.00 03/04/16
80358 TX 01 91 $33.00 03/04/16
80359 TX 01 91 $65.00 03/04/16
80359 TX 04 00 $45.00 03/04/16
80359 TX 04 91 $65.00 03/04/16
80359 TX 01 00 $45.00 03/04/16
80359 TX 01 59 $45.00 03/04/16
80359 TX 04 59 $45.00 03/04/16
80360 TX 01 00 $50.00 03/04/16
80360 TX 04 00 $50.00 03/04/16
80361 TX 01 59 $50.00 03/04/16
80361 TX 04 00 $222.00 03/04/16
80361 TX 01 00 $222.00 03/04/16
80361 TX 04 59 $50.00 03/04/16
80362 TX 01 59 $45.00 03/04/16
80362 TX 04 59 $45.00 03/04/16
80363 TX 01 00 $150.00 03/04/16
80363 TX 04 00 $150.00 03/04/16
80364 TX 04 90 $106.40 03/04/16
80364 TX 01 90 $106.40 03/04/16
80364 TX 01 00 $105.00 03/04/16
80364 TX 04 00 $105.00 03/04/16
80365 TX 04 90 $106.00 03/04/16
80365 TX 01 90 $106.00 03/04/16
80365 TX 04 59 $55.00 03/04/16
80365 TX 01 00 $80.11 03/04/16
80365 TX 01 59 $55.00 03/04/16
80365 TX 04 00 $80.11 03/04/16
80366 TX 01 00 $98.32 03/04/16
80366 TX 04 00 $98.32 03/04/16
80367 TX 01 00 $40.00 03/04/16
80367 TX 04 59 $40.00 03/04/16
80367 TX 01 59 $40.00 03/04/16
80367 TX 04 00 $40.00 03/04/16
80368 TX 04 00 $45.00 03/04/16
80368 TX 01 00 $45.00 03/04/16
80369 TX 01 00 $72.00 03/04/16
80369 TX 04 00 $72.00 03/04/16
80369 TX 01 59 $50.00 03/04/16
80369 TX 04 59 $50.00 03/04/16
80369 TX 04 90 $96.00 03/04/16
80369 TX 01 90 $96.00 03/04/16
80370 TX 01 00 $148.00 03/04/16
80370 TX 04 00 $148.00 03/04/16
80372 TX 01 59 $50.00 03/04/16
80372 TX 04 59 $50.00 03/04/16
80372 TX 01 90 $106.00 03/04/16
80372 TX 04 90 $106.00 03/04/16
80373 TX 01 59 $40.00 03/04/16
80373 TX 04 59 $40.00 03/04/16
80373 TX 01 00 $40.00 03/04/16
80373 TX 04 00 $40.00 03/04/16
81229 TX 01 00 $3,279.00 03/04/16
81229 TX 04 00 $3,279.00 03/04/16
86960 TX 01 00 $42.00 03/04/16
86960 TX 04 00 $42.00 03/04/16
90664 TX 04 00 $80.00 03/04/16
90664 TX 01 00 $80.00 03/04/16
90668 TX 04 00 $25.00 03/04/16
90668 TX 01 00 $25.00 03/04/16
90736 TX 04 00 $254.35 07/20/17
90736 TX 01 00 $254.35 07/20/17
99071 TX 04 00 $10.00 03/04/16 $25.00 06/18/14
99455 TX 04 00 $100.00 03/04/16
99455 TX 01 00 $100.00 03/04/16
99605 TX 04 00 $79.00 03/04/16
99605 TX 01 00 $79.00 03/04/16
99606 TX 04 00 $59.00 03/04/16 $158.20 06/18/14
99606 TX 01 00 $59.00 03/04/16 $158.20 06/18/14
A0130 TX 04 HH $40.00 02/26/16
A0130 TX 01 HH $40.00 02/26/16
A0420 TX 01 00 $75.00 02/26/16
A0420 TX 04 00 $75.00 02/26/16
A0430 TX 04 00 $4,118.25 12/11/15
A0430 TX 04 00 $2,975.43 04/09/18 $3,500.51 12/08/16
A0430 TX 01 00 $2,975.43 04/09/18 $3,500.51 12/08/16
A0430 TX 01 00 $4,118.25 12/11/15
A0431 TX 01 00 $4,584.81 12/11/15
A0431 TX 04 00 $4,584.81 12/11/15
A0431 TX 04 00 $3,312.53 04/09/18 $3,897.09 12/08/16
A0431 TX 01 00 $3,312.53 04/09/18 $3,897.09 12/08/16
A0435 TX 01 00 $20.36 04/09/18 $23.95 12/08/16
A0435 TX 04 00 $28.18 12/11/15
A0435 TX 01 00 $28.18 12/11/15
A0435 TX 04 00 $20.36 04/09/18 $23.95 12/08/16
A0436 TX 01 00 $65.03 12/11/15
A0436 TX 04 00 $46.99 04/09/18 $55.28 12/08/16
A0436 TX 01 00 $46.99 04/09/18 $55.28 12/08/16
A0436 TX 04 00 $65.03 12/11/15
A4215 TX 01 SC $5.00 02/26/16
A4215 TX 04 SC $5.00 02/26/16
A6250 TX 04 UA $7.25 02/26/16 $6.00 06/26/14
A6250 TX 01 SU $9.00 02/26/16
A6250 TX 01 UA $7.25 02/26/16 $6.00 06/26/14
A6250 TX 04 SU $9.00 02/26/16
B4100 TX 04 00 $3.10 02/26/16 $1.50 07/02/14
B4100 TX 01 00 $3.10 02/26/16 $1.50 07/02/14
C1726 TX 01 00 $1,971.00 08/21/17
C1726 TX 04 00 $1,971.00 08/21/17
E0218 TX 01 00 $600.00 02/26/16 $129.95 07/22/14
E0218 TX 04 00 $600.00 02/26/16 $129.95 07/22/14
E0218 TX 01 NU $600.00 02/26/16 $129.95 07/22/14
E0218 TX 04 NU $600.00 02/26/16 $129.95 07/22/14
E0221 TX 04 00 $2,113.46 02/26/16
E0221 TX 04 RR $211.34 02/26/16
E0221 TX 01 00 $2,113.46 02/26/16
E0221 TX 01 RR $211.34 02/26/16
E0274 TX 04 00 $37.00 02/29/16
E0274 TX 01 00 $37.00 02/29/16
E0274 TX 04 RR $21.00 02/29/16
E0274 TX 01 NU $37.00 02/29/16
E0274 TX 04 NU $37.00 02/29/16
E0274 TX 01 RR $21.00 02/29/16
G0155 TX 04 00 $60.50 02/29/16
G0477 TX 04 QW $40.00 02/29/16
G0477 TX 01 QW $360.00 02/29/16
G0477 TX 01 00 $30.00 02/29/16
G0477 TX 04 00 $30.00 02/29/16
G0479 TX 04 00 $400.00 02/29/16
G0479 TX 01 00 $400.00 02/29/16
G0480 TX 04 00 $315.00 03/01/16
G0480 TX 01 00 $315.00 03/01/16
G0481 TX 04 00 $369.00 03/01/16
G0481 TX 01 00 $369.00 03/01/16
G0482 TX 04 00 $2,500.00 03/01/16
G0482 TX 01 00 $2,500.00 03/01/16
G0483 TX 04 00 $1,200.00 03/01/16
G0483 TX 01 00 $1,200.00 03/01/16
G8428 TX 04 00 $0.01 02/29/16
G8752 TX 04 00 $0.01 02/29/16
G9051 TX 04 00 $23.00 02/29/16
G9051 TX 01 00 $23.00 02/29/16
G9052 TX 01 00 $23.00 02/29/16
G9052 TX 04 00 $23.00 02/29/16
G9056 TX 04 00 $23.00 02/29/16
G9056 TX 01 00 $23.00 02/29/16
G9063 TX 01 00 $23.00 02/29/16
G9063 TX 04 00 $23.00 02/29/16
G9064 TX 04 00 $23.00 02/29/16
G9064 TX 01 00 $23.00 02/29/16
G9065 TX 04 00 $23.00 02/29/16
G9065 TX 01 00 $23.00 02/29/16
G9066 TX 04 00 $23.00 02/29/16
G9066 TX 01 00 $23.00 02/29/16
G9067 TX 04 00 $23.00 02/29/16
G9067 TX 01 00 $23.00 02/29/16
G9068 TX 04 00 $23.00 02/29/16
G9068 TX 01 00 $23.00 02/29/16
G9071 TX 01 00 $23.00 02/29/16
G9071 TX 04 00 $23.00 02/29/16
G9072 TX 04 00 $23.00 02/29/16
G9072 TX 01 00 $23.00 02/29/16
G9087 TX 04 00 $23.00 02/29/16
G9087 TX 01 00 $23.00 02/29/16
G9098 TX 01 00 $23.00 02/29/16
G9098 TX 04 00 $23.00 02/29/16
G9107 TX 04 00 $23.00 02/29/16
G9107 TX 01 00 $23.00 02/29/16
H0015 TX 04 00 $307.00 09/18/17 $291.00 02/24/16
H0015 TX 01 00 $307.00 09/18/17 $291.00 02/24/16
H0015 TX 04 00 $291.00 02/24/16
H0015 TX 01 00 $291.00 02/24/16
H0035 TX 01 00 $291.00 09/22/15 $276.00 01/03/14
H0035 TX 04 00 $291.00 09/22/15 $276.00 01/03/14
H0035 TX 01 00 $307.00 09/18/17 $291.00 09/22/15
H0035 TX 04 00 $307.00 09/18/17 $291.00 09/22/15
H0037 TX 04 00 $388.00 09/22/15 $368.00 01/03/14
H0037 TX 04 00 $409.00 09/18/17 $388.00 09/22/15
H0037 TX 01 00 $388.00 09/22/15 $368.00 01/03/14
H0037 TX 01 00 $409.00 09/18/17 $388.00 09/22/15
H1010 TX 04 00 $12.00 02/29/16
K0739 TX 01 00 $14.87 12/01/15 $14.55 12/19/13
K0739 TX 04 NU $14.87 12/01/15 $14.55 12/19/13
K0739 TX 01 NU $15.26 01/24/18 $15.02 12/29/16
K0739 TX 04 00 $15.26 01/24/18 $15.02 12/29/16
K0739 TX 04 NU $15.26 01/24/18 $15.02 12/29/16
K0739 TX 01 00 $15.26 01/24/18 $15.02 12/29/16
K0739 TX 04 00 $14.87 12/01/15 $14.55 12/19/13
K0739 TX 01 NU $14.87 12/01/15 $14.55 12/19/13
L3215 TX 01 00 $76.60 02/29/16
L3215 TX 04 00 $76.60 02/29/16
L3216 TX 04 00 $119.00 02/29/16
L3216 TX 01 00 $119.00 02/29/16
L3219 TX 01 00 $89.80 02/29/16
L3219 TX 04 00 $89.80 02/29/16
L3221 TX 01 00 $166.83 02/29/16
L3221 TX 04 00 $166.83 02/29/16
L3222 TX 01 00 $122.99 02/29/16
L3222 TX 04 00 $122.99 02/29/16
L3230 TX 01 00 $293.63 02/29/16
L3230 TX 04 00 $293.63 02/29/16
L3250 TX 04 00 $300.00 02/29/16
L3250 TX 01 00 $300.00 02/29/16
L3251 TX 04 00 $308.00 02/29/16
L3251 TX 01 00 $308.00 02/29/16
L3252 TX 04 00 $200.20 02/29/16
L3252 TX 01 00 $200.20 02/29/16
L3253 TX 04 00 $95.18 02/29/16
L3253 TX 01 00 $95.18 02/29/16
L4205 TX 01 00 $22.74 01/24/18 $22.38 12/29/16
L4205 TX 04 00 $22.16 12/01/15 $21.68 12/19/13
L4205 TX 04 00 $22.74 01/24/18 $22.38 12/29/16
L4205 TX 01 00 $22.16 12/01/15 $21.68 12/19/13
L7520 TX 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 TX 04 00 $30.87 01/24/18 $30.38 12/29/16
L7520 TX 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 TX 04 00 $30.08 12/01/15 $29.43 12/19/13
L7900 TX 01 KX $525.00 03/01/16
L7900 TX 04 KX $525.00 03/01/16
L8680 TX 01 59 $1,200.00 02/29/16
L8680 TX 04 59 $1,200.00 02/29/16
P9604 TX 04 LR $11.00 02/29/16
P9604 TX 01 LR $29.00 02/29/16
S0020 TX 01 00 $30.00 02/29/16
S0020 TX 04 00 $30.00 02/29/16
S0023 TX 04 00 $40.00 02/29/16
S0023 TX 01 00 $40.00 02/29/16
S0028 TX 04 00 $24.44 02/29/16
S0028 TX 01 00 $50.00 02/29/16
S0030 TX 01 00 $112.00 02/29/16 $58.00 07/29/14
S0030 TX 04 00 $58.00 02/29/16
S0077 TX 04 00 $50.00 02/29/16 $15.97 07/29/14
S0077 TX 01 00 $50.00 02/29/16 $36.00 07/29/14
S0093 TX 01 00 $774.00 02/29/16
S0093 TX 04 00 $774.00 02/29/16
S0119 TX 04 00 $21.00 02/29/16 $10.00 07/29/14
S0119 TX 01 00 $37.00 02/29/16 $10.00 07/29/14
S0164 TX 01 00 $182.16 02/29/16 $262.50 07/29/14
S0164 TX 04 00 $90.00 02/29/16
S0260 TX 01 00 $100.00 02/29/16
S0260 TX 04 00 $100.00 02/29/16
S0315 TX 01 00 $216.35 02/29/16
S0315 TX 04 00 $216.35 02/29/16
S0316 TX 04 00 $139.18 02/29/16
S0316 TX 01 00 $139.18 02/29/16
S0395 TX 01 00 $75.00 02/29/16
S0395 TX 04 00 $75.00 02/29/16
S0500 TX 01 00 $38.96 02/29/16
S0500 TX 04 00 $38.96 02/29/16
S0610 TX 01 00 $210.00 02/29/16
S0610 TX 04 00 $210.00 02/29/16
S0612 TX 01 00 $175.00 02/29/16 $100.00 07/29/14
S0612 TX 04 00 $100.00 02/29/16
S0613 TX 01 00 $50.00 02/29/16
S0613 TX 04 00 $50.00 02/29/16
S0621 TX 01 00 $97.65 02/29/16 $96.00 07/29/14
S0621 TX 04 00 $38.31 02/29/16
S0630 TX 01 00 $75.00 02/29/16
S0630 TX 04 00 $20.80 02/29/16
S1015 TX 04 00 $15.00 02/29/16
S1015 TX 01 00 $15.00 02/29/16
S2900 TX 04 00 $1,299.00 02/29/16
S2900 TX 01 00 $1,450.00 02/29/16 $1,377.00 07/29/14
S4993 TX 01 00 $2.80 02/29/16
S4993 TX 04 00 $2.80 02/29/16
S5010 TX 04 00 $366.08 02/29/16
S5010 TX 01 00 $366.08 02/29/16
S5502 TX 04 00 $9.00 02/29/16
S5502 TX 01 00 $9.00 02/29/16
S8100 TX 01 00 $50.00 02/29/16
S8100 TX 04 00 $50.00 02/29/16
S8120 TX 01 00 $41.10 02/29/16
S8121 TX 04 00 $4.00 02/29/16
S8121 TX 01 00 $4.00 02/29/16
S8186 TX 01 00 $28.00 02/29/16
S8186 TX 04 00 $28.00 02/29/16
S8189 TX 04 00 $11.30 02/29/16
S8189 TX 01 00 $11.30 02/29/16
S9140 TX 04 00 $156.00 02/29/16
S9141 TX 01 00 $274.22 02/29/16
S9141 TX 04 00 $274.22 02/29/16
S9338 TX 01 00 $800.00 02/29/16 $360.00 07/30/14
S9340 TX 04 00 $200.00 02/29/16
S9340 TX 01 00 $200.00 02/29/16
S9342 TX 04 00 $71.50 02/29/16 $65.00 07/30/14
S9342 TX 01 00 $71.50 02/29/16 $65.00 07/30/14
S9345 TX 01 00 $147.39 02/29/16
S9345 TX 04 00 $147.39 02/29/16
S9355 TX 01 00 $147.39 02/29/16
S9355 TX 04 00 $147.39 02/29/16
S9359 TX 01 00 $147.39 02/29/16
S9359 TX 04 00 $147.39 02/29/16
S9366 TX 01 00 $3,080.00 02/29/16
S9366 TX 04 00 $3,080.00 02/29/16
S9374 TX 01 00 $225.00 02/29/16
S9441 TX 04 00 $50.00 02/29/16 $97.00 07/30/14
S9460 TX 01 00 $237.02 02/29/16
S9460 TX 04 00 $172.00 02/29/16
S9465 TX 04 00 $185.92 02/29/16
S9480 TX 04 00 $307.00 09/18/17 $291.00 02/24/16
S9480 TX 01 00 $291.00 02/24/16
S9480 TX 04 00 $291.00 02/24/16
S9480 TX 01 00 $307.00 09/18/17 $291.00 02/24/16
S9494 TX 01 00 $120.00 02/29/16
S9494 TX 04 00 $120.00 02/29/16
S9503 TX 04 00 $1,925.00 02/29/16
S9503 TX 01 00 $1,925.00 02/29/16
T1000 TX 01 TE $100.00 02/29/16
T1000 TX 04 TE $45.12 02/29/16
T1017 TX 01 00 $35.00 02/29/16
T1017 TX 04 00 $35.00 02/29/16
T1019 TX 01 00 $31.44 02/29/16
T1019 TX 04 00 $31.44 02/29/16
V2025 TX 04 00 $91.00 02/29/16
V2025 TX 01 00 $91.00 02/29/16