MISSISSIPPI MEDICARE CARRIER - 07302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**A2001**1174.20*1115.49*1282.81
**A2002**180.18*171.17*196.85
**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**402.42*382.30*439.65
#**G0186**348.30*330.89*380.52
**G0339**2451.51*2328.93*2678.27
**G0340**1843.71*1751.52*2014.25
**G0398**117.81*111.92*128.71
**G0398*TC*81.41*77.34*88.94
**G0398*26*36.40*34.58*39.77
**G0399**83.32*79.15*91.02
**G0399*TC*43.19*41.03*47.18
**G0399*26*40.41*38.39*44.15
**G0400**85.44*81.17*93.35
**G0400*TC*47.93*45.53*52.36
**G0400*26*37.51*35.63*40.97
**G0460**677.21*643.35*739.85
#**G0460**110.60*105.07*120.83
**G0465**677.21*643.35*739.85
#**G0465**110.60*105.07*120.83
**G0498**124.13*117.92*135.61
**G6017**68.92*65.47*75.29
**0042T**199.66*189.68*218.13
**0054T**207.79*197.40*227.01
**0055T**207.79*197.40*227.01
**0071T**519.40*493.43*567.44
**0072T**519.40*493.43*567.44
**0075T**883.58*839.40*965.31
**0075T*TC*883.58*839.40*965.31
**0075T*26*883.58*839.40*965.31
**0076T**1001.86*951.77*1094.54
**0076T*TC*801.49*761.42*875.63
**0076T*26*200.37*190.35*218.90
**0095T**559.74*531.75*611.51
**0098T**626.99*595.64*684.99
**0100T**1712.53*1626.90*1870.94
**0101T**278.41*264.49*304.16
#**0101T**204.48*194.26*223.40
**0102T**278.41*264.49*304.16
#**0102T**204.48*194.26*223.40
**0106T**28.36*26.94*30.98
**0107T**28.36*26.94*30.98
**0108T**28.36*26.94*30.98
**0109T**28.36*26.94*30.98
**0110T**28.36*26.94*30.98
**0164T**611.49*580.92*668.06
**0165T**626.60*595.27*684.56
**0174T**9.17*8.71*10.02
**0175T**19.17*18.21*20.94
**0184T**743.35*706.18*812.11
**0198T**74.04*70.34*80.89
#**0198T**29.40*27.93*32.12
**0200T**1520.66*1444.63*1661.32
#**0200T**369.59*351.11*403.78
**0201T**2280.99*2166.94*2491.98
#**0201T**554.38*526.66*605.66
**0207T**121.70*115.62*132.96
**0208T**31.78*30.19*34.72
**0209T**38.47*36.55*42.03
**0210T**24.24*23.03*26.48
**0211T**37.63*35.75*41.11
**0212T**33.26*31.60*36.34
#**0212T**29.08*27.63*31.77
**0213T**169.85*161.36*185.56
#**0213T**95.92*91.12*104.79
**0214T**86.75*82.41*94.77
#**0214T**54.39*51.67*59.42
**0215T**87.03*82.68*95.08
#**0215T**55.23*52.47*60.34
**0216T**155.65*147.87*170.05
#**0216T**82.28*78.17*89.90
**0217T**80.73*76.69*88.19
#**0217T**46.70*44.37*51.03
**0218T**80.73*76.69*88.19
#**0218T**47.53*45.15*51.92
**0219T**1175.04*1116.29*1283.73
**0220T**1155.92*1098.12*1262.84
**0221T**1428.74*1357.30*1560.90
**0222T**351.85*334.26*384.40
**0232T**677.21*643.35*739.85
#**0232T**110.60*105.07*120.83
**0234T**7211.67*6851.09*7878.75
#**0234T**535.66*508.88*585.21
**0235T**7211.67*6851.09*7878.75
#**0235T**535.66*508.88*585.21
**0236T**7346.18*6978.87*8025.70
#**0236T**621.35*590.28*678.82
**0237T**7346.18*6978.87*8025.70
#**0237T**621.35*590.28*678.82
**0238T**7346.18*6978.87*8025.70
#**0238T**621.35*590.28*678.82
**0253T**778.14*739.23*850.11
**0266T**812.02*771.42*887.13
**0267T**144.73*137.49*158.11
**0268T**301.24*286.18*329.11
**0269T**767.62*729.24*838.63
**0270T**144.73*137.49*158.11
**0271T**301.24*286.18*329.11
**0272T**48.90*46.46*53.43
**0273T**63.51*60.33*69.38
**0274T**990.60*941.07*1082.23
**0278T**13.18*12.52*14.40
**0308T**1255.31*1192.54*1371.42
**0329T**74.04*70.34*80.89
#**0329T**29.40*27.93*32.12
**0330T**38.21*36.30*41.75
**0331T**157.12*149.26*171.65
**0332T**268.38*254.96*293.20
**0347T**129.06*122.61*141.00
**0348T**28.53*27.10*31.17
**0349T**30.11*28.60*32.89
**0350T**30.67*29.14*33.51
**0351T**145.77*138.48*159.25
**0352T**39.50*37.53*43.16
**0353T**145.77*138.48*159.25
**0354T**39.50*37.53*43.16
**0358T**22.57*21.44*24.66
**0362T**82.19*78.08*89.79
#**0362T**60.71*57.67*66.32
**0378T**22.89*21.75*25.01
**0394T**214.08*203.38*233.89
**0395T**524.58*498.35*573.10
**0397T**43.33*41.16*47.33
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**461.43*438.36*504.11
**0409T**318.06*302.16*347.48
**0410T**330.06*313.56*360.59
**0411T**330.06*313.56*360.59
**0412T**206.29*195.98*225.38
**0413T**430.75*409.21*470.59
**0414T**331.59*315.01*362.26
**0415T**276.56*262.73*302.14
**0416T**304.43*289.21*332.59
**0417T**73.75*70.06*80.57
**0418T**48.90*46.46*53.43
**0419T**398.10*378.20*434.93
#**0419T**323.33*307.16*353.23
**0420T**568.27*539.86*620.84
#**0420T**475.93*452.13*519.95
**0421T**1399.75*1329.76*1529.22
#**0421T**632.83*601.19*691.37
**0437T**193.45*183.78*211.35
**0439T**62.47*59.35*68.25
**0440T**217.14*206.28*237.22
#**0440T**108.33*102.91*118.35
**0441T**217.14*206.28*237.22
#**0441T**108.33*102.91*118.35
**0442T**217.14*206.28*237.22
#**0442T**108.33*102.91*118.35
**0449T**680.61*646.58*743.57
**0464T**58.00*55.10*63.37
**0472T**59.14*56.18*64.61
**0473T**48.90*46.46*53.43
**0479T**57.88*54.99*63.24
**0480T**67.86*64.47*74.14
#**0480T**28.94*27.49*31.61
**0483T**1082.63*1028.50*1182.78
**0484T**1404.66*1334.43*1534.59
**0485T**20.95*19.90*22.89
**0485T*TC*7.37*7.00*8.05
**0485T*26*13.84*13.15*15.12
**0486T**41.90*39.81*45.78
**0486T*TC*14.48*13.76*15.82
**0486T*26*27.42*26.05*29.96
**0488T**57.10*54.25*62.39
#**0488T**46.22*43.91*50.50
**0505T**9539.52*9062.54*10421.92
#**0505T**493.15*468.49*538.76
**0507T**19.72*18.73*21.54
**0507T*TC*16.99*16.14*18.56
**0507T*26*2.73*2.59*2.98
**0510T**531.20*504.64*580.34
#**0510T**380.55*361.52*415.75
**0512T**278.41*264.49*304.16
#**0512T**204.48*194.26*223.40
**0513T**83.52*79.34*91.24
#**0513T**61.35*58.28*67.02
**0515T**461.43*438.36*504.11
**0516T**425.74*404.45*465.12
**0517T**301.24*286.18*329.11
**0518T**206.29*195.98*225.38
**0519T**301.93*286.83*329.85
**0520T**425.74*404.45*465.12
**0521T**48.90*46.46*53.43
**0521T*TC*30.10*28.60*32.89
**0521T*26*18.80*17.86*20.54
**0522T**59.14*56.18*64.61
**0522T*TC*30.66*29.13*33.50
**0522T*26*28.48*27.06*31.12
**0523T**133.48*126.81*145.83
**0524T**1389.52*1320.04*1518.05
#**0524T**161.72*153.63*176.67
**0525T**426.02*404.72*465.43
**0526T**330.06*313.56*360.59
**0527T**287.54*273.16*314.13
**0528T**59.14*56.18*64.61
**0528T*TC*30.66*29.13*33.50
**0528T*26*28.48*27.06*31.12
**0529T**48.90*46.46*53.43
**0529T*TC*30.10*28.60*32.89
**0529T*26*18.80*17.86*20.54
**0530T**565.41*537.14*617.71
**0531T**430.75*409.21*470.59
**0532T**301.93*286.83*329.85
**0540T**161.57*153.49*176.51
**0543T**1404.66*1334.43*1534.59
**0544T**1610.01*1529.51*1758.94
**0545T**1610.01*1529.51*1758.94
**0546T**63.56*60.38*69.44
**0552T**5.84*5.55*6.38
**0553T**2088.19*1983.78*2281.35
#**0553T**358.23*340.32*391.37
**0565T**543.34*516.17*593.60
#**0565T**459.92*436.92*502.46
**0566T**88.33*83.91*96.50
#**0566T**54.02*51.32*59.02
**0569T**1610.01*1529.51*1758.94
**0570T**378.83*359.89*413.87
**0571T**498.75*473.81*544.88
**0572T**406.29*385.98*443.88
**0573T**309.09*293.64*337.69
**0574T**359.05*341.10*392.27
**0575T**59.14*56.18*64.61
**0576T**48.90*46.46*53.43
**0577T**173.20*164.54*189.22
**0578T**27.07*25.72*29.58
**0579T**17.83*16.94*19.48
**0580T**190.52*180.99*208.14
**0581T**1912.62*1816.99*2089.54
#**0581T**190.19*180.68*207.78
**0582T**1412.98*1342.33*1543.68
#**0582T**347.00*329.65*379.10
**0583T**1496.16*1421.35*1634.55
#**0583T**118.14*112.23*129.06
**0587T**392.91*373.26*429.25
#**0587T**269.05*255.60*293.94
**0588T**322.03*305.93*351.82
#**0588T**209.04*198.59*228.38
**0589T**43.76*41.57*47.81
#**0589T**35.67*33.89*38.97
**0590T**51.08*48.53*55.81
#**0590T**36.86*35.02*40.27
**0596T**2235.23*2123.47*2441.99
#**0596T**123.23*117.07*134.63
**0597T**672.69*639.06*734.92
#**0597T**123.23*117.07*134.63
**0598T**127.86*121.47*139.69
**0599T**85.44*81.17*93.35
**0600T**3060.27*2907.26*3343.35
#**0600T**668.29*634.88*730.11
**0601T**1312.90*1247.26*1434.35
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**170.94*162.39*186.75
**0611T**33.98*32.28*37.12
**0614T**331.13*314.57*361.76
**0615T**42.50*40.38*46.44
**0616T**596.44*566.62*651.61
**0617T**664.33*631.11*725.78
**0618T**803.60*763.42*877.93
**0619T**580.17*551.16*633.83
#**0619T**431.28*409.72*471.18
**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**224.72*213.48*245.50
#**0627T**90.81*86.27*99.21
**0628T**67.42*64.05*73.66
#**0628T**27.24*25.88*29.76
**0629T**224.72*213.48*245.50
#**0629T**90.81*86.27*99.21
**0630T**67.42*64.05*73.66
#**0630T**27.24*25.88*29.76
**0631T**69.98*66.48*76.45
**0632T**517.51*491.63*565.37
**0633T**174.34*165.62*190.46
*C*0633T*TC*89.25*84.79*97.51
**0633T*26*54.71*51.97*59.77
**0634T**174.34*165.62*190.46
**0634T*TC*119.63*113.65*130.70
**0634T*26*54.71*51.97*59.77
**0635T**174.34*165.62*190.46
**0635T*TC*119.63*113.65*130.70
**0635T*26*54.71*51.97*59.77
**0636T**174.34*165.62*190.46
**0636T*TC*119.63*113.65*130.70
**0636T*26*54.71*51.97*59.77
**0637T**174.34*165.62*190.46
**0637T*TC*119.63*113.65*130.70
**0637T*26*54.71*51.97*59.77
**0638T**174.34*165.62*190.46
**0638T*TC*119.63*113.65*130.70
**0638T*26*54.71*51.97*59.77
**0639T**69.98*66.48*76.45
**0640T**19.72*18.73*21.54
**0640T*TC*16.99*16.14*18.56
**0640T*26*2.73*2.59*2.98
**0644T**992.75*943.11*1084.58
#**0644T**219.14*208.18*239.41
**0646T**1610.01*1529.51*1758.94
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**52.38*49.76*57.22
**0652T**250.17*237.66*273.31
#**0652T**110.68*105.15*120.92
**0653T**325.45*309.18*355.56
#**0653T**125.14*118.88*136.71
**0654T**128.61*122.18*140.51
**0655T**1399.75*1329.76*1529.22
#**0655T**632.83*601.19*691.37
**0658T**79.48*75.51*86.84
**0659T**2288.24*2173.83*2499.90
#**0659T**395.36*375.59*431.93
**0671T**915.32*869.55*999.98
**0673T**2902.04*2756.94*3170.48
#**0673T**332.91*316.26*363.70
**0699T**100.69*95.66*110.01
#**0699T**82.28*78.17*89.90
**0707T**323.98*307.78*353.95
#**0707T**246.70*234.37*269.53
**0714T**1201.19*1141.13*1312.30
#**0714T**323.52*307.34*353.44
**0730T**239.47*227.50*261.63
#**0730T**216.45*205.63*236.47
**0738T**64.94*61.69*70.94
**0739T**1399.75*1329.76*1529.22
#**0739T**632.83*601.19*691.37
**0740T**16.68*15.85*18.23
**0741T**39.59*37.61*43.25
**0742T**80.51*76.48*87.95
**0742T*TC*62.73*59.59*68.53
**0742T*26*17.78*16.89*19.42
**0743T**46.01*43.71*50.27
**0744T**804.69*764.46*879.13
**0745T**215.18*204.42*235.08
**0746T**207.21*196.85*226.38
**0747T**832.07*790.47*909.04
**0748T**165.85*157.56*181.19
**0751T**9.43*8.96*10.30
**0752T**12.24*11.63*13.37
**0753T**20.66*19.63*22.57
**0754T**83.17*79.01*90.86
**0755T**376.86*358.02*411.72
**0756T**96.02*91.22*104.90
**0757T**69.18*65.72*75.58
**0758T**77.45*73.58*84.62
**0759T**115.19*109.43*125.84
**0760T**86.47*82.15*94.47
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**102.27*97.16*111.73
**0764T**3.83*3.64*4.19
**0765T**7.49*7.12*8.19
**0771T**24.28*23.07*26.53
**0772T**24.28*23.07*26.53
**0773T**20.37*19.35*22.25
**0774T**20.37*19.35*22.25
**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*45.75*43.46*49.98
#**0777T*26*3.75*3.56*4.09
**0779T**368.46*350.04*402.55
**0779T*TC*344.51*327.28*376.37
**0779T*26*23.95*22.75*26.16
**0780T**20.37*19.35*22.25
**0783T**11.97*11.37*13.08
**0784T**1802.20*1712.09*1968.90
#**0784T**296.26*281.45*323.67
**0785T**212.50*201.88*232.16
#**0785T**130.20*123.69*142.24
**0786T**638.08*606.18*697.11
#**0786T**277.08*263.23*302.71
**0787T**212.50*201.88*232.16
#**0787T**130.20*123.69*142.24
**0788T**17.24*16.38*18.84
#**0788T**16.68*15.85*18.23
**0789T**23.62*22.44*25.81
#**0789T**20.85*19.81*22.78
**0790T**1763.40*1675.23*1926.51
**0791T**8.19*7.78*8.95
**0793T**517.51*491.63*565.37
**0794T**130.35*123.83*142.40
**0795T**638.60*606.67*697.67
**0796T**425.74*404.45*465.12
**0797T**425.74*404.45*465.12
**0798T**676.92*643.07*739.53
**0799T**451.28*428.72*493.03
**0800T**451.28*428.72*493.03
**0801T**877.01*833.16*958.13
**0802T**438.51*416.58*479.07
**0803T**438.51*416.58*479.07
**0804T**69.21*65.75*75.61
**0804T*TC*35.40*33.63*38.67
**0804T*26*33.81*32.12*36.94
**0805T**2507.17*2381.81*2739.08
#**0805T**298.48*283.56*326.09
**0806T**3342.89*3175.75*3652.11
#**0806T**397.97*378.07*434.78
**0807T**37.05*35.20*40.48
**0807T*TC*23.41*22.24*25.58
**0807T*26*13.65*12.97*14.92
**0808T**37.05*35.20*40.48
**0808T*TC*23.41*22.24*25.58
**0808T*26*13.65*12.97*14.92
**0810T**1018.85*967.91*1113.10
**0811T**16.68*15.85*18.23
**0813T**2189.22*2079.76*2391.72
#**0813T**163.27*155.11*178.38
**0814T**404.98*384.73*442.44
#**0814T**308.38*292.96*336.90
**0818T**322.03*305.93*351.82
#**0818T**209.04*198.59*228.38
**0820T**138.37*131.45*151.17
#**0820T**123.59*117.41*135.02
**0821T**138.37*131.45*151.17
#**0821T**123.59*117.41*135.02
**0822T**117.62*111.74*128.50
#**0822T**105.05*99.80*114.77
**0823T**638.60*606.67*697.67
**0824T**676.92*643.07*739.53
**0825T**877.01*833.16*958.13
**0826T**59.14*56.18*64.61
**0826T*TC*30.66*29.13*33.50
**0826T*26*28.48*27.06*31.12
**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**19.72*18.73*21.54
**0859T*TC*16.99*16.14*18.56
**0859T*26*2.73*2.59*2.98
**0864T**278.41*264.49*304.16
#**0864T**204.48*194.26*223.40
**10011**367.16*348.80*401.12
#**10011**99.62*94.64*108.84
**10012**204.10*193.90*222.99
#**10012**66.84*63.50*73.03
**15847**316.61*300.78*345.90
**21088**1686.18*1601.87*1842.15
**21742**1049.32*996.85*1146.38
**21743**1203.23*1143.07*1314.53
**32855**330.90*314.36*361.51
**32856**410.98*390.43*448.99
**33928**3024.40*2873.18*3304.16
**33929**1133.08*1076.43*1237.89
**33933**507.00*481.65*553.90
**33944**406.82*386.48*444.45
**34841**1909.76*1814.27*2086.41
**34842**2135.54*2028.76*2333.07
**34843**2361.32*2243.25*2579.74
**34844**2587.09*2457.74*2826.40
**34845**1909.76*1814.27*2086.41
**34846**2135.54*2028.76*2333.07
**34847**2361.32*2243.25*2579.74
**34848**2587.09*2457.74*2826.40
**43496**1941.81*1844.72*2121.43
**43647**718.12*682.21*784.54
#**43647**718.02*682.12*784.44
**43648**491.78*467.19*537.27
#**43648**225.44*214.17*246.30
**43881**611.70*581.12*668.29
#**43881**562.42*534.30*614.45
**43882**644.68*612.45*704.32
#**43882**591.62*562.04*646.35
**47143**381.20*362.14*416.46
**47144**452.68*430.05*494.56
**47145**428.81*407.37*468.48
**48551**249.50*237.03*272.58
**49906**1853.68*1761.00*2025.15
**50323**190.52*180.99*208.14
**50325**276.55*262.72*302.13
**53451**690.80*656.26*754.70
**53452**345.40*328.13*377.35
**53453**587.01*557.66*641.31
**53454**50.65*48.12*55.34
#**53454**32.52*30.89*35.52
**54440**702.88*667.74*767.90
**63043**509.72*484.23*556.86
**63044**474.82*451.08*518.74
**64596**1802.20*1712.09*1968.90
#**64596**296.26*281.45*323.67
**64597**540.66*513.63*590.67
#**64597**88.88*84.44*97.11
**64598**212.50*201.88*232.16
#**64598**130.20*123.69*142.24
**65757**107.46*102.09*117.40
**66983**596.44*566.62*651.61
**66987**697.74*662.85*762.28
**66988**577.26*548.40*630.66
*C*70170**212.28*201.67*231.92
*C*70170*TC*198.89*188.95*217.29
**70555**233.47*221.80*255.07
**70555*TC*123.85*117.66*135.31
*C*70557**586.97*557.62*641.26
*C*70557*TC*447.74*425.35*489.15
*C*70558**302.72*287.58*330.72
*C*70558*TC*149.23*141.77*163.04
*C*70559**294.02*279.32*321.22
*C*70559*TC*149.23*141.77*163.04
*C*74190**468.11*444.70*511.41
*C*74190*TC*447.74*425.35*489.15
**74235**127.97*121.57*139.81
**74235*TC*75.78*71.99*82.79
**74300**72.61*68.98*79.33
**74300*TC*60.48*57.46*66.08
**74301**22.31*21.19*24.37
**74301*TC*13.23*12.57*14.46
**74328**175.06*166.31*191.26
**74328*TC*153.87*146.18*168.11
**74329**122.25*116.14*133.56
**74329*TC*100.78*95.74*110.10
**74330**262.59*249.46*286.88
**74330*TC*237.64*225.76*259.62
**74340**86.58*82.25*94.59
**74340*TC*63.12*59.96*68.95
**74355**86.58*82.25*94.59
**74355*TC*53.16*50.50*58.08
**74360**86.58*82.25*94.59
**74360*TC*61.78*58.69*67.49
**74363**175.06*166.31*191.26
**74363*TC*136.90*130.06*149.57
*C*74445**138.74*131.80*151.57
*C*74445*TC*89.25*84.79*97.51
*C*74450**213.29*202.63*233.02
*C*74450*TC*198.89*188.95*217.29
*C*74470**470.64*447.11*514.18
*C*74470*TC*447.74*425.35*489.15
**74742**233.47*221.80*255.07
**74742*TC*206.60*196.27*225.71
*C*74775**226.08*214.78*247.00
*C*74775*TC*198.89*188.95*217.29
*C*75801**548.67*521.24*599.43
*C*75801*TC*509.95*484.45*557.12
*C*75803**1351.56*1283.98*1476.58
*C*75803*TC*1300.02*1235.02*1420.27
*C*75805**2623.14*2491.98*2865.78
*C*75805*TC*2587.52*2458.14*2826.86
*C*75807**2636.21*2504.40*2880.06
*C*75807*TC*2587.52*2458.14*2826.86
*C*75810**2632.38*2500.76*2875.87
*C*75810*TC*2587.52*2458.14*2826.86
**75894**763.97*725.77*834.64
**75894*TC*699.50*664.53*764.21
*C*75898**2669.57*2536.09*2916.50
*C*75898*TC*2587.52*2458.14*2826.86
**75970**373.86*355.17*408.45
**75970*TC*339.04*322.09*370.40
**76125**34.62*32.89*37.82
**76125*TC*22.49*21.37*24.58
**76390**178.08*169.18*194.56
**76390*TC*129.67*123.19*141.67
**76390*26*48.41*45.99*52.89
*C*76496*TC*73.62*69.94*80.43
*C*76497*TC*73.62*69.94*80.43
*C*76498*TC*73.62*69.94*80.43
**76932**74.34*70.62*81.21
**76932*TC*41.77*39.68*45.63
**76940**141.12*134.06*154.17
**76940*TC*49.59*47.11*54.18
**76941**103.45*98.28*113.02
**76941*TC*44.31*42.09*48.40
**76945**73.53*69.85*80.33
**76945*TC*44.09*41.89*48.17
**76975**93.82*89.13*102.50
*C*76975*TC*198.89*188.95*217.29
**76998**175.06*166.31*191.26
**76998*TC*132.59*125.96*144.85
**77013**363.03*344.88*396.61
**77013*TC*194.57*184.84*212.57
**77022**412.14*391.53*450.26
**77022*TC*228.71*217.27*249.86
**77371**533.40*506.73*582.74
**77520**773.98*735.28*845.57
**77522**773.98*735.28*845.57
**77523**888.71*844.27*970.91
**77525**1003.47*953.30*1096.30
*C*78282**349.12*331.66*381.41
*C*78282*TC*334.75*318.01*365.71
**78414**514.99*489.24*562.63
**78414*TC*495.54*470.76*541.37
*C*78429**1342.98*1275.83*1467.20
*C*78429*TC*1269.89*1206.40*1387.36
*C*78430**1339.50*1272.53*1463.41
*C*78430*TC*1269.89*1206.40*1387.36
*C*78431**1998.43*1898.51*2183.29
*C*78431*TC*1917.41*1821.54*2094.77
*C*78432**1663.33*1580.16*1817.18
*C*78432*TC*1576.49*1497.67*1722.32
*C*78433**1756.84*1669.00*1919.35
*C*78433*TC*1661.86*1578.77*1815.59
**78434**599.53*569.55*654.98
**78434*TC*572.82*544.18*625.81
*C*78459**1220.34*1159.32*1333.22
*C*78459*TC*1152.72*1095.08*1259.34
*C*78491**1336.18*1269.37*1459.78
*C*78491*TC*1269.89*1206.40*1387.36
*C*78492**1347.64*1280.26*1472.30
*C*78492*TC*1269.89*1206.40*1387.36
*C*78608**1333.63*1266.95*1456.99
*C*78608*TC*1269.89*1206.40*1387.36
*C*78811**1218.30*1157.39*1331.00
*C*78811*TC*1152.72*1095.08*1259.34
*C*78812**1352.65*1285.02*1477.77
*C*78812*TC*1269.89*1206.40*1387.36
*C*78813**1354.66*1286.93*1479.97
*C*78813*TC*1269.89*1206.40*1387.36
*C*78814**1363.69*1295.51*1489.84
*C*78814*TC*1269.89*1206.40*1387.36
*C*78815**1374.31*1305.59*1501.43
*C*78815*TC*1269.89*1206.40*1387.36
*C*78816**1375.47*1306.70*1502.71
*C*78816*TC*1269.89*1206.40*1387.36
**79300**237.04*225.19*258.97
**79300*TC*177.17*168.31*193.56
**79445**237.04*225.19*258.97
**79445*TC*136.24*129.43*148.84
**86485**15.20*14.44*16.61
**90867**260.09*247.09*284.15
#**90867**123.25*117.09*134.65
**90868**177.74*168.85*194.18
#**90868**97.63*92.75*106.66
**90869**246.32*234.00*269.10
#**90869**143.70*136.52*157.00
**90952**466.47*443.15*509.62
**90953**331.26*314.70*361.91
**92978**213.79*203.10*233.57
**92978*TC*129.00*122.55*140.93
**92979**131.44*124.87*143.60
**92979*TC*64.08*60.88*70.01
*C*93315**563.47*535.30*615.60
*C*93315*TC*447.74*425.35*489.15
**93317**187.71*178.32*205.07
**93317*TC*107.43*102.06*117.37
*C*93318**540.68*513.65*590.70
*C*93318*TC*447.74*425.35*489.15
**93571**212.95*202.30*232.65
**93571*TC*148.36*140.94*162.08
**93572**129.51*123.03*141.48
**93572*TC*82.50*78.38*90.14
**93600**3557.81*3379.92*3886.91
**93600*TC*3454.34*3281.62*3773.86
**93602**3557.81*3379.92*3886.91
**93602*TC*3455.96*3283.16*3775.63
**93603**3557.81*3379.92*3886.91
**93603*TC*3455.96*3283.16*3775.63
**93609**2134.69*2027.96*2332.15
**93609*TC*1891.86*1797.27*2066.86
**93610**3557.81*3379.92*3886.91
**93610*TC*3413.82*3243.13*3729.60
**93612**3557.81*3379.92*3886.91
**93612*TC*3415.69*3244.91*3731.65
**93615**44.70*42.47*48.84
**93615*TC*11.88*11.29*12.98
**93619**7115.62*6759.84*7773.82
**93619*TC*6772.61*6433.98*7399.08
**93620**7115.62*6759.84*7773.82
**93620*TC*6565.35*6237.08*7172.64
**93621**7115.62*6759.84*7773.82
**93621*TC*7042.47*6690.35*7693.90
**93622**7115.62*6759.84*7773.82
**93622*TC*6964.68*6616.45*7608.92
**93623**2134.69*2027.96*2332.15
**93623*TC*2075.23*1971.47*2267.19
**93624**3557.81*3379.92*3886.91
**93624*TC*3343.73*3176.54*3653.02
**93631**7115.62*6759.84*7773.82
**93631*TC*6762.52*6424.39*7388.05
**93640**1133.95*1077.25*1238.84
**93640*TC*976.71*927.87*1067.05
**93641**1133.95*1077.25*1238.84
**93641*TC*859.25*816.29*938.73
**93662**363.73*345.54*397.37
**93662*TC*299.67*284.69*327.39
**93745**78.84*74.90*86.14
**93745*TC*56.61*53.78*61.85
**93745*26*22.24*21.13*24.30
**94642**203.81*193.62*222.66
**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**903.87*858.68*987.48
**95965*TC*529.38*502.91*578.35
**95966**1820.86*1729.82*1989.29
**96020**376.39*357.57*411.21
**96020*TC*231.26*219.70*252.66
**96547**634.25*602.54*692.92
#**96547**121.76*115.67*133.02
**96548**317.12*301.26*346.45
#**96548**60.88*57.84*66.52
**97151**46.66*44.33*50.98
#**97151**41.92*39.82*45.79
**97152**39.66*37.68*43.33
#**97152**35.63*33.85*38.93
**97153**31.67*30.09*34.60
#**97153**28.18*26.77*30.79
**97154**4.26*4.05*4.66
#**97154**3.91*3.71*4.27
**97155**31.67*30.09*34.60
#**97155**28.18*26.77*30.79
**97156**33.44*31.77*36.54
#**97156**29.82*28.33*32.58
**97157**9.69*9.21*10.59
#**97157**8.85*8.41*9.67
**97158**4.97*4.72*5.43
#**97158**4.55*4.32*4.97
**98978**39.59*37.61*43.25
# - 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.