TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BEAUMONT
******
**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**419.66*398.68*458.48
#**G0186**362.30*344.19*395.82
**G0339**2536.78*2409.94*2771.43
**G0340**1907.92*1812.52*2084.40
**G0398**123.41*117.24*134.83
**G0398*TC*86.37*82.05*94.36
**G0398*26*37.04*35.19*40.47
**G0399**86.70*82.37*94.73
**G0399*TC*45.86*43.57*50.11
**G0399*26*41.14*39.08*44.94
**G0400**89.11*84.65*97.35
**G0400*TC*50.89*48.35*55.60
**G0400*26*38.22*36.31*41.76
**G0460**714.95*679.20*781.08
#**G0460**114.42*108.70*125.01
**G0465**714.95*679.20*781.08
#**G0465**114.42*108.70*125.01
**G0498**131.46*124.89*143.62
**G6017**71.80*68.21*78.44
**0042T**208.15*197.74*227.40
**0054T**218.76*207.82*238.99
**0055T**218.76*207.82*238.99
**0071T**539.65*512.67*589.57
**0072T**539.65*512.67*589.57
**0075T**921.63*875.55*1006.88
**0075T*TC*921.63*875.55*1006.88
**0075T*26*921.63*875.55*1006.88
**0076T**999.26*949.30*1091.70
**0076T*TC*799.42*759.45*873.37
**0076T*26*199.85*189.86*218.34
**0095T**591.97*562.37*646.73
**0098T**663.07*629.92*724.41
**0100T**1770.70*1682.17*1934.50
**0101T**289.63*275.15*316.42
#**0101T**211.27*200.71*230.82
**0102T**289.63*275.15*316.42
#**0102T**211.27*200.71*230.82
**0106T**30.05*28.55*32.83
**0107T**30.05*28.55*32.83
**0108T**30.05*28.55*32.83
**0109T**30.05*28.55*32.83
**0110T**30.05*28.55*32.83
**0164T**646.69*614.36*706.51
**0165T**662.69*629.56*723.99
**0174T**9.44*8.97*10.32
**0184T**773.43*734.76*844.97
**0198T**77.36*73.49*84.51
#**0198T**30.06*28.56*32.84
**0200T**1601.98*1521.88*1750.16
#**0200T**382.00*362.90*417.34
**0201T**2402.97*2282.82*2625.24
#**0201T**573.01*544.36*626.01
**0207T**121.70*115.62*132.96
**0208T**33.72*32.03*36.83
**0209T**40.82*38.78*44.60
**0210T**25.74*24.45*28.12
**0211T**39.93*37.93*43.62
**0212T**34.16*32.45*37.32
#**0212T**29.73*28.24*32.48
**0213T**177.24*168.38*193.64
#**0213T**98.88*93.94*108.03
**0214T**90.20*85.69*98.54
#**0214T**55.90*53.11*61.08
**0215T**90.49*85.97*98.87
#**0215T**56.78*53.94*62.03
**0216T**162.64*154.51*177.69
#**0216T**84.88*80.64*92.74
**0217T**84.04*79.84*91.82
#**0217T**47.97*45.57*52.41
**0218T**84.04*79.84*91.82
#**0218T**48.86*46.42*53.38
**0219T**1237.93*1176.03*1352.43
**0220T**1216.34*1155.52*1328.85
**0221T**1497.50*1422.63*1636.02
**0222T**369.37*350.90*403.54
**0232T**714.95*679.20*781.08
#**0232T**114.42*108.70*125.01
**0234T**7631.38*7249.81*8337.28
#**0234T**555.76*527.97*607.17
**0235T**7631.38*7249.81*8337.28
#**0235T**555.76*527.97*607.17
**0236T**7771.02*7382.47*8489.84
#**0236T**643.65*611.47*703.19
**0237T**7771.02*7382.47*8489.84
#**0237T**643.65*611.47*703.19
**0238T**7771.02*7382.47*8489.84
#**0238T**643.65*611.47*703.19
**0253T**801.01*760.96*875.10
**0266T**846.19*803.88*924.46
**0267T**150.16*142.65*164.05
**0268T**314.19*298.48*343.25
**0269T**800.40*760.38*874.44
**0270T**150.16*142.65*164.05
**0271T**314.19*298.48*343.25
**0272T**51.07*48.52*55.80
**0273T**66.01*62.71*72.12
**0274T**1041.97*989.87*1138.35
**0278T**13.52*12.84*14.77
**0308T**1298.51*1233.58*1418.62
**0329T**77.36*73.49*84.51
#**0329T**30.06*28.56*32.84
**0330T**38.21*36.30*41.75
**0331T**165.27*157.01*180.56
**0332T**282.17*268.06*308.27
**0347T**134.01*127.31*146.41
**0348T**29.94*28.44*32.71
**0349T**31.65*30.07*34.58
**0350T**32.24*30.63*35.22
**0351T**153.10*145.45*167.27
**0352T**40.43*38.41*44.17
**0353T**153.10*145.45*167.27
**0354T**40.43*38.41*44.17
**0358T**23.96*22.76*26.17
**0362T**84.99*80.74*92.85
#**0362T**62.23*59.12*67.99
**0378T**23.45*22.28*25.62
**0394T**225.22*213.96*246.05
**0395T**549.71*522.22*600.55
**0397T**44.36*42.14*48.46
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**480.75*456.71*525.22
**0409T**331.67*315.09*362.35
**0410T**344.34*327.12*376.19
**0411T**344.34*327.12*376.19
**0412T**215.62*204.84*235.57
**0413T**449.05*426.60*490.59
**0414T**345.84*328.55*377.83
**0415T**288.39*273.97*315.07
**0416T**318.02*302.12*347.44
**0417T**76.68*72.85*83.78
**0418T**51.07*48.52*55.80
**0419T**414.85*394.11*453.23
#**0419T**335.61*318.83*366.65
**0420T**592.09*562.49*646.86
#**0420T**494.22*469.51*539.94
**0421T**1466.21*1392.90*1601.84
#**0421T**653.39*620.72*713.83
**0437T**200.96*190.91*219.55
**0439T**65.62*62.34*71.69
**0440T**227.17*215.81*248.18
#**0440T**111.85*106.26*122.20
**0441T**227.17*215.81*248.18
#**0441T**111.85*106.26*122.20
**0442T**227.17*215.81*248.18
#**0442T**111.85*106.26*122.20
**0449T**705.61*670.33*770.88
**0464T**60.87*57.83*66.50
**0472T**61.54*58.46*67.23
**0473T**51.07*48.52*55.80
**0479T**59.31*56.34*64.79
**0480T**70.90*67.36*77.46
#**0480T**29.66*28.18*32.41
**0483T**1126.22*1069.91*1230.40
**0484T**1460.75*1387.71*1595.87
**0485T**21.72*20.63*23.72
**0485T*TC*7.85*7.46*8.58
**0485T*26*14.18*13.47*15.49
**0486T**43.43*41.26*47.45
**0486T*TC*15.39*14.62*16.81
**0486T*26*28.05*26.65*30.65
**0488T**58.86*55.92*64.31
#**0488T**47.33*44.96*51.70
**0505T**10143.86*9636.67*11082.17
#**0505T**535.97*509.17*585.55
**0507T**20.89*19.85*22.83
**0507T*TC*18.05*17.15*19.72
**0507T*26*2.83*2.69*3.09
**0510T**555.93*528.13*607.35
#**0510T**396.27*376.46*432.93
**0512T**289.63*275.15*316.42
#**0512T**211.27*200.71*230.82
**0513T**86.89*82.55*94.93
#**0513T**63.38*60.21*69.24
**0515T**480.75*456.71*525.22
**0516T**443.64*421.46*484.68
**0517T**314.19*298.48*343.25
**0518T**215.62*204.84*235.57
**0519T**314.99*299.24*344.13
**0520T**443.64*421.46*484.68
**0521T**51.07*48.52*55.80
**0521T*TC*31.95*30.35*34.90
**0521T*26*19.12*18.16*20.88
**0522T**61.54*58.46*67.23
**0522T*TC*32.54*30.91*35.55
**0522T*26*29.00*27.55*31.68
**0523T**139.78*132.79*152.71
**0524T**1468.97*1395.52*1604.85
#**0524T**167.68*159.30*183.20
**0525T**443.94*421.74*485.00
**0526T**344.34*327.12*376.19
**0527T**299.94*284.94*327.68
**0528T**61.54*58.46*67.23
**0528T*TC*32.54*30.91*35.55
**0528T*26*29.00*27.55*31.68
**0529T**51.07*48.52*55.80
**0529T*TC*31.95*30.35*34.90
**0529T*26*19.12*18.16*20.88
**0530T**589.69*560.21*644.24
**0531T**449.05*426.60*490.59
**0532T**314.99*299.24*344.13
**0540T**166.23*157.92*181.61
**0543T**1460.75*1387.71*1595.87
**0544T**1675.50*1591.73*1830.49
**0545T**1675.50*1591.73*1830.49
**0546T**65.98*62.68*72.08
**0552T**6.12*5.81*6.68
**0553T**2205.28*2095.02*2409.27
#**0553T**371.77*353.18*406.16
**0565T**568.12*539.71*620.67
#**0565T**479.71*455.72*524.08
**0566T**92.12*87.51*100.64
#**0566T**55.75*52.96*60.90
**0569T**1675.50*1591.73*1830.49
**0570T**393.85*374.16*430.28
**0571T**519.74*493.75*567.81
**0572T**423.40*402.23*462.56
**0573T**322.37*306.25*352.19
**0574T**374.38*355.66*409.01
**0575T**61.54*58.46*67.23
**0576T**51.07*48.52*55.80
**0577T**178.04*169.14*194.51
**0578T**27.69*26.31*30.26
**0579T**18.94*17.99*20.69
**0580T**199.01*189.06*217.42
**0581T**2024.01*1922.81*2211.23
#**0581T**198.48*188.56*216.84
**0582T**1489.12*1414.66*1626.86
#**0582T**359.33*341.36*392.56
**0583T**1496.16*1421.35*1634.55
#**0583T**123.20*117.04*134.60
**0587T**409.62*389.14*447.51
#**0587T**278.34*264.42*304.08
**0588T**336.32*319.50*367.43
#**0588T**216.57*205.74*236.60
**0589T**45.16*42.90*49.34
#**0589T**36.58*34.75*39.96
**0590T**52.92*50.27*57.81
#**0590T**37.84*35.95*41.34
**0596T**2235.23*2123.47*2441.99
#**0596T**125.36*119.09*136.95
**0597T**672.69*639.06*734.92
#**0597T**125.36*119.09*136.95
**0598T**135.09*128.34*147.59
**0599T**90.10*85.60*98.44
**0600T**3220.99*3059.94*3518.93
#**0600T**685.83*651.54*749.27
**0601T**1369.23*1300.77*1495.89
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**178.70*169.77*195.24
**0611T**36.10*34.30*39.45
**0614T**345.31*328.04*377.25
**0615T**43.86*41.67*47.92
**0616T**615.90*585.11*672.88
**0617T**687.44*653.07*751.03
**0618T**831.86*790.27*908.81
**0619T**604.05*573.85*659.93
#**0619T**446.32*424.00*487.60
**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**235.42*223.65*257.20
#**0627T**93.50*88.83*102.15
**0628T**70.63*67.10*77.17
#**0628T**28.05*26.65*30.65
**0629T**235.42*223.65*257.20
#**0629T**93.50*88.83*102.15
**0630T**70.63*67.10*77.17
#**0630T**28.05*26.65*30.65
**0631T**73.90*70.21*80.74
**0632T**538.52*511.59*588.33
**0633T**182.68*173.55*199.58
*C*0633T*TC*94.63*89.90*103.39
**0633T*26*55.80*53.01*60.96
**0634T**182.68*173.55*199.58
**0634T*TC*126.88*120.54*138.62
**0634T*26*55.80*53.01*60.96
**0635T**182.68*173.55*199.58
**0635T*TC*126.88*120.54*138.62
**0635T*26*55.80*53.01*60.96
**0636T**182.68*173.55*199.58
**0636T*TC*126.88*120.54*138.62
**0636T*26*55.80*53.01*60.96
**0637T**182.68*173.55*199.58
**0637T*TC*126.88*120.54*138.62
**0637T*26*55.80*53.01*60.96
**0638T**182.68*173.55*199.58
**0638T*TC*126.88*120.54*138.62
**0638T*26*55.80*53.01*60.96
**0639T**73.90*70.21*80.74
**0640T**20.89*19.85*22.83
**0640T*TC*18.05*17.15*19.72
**0640T*26*2.83*2.69*3.09
**0644T**1046.94*994.59*1143.78
#**0644T**227.01*215.66*248.01
**0646T**1675.50*1591.73*1830.49
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**54.62*51.89*59.67
**0652T**262.18*249.07*286.43
#**0652T**114.34*108.62*124.91
**0653T**341.55*324.47*373.14
#**0653T**129.25*122.79*141.21
**0654T**132.87*126.23*145.16
**0655T**1466.21*1392.90*1601.84
#**0655T**653.39*620.72*713.83
**0658T**84.28*80.07*92.08
**0659T**2416.39*2295.57*2639.91
#**0659T**410.20*389.69*448.14
**0671T**948.81*901.37*1036.58
**0673T**3066.70*2913.37*3350.38
#**0673T**343.78*326.59*375.58
**0699T**104.38*99.16*114.03
#**0699T**84.86*80.62*92.71
**0707T**339.32*322.35*370.70
#**0707T**257.41*244.54*281.22
**0714T**1265.34*1202.07*1382.38
#**0714T**335.13*318.37*366.13
**0730T**252.90*240.26*276.30
#**0730T**227.09*215.74*248.10
**0738T**66.63*63.30*72.80
**0739T**1466.21*1392.90*1601.84
#**0739T**653.39*620.72*713.83
**0740T**17.77*16.88*19.41
**0741T**42.00*39.90*45.89
**0742T**84.65*80.42*92.48
**0742T*TC*66.55*63.22*72.70
**0742T*26*18.10*17.20*19.78
**0743T**48.30*45.89*52.77
**0744T**838.08*796.18*915.61
**0745T**228.37*216.95*249.49
**0746T**211.99*201.39*231.60
**0747T**882.97*838.82*964.64
**0748T**172.20*163.59*188.13
**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**394.28*374.57*430.76
**0756T**100.80*95.76*110.12
**0757T**72.94*69.29*79.68
**0758T**81.29*77.23*88.81
**0759T**121.18*115.12*132.39
**0760T**90.36*85.84*98.72
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**106.81*101.47*116.69
**0764T**3.98*3.78*4.35
**0765T**7.65*7.27*8.36
**0771T**24.98*23.73*27.29
**0772T**24.98*23.73*27.29
**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*45.75*43.46*49.98
#**0777T*26*3.75*3.56*4.09
**0779T**389.63*370.15*425.67
**0779T*TC*365.18*346.92*398.96
**0779T*26*24.45*23.23*26.71
**0780T**21.28*20.22*23.25
**0783T**12.73*12.09*13.90
**0784T**1901.49*1806.42*2077.38
#**0784T**305.41*290.14*333.66
**0785T**222.39*211.27*242.96
#**0785T**135.16*128.40*147.66
**0786T**668.84*635.40*730.71
#**0786T**286.23*271.92*312.71
**0787T**222.39*211.27*242.96
#**0787T**135.16*128.40*147.66
**0788T**17.71*16.82*19.34
#**0788T**17.12*16.26*18.70
**0789T**24.70*23.47*26.99
#**0789T**21.40*20.33*23.38
**0790T**1814.51*1723.78*1982.35
**0791T**8.46*8.04*9.25
**0793T**538.52*511.59*588.33
**0794T**130.35*123.83*142.40
**0795T**665.46*632.19*727.02
**0796T**443.64*421.46*484.68
**0797T**443.64*421.46*484.68
**0798T**705.18*669.92*770.41
**0799T**470.12*446.61*513.60
**0800T**470.12*446.61*513.60
**0801T**913.76*868.07*998.28
**0802T**456.88*434.04*499.15
**0803T**456.88*434.04*499.15
**0804T**71.97*68.37*78.63
**0804T*TC*37.57*35.69*41.04
**0804T*26*34.41*32.69*37.59
**0805T**2648.25*2515.84*2893.22
#**0805T**307.35*291.98*335.78
**0806T**3531.00*3354.45*3857.62
#**0806T**409.80*389.31*447.71
**0807T**38.86*36.92*42.46
**0807T*TC*24.85*23.61*27.15
**0807T*26*14.01*13.31*15.31
**0808T**38.86*36.92*42.46
**0808T*TC*24.85*23.61*27.15
**0808T*26*14.01*13.31*15.31
**0810T**1053.41*1000.74*1150.85
**0811T**17.77*16.88*19.41
**0813T**2317.18*2201.32*2531.52
#**0813T**169.95*161.45*185.67
**0814T**424.15*402.94*463.38
#**0814T**321.77*305.68*351.53
**0818T**336.32*319.50*367.43
#**0818T**216.57*205.74*236.60
**0820T**140.66*133.63*153.67
#**0820T**124.99*118.74*136.55
**0821T**140.66*133.63*153.67
#**0821T**124.99*118.74*136.55
**0822T**119.56*113.58*130.62
#**0822T**106.24*100.93*116.07
**0823T**665.46*632.19*727.02
**0824T**705.18*669.92*770.41
**0825T**913.76*868.07*998.28
**0826T**61.54*58.46*67.23
**0826T*TC*32.54*30.91*35.55
**0826T*26*29.00*27.55*31.68
**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**20.89*19.85*22.83
**0859T*TC*18.05*17.15*19.72
**0859T*26*2.83*2.69*3.09
**0864T**289.63*275.15*316.42
#**0864T**211.27*200.71*230.82
**10011**385.67*366.39*421.35
#**10011**102.11*97.00*111.55
**10012**214.00*203.30*233.80
#**10012**68.52*65.09*74.85
**15847**329.91*313.41*360.42
**21742**1091.43*1036.86*1192.39
**21743**1254.69*1191.96*1370.75
**32855**335.50*318.73*366.54
**32856**428.05*406.65*467.65
**33928**3144.08*2986.88*3434.91
**33929**1177.67*1118.79*1286.61
**33933**514.67*488.94*562.28
**33944**514.67*488.94*562.28
**34841**2021.84*1920.75*2208.86
**34842**2247.63*2135.25*2455.54
**34843**2473.40*2349.73*2702.19
**34844**2699.18*2564.22*2948.85
**34845**2021.84*1920.75*2208.86
**34846**2247.63*2135.25*2455.54
**34847**2473.40*2349.73*2702.19
**34848**2699.18*2564.22*2948.85
**43496**1980.30*1881.29*2163.48
**43647**442.49*420.37*483.43
**43648**499.58*474.60*545.79
#**43648**227.12*215.76*248.12
**43881**633.66*601.98*692.28
#**43881**582.68*553.55*636.58
**43882**668.95*635.50*730.83
#**43882**614.08*583.38*670.89
**47143**402.73*382.59*439.98
**47144**478.24*454.33*522.48
**47145**453.07*430.42*494.98
**48551**253.32*240.65*276.75
**49906**1895.60*1800.82*2070.94
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**713.59*677.91*779.60
**53452**356.80*338.96*389.80
**53453**606.43*576.11*662.53
**53454**52.58*49.95*57.44
#**53454**33.36*31.69*36.44
**54440**708.50*673.08*774.04
**63043**541.05*514.00*591.10
**63044**488.74*464.30*533.95
**64596**1901.49*1806.42*2077.38
#**64596**305.41*290.14*333.66
**64597**570.45*541.93*623.22
#**64597**91.62*87.04*100.10
**64598**222.39*211.27*242.96
#**64598**135.16*128.40*147.66
**65757**111.54*105.96*121.85
**66983**615.90*585.11*672.88
**66987**718.69*682.76*785.17
**66988**594.69*564.96*649.70
*C*70170**224.53*213.30*245.30
*C*70170*TC*210.83*200.29*230.33
**70555**233.47*221.80*255.07
**70555*TC*121.74*115.65*133.00
*C*70557**617.04*586.19*674.12
*C*70557*TC*474.58*450.85*518.48
*C*70558**315.23*299.47*344.39
*C*70558*TC*158.20*150.29*172.83
*C*70559**306.53*291.20*334.88
*C*70559*TC*158.20*150.29*172.83
*C*74190**495.37*470.60*541.19
*C*74190*TC*474.58*450.85*518.48
**74235**134.17*127.46*146.58
**74235*TC*80.93*76.88*88.41
**74300**76.46*72.64*83.54
**74300*TC*64.04*60.84*69.97
**74301**23.59*22.41*25.77
**74301*TC*14.33*13.61*15.65
**74328**175.06*166.31*191.26
**74328*TC*153.43*145.76*167.62
**74329**129.06*122.61*141.00
**74329*TC*107.14*101.78*117.05
**74330**262.59*249.46*286.88
**74330*TC*237.11*225.25*259.04
**74340**86.58*82.25*94.59
**74340*TC*62.65*59.52*68.45
**74355**86.58*82.25*94.59
**74355*TC*52.47*49.85*57.33
**74360**86.58*82.25*94.59
**74360*TC*61.14*58.08*66.79
**74363**175.06*166.31*191.26
**74363*TC*136.12*129.31*148.71
*C*74445**145.03*137.78*158.45
*C*74445*TC*94.63*89.90*103.39
*C*74450**225.50*214.23*246.36
*C*74450*TC*210.83*200.29*230.33
*C*74470**497.92*473.02*543.97
*C*74470*TC*474.58*450.85*518.48
**74742**233.47*221.80*255.07
**74742*TC*206.06*195.76*225.12
*C*74775**238.57*226.64*260.64
*C*74775*TC*210.83*200.29*230.33
**75801**280.53*266.50*306.48
*C*75801*TC*540.52*513.49*590.51
*C*75803**1430.47*1358.95*1562.79
*C*75803*TC*1377.88*1308.99*1505.34
*C*75805**2778.79*2639.85*3035.83
*C*75805*TC*2742.45*2605.33*2996.13
*C*75807**2792.11*2652.50*3050.38
*C*75807*TC*2742.45*2605.33*2996.13
*C*75810**2788.20*2648.79*3046.11
*C*75810*TC*2742.45*2605.33*2996.13
**75894**813.02*772.37*888.23
**75894*TC*746.08*708.78*815.10
*C*75898**2827.74*2686.35*3089.30
*C*75898*TC*2742.45*2605.33*2996.13
**75970**397.40*377.53*434.16
**75970*TC*361.86*343.77*395.34
**76125**36.43*34.61*39.80
**76125*TC*24.01*22.81*26.23
**76390**186.93*177.58*204.22
**76390*TC*137.52*130.64*150.24
**76390*26*49.41*46.94*53.98
**76932**78.00*74.10*85.22
**76932*TC*44.40*42.18*48.51
**76940**148.26*140.85*161.98
**76940*TC*54.00*51.30*59.00
**76941**107.66*102.28*117.62
**76941*TC*47.48*45.11*51.88
**76945**77.09*73.24*84.23
**76945*TC*47.15*44.79*51.51
*C*76975**248.93*236.48*271.95
*C*76975*TC*210.83*200.29*230.33
**76998**175.06*166.31*191.26
**76998*TC*131.14*124.58*143.27
**77013**382.17*363.06*417.52
**77013*TC*210.36*199.84*229.82
**77022**431.28*409.72*471.18
**77022*TC*244.23*232.02*266.82
**77371**552.12*524.51*603.19
**77520**801.05*761.00*875.15
**77522**801.05*761.00*875.15
**77523**919.75*873.76*1004.82
**77525**1038.47*986.55*1134.53
*C*78282**369.36*350.89*403.52
*C*78282*TC*354.83*337.09*387.65
**78414**514.99*489.24*562.63
**78414*TC*495.21*470.45*541.02
*C*78429**1420.22*1349.21*1551.59
*C*78429*TC*1345.95*1278.65*1470.45
*C*78430**1416.67*1345.84*1547.72
*C*78430*TC*1345.95*1278.65*1470.45
*C*78431**2114.63*2008.90*2310.24
*C*78431*TC*2032.22*1930.61*2220.20
*C*78432**1759.19*1671.23*1921.91
*C*78432*TC*1670.90*1587.36*1825.46
*C*78433**1857.97*1765.07*2029.83
*C*78433*TC*1761.38*1673.31*1924.31
**78434**634.39*602.67*693.07
**78434*TC*607.23*576.87*663.40
*C*78459**1290.54*1226.01*1409.91
*C*78459*TC*1221.76*1160.67*1334.77
*C*78491**1413.37*1342.70*1544.11
*C*78491*TC*1345.95*1278.65*1470.45
*C*78492**1425.08*1353.83*1556.90
*C*78492*TC*1345.95*1278.65*1470.45
*C*78608**1410.82*1340.28*1541.32
*C*78608*TC*1345.95*1278.65*1470.45
*C*78811**1288.55*1224.12*1407.74
*C*78811*TC*1221.76*1160.67*1334.77
*C*78812**1430.27*1358.76*1562.57
*C*78812*TC*1345.95*1278.65*1470.45
*C*78813**1432.27*1360.66*1564.76
*C*78813*TC*1345.95*1278.65*1470.45
*C*78814**1441.49*1369.42*1574.83
*C*78814*TC*1345.95*1278.65*1470.45
*C*78815**1452.32*1379.70*1586.66
*C*78815*TC*1345.95*1278.65*1470.45
*C*78816**1453.38*1380.71*1587.82
*C*78816*TC*1345.95*1278.65*1470.45
**79300**237.04*225.19*258.97
**79300*TC*176.64*167.81*192.98
**79445**237.04*225.19*258.97
**79445*TC*134.30*127.59*146.73
**86485**17.28*16.42*18.88
**90867**273.01*259.36*298.26
#**90867**127.98*121.58*139.82
**90868**185.37*176.10*202.52
#**90868**99.56*94.58*108.77
**90869**255.99*243.19*279.67
#**90869**149.30*141.84*163.12
**90952**463.95*440.75*506.86
**90953**329.56*313.08*360.04
**92978**224.36*213.14*245.11
**92978*TC*136.55*129.72*149.18
**92979**137.31*130.44*150.01
**92979*TC*67.61*64.23*73.86
*C*93315**592.36*562.74*647.15
*C*93315*TC*474.58*450.85*518.48
**93317**196.66*186.83*214.85
**93317*TC*114.65*108.92*125.26
*C*93318**569.40*540.93*622.07
*C*93318*TC*474.58*450.85*518.48
**93571**223.47*212.30*244.15
**93571*TC*156.63*148.80*171.12
**93572**135.23*128.47*147.74
**93572*TC*68.39*64.97*74.72
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.56*3278.03*3769.73
**93602**3557.81*3379.92*3886.91
**93602*TC*3452.36*3279.74*3771.70
**93603**3557.81*3379.92*3886.91
**93603*TC*3452.36*3279.74*3771.70
**93609**2134.69*2027.96*2332.15
**93609*TC*1883.01*1788.86*2057.19
**93610**3557.81*3379.92*3886.91
**93610*TC*3408.77*3238.33*3724.08
**93612**3557.81*3379.92*3886.91
**93612*TC*3410.88*3240.34*3726.39
**93615**48.14*45.73*52.59
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6760.12*6422.11*7385.43
**93620**7115.62*6759.84*7773.82
**93620*TC*6545.23*6217.97*7150.67
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.77*6687.78*7690.95
**93622**7115.62*6759.84*7773.82
**93622*TC*6959.15*6611.19*7602.87
**93623**2134.69*2027.96*2332.15
**93623*TC*2072.76*1969.12*2264.49
**93624**3557.81*3379.92*3886.91
**93624*TC*3336.00*3169.20*3644.58
**93631**7115.62*6759.84*7773.82
**93631*TC*6749.56*6412.08*7373.89
**93640**1133.95*1077.25*1238.84
**93640*TC*971.03*922.48*1060.85
**93641**1133.95*1077.25*1238.84
**93641*TC*849.13*806.67*927.67
**93662**388.98*369.53*424.96
**93662*TC*323.73*307.54*353.67
**93745**60.46*57.44*66.06
**93745*TC*42.32*40.20*46.23
**93745*26*18.15*17.24*19.83
**94642**19.40*18.43*21.19
**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**896.82*851.98*979.78
**95965*TC*514.05*488.35*561.60
**95966**530.43*503.91*579.50
**95966*TC*345.30*328.04*377.25
**95967**446.09*423.79*487.36
**95967*TC*285.34*271.07*311.73
**96020**374.66*355.93*409.32
**96020*TC*226.96*215.61*247.95
**96547**668.67*635.24*730.53
#**96547**125.50*119.23*137.11
**96548**334.33*317.61*365.25
#**96548**62.75*59.61*68.55
**97151**47.45*45.08*51.84
#**97151**42.43*40.31*46.36
**97152**40.33*38.31*44.06
#**97152**36.06*34.26*39.40
**97153**32.16*30.55*35.13
#**97153**28.46*27.04*31.10
**97154**4.38*4.16*4.78
#**97154**4.00*3.80*4.37
**97155**32.16*30.55*35.13
#**97155**28.46*27.04*31.10
**97156**33.94*32.24*37.08
#**97156**30.10*28.60*32.89
**97157**9.88*9.39*10.80
#**97157**8.99*8.54*9.82
**97158**5.09*4.84*5.57
#**97158**4.65*4.42*5.08
**98978**42.00*39.90*45.89
# - 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.