MISSISSIPPI MEDICARE CARRIER - 07302
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
STATEWIDE
******
**A2001**1287.50*1223.13*1406.60
**A2002**344.73*327.49*376.61
**A2004**12.78*12.14*13.96
**A2005**267.80*254.41*292.57
**A2007**84.75*80.51*92.59
**A2008**92.91*88.26*101.50
**A2009**91.05*86.50*99.48
**A2013**1390.50*1320.98*1519.13
**A2014**61.16*58.10*66.82
**A2015**1236.00*1174.20*1350.33
**A2021**1387.93*1318.53*1516.31
**A2022**1467.75*1394.36*1603.51
**A2023**16.74*15.90*18.29
**A2024**2008.50*1908.08*2194.29
**A2025**257.50*244.63*281.32
**A2029**515.00*489.25*562.64
**A9500**134.67*127.94*147.13
**A9502**129.61*123.13*141.60
**A9505**77.23*73.37*84.38
**A9521**1742.80*1655.66*1904.01
**A9524**141.09*134.04*154.15
**A9537**9.45*8.98*10.33
**A9543**73939.13*70242.17*80778.50
**A9547**2399.68*2279.70*2621.66
**A9554**33.25*31.59*36.33
**A9558**290.82*276.28*317.72
**A9586**3257.44*3094.57*3558.76
**G0186**445.46*423.19*486.67
#**G0186**384.55*365.32*420.12
**G0339**2451.51*2328.93*2678.27
**G0340**1843.71*1751.52*2014.25
**G0398**110.04*104.54*120.22
**G0398*TC*74.36*70.64*81.24
**G0398*26*35.68*33.90*38.99
**G0399**83.69*79.51*91.44
**G0399*TC*43.76*41.57*47.81
**G0399*26*39.92*37.92*43.61
**G0400**84.41*80.19*92.22
**G0400*TC*47.35*44.98*51.73
**G0400*26*37.06*35.21*40.49
**G0460**668.98*635.53*730.86
#**G0460**109.25*103.79*119.36
**G0498**122.63*116.50*133.98
**G0552**128.87*122.43*140.79
**G6017**69.21*65.75*75.61
**0042T**197.51*187.63*215.77
**0054T**206.40*196.08*225.49
**0055T**206.40*196.08*225.49
**0071T**505.71*480.42*552.48
**0072T**505.71*480.42*552.48
**0075T*26*872.13*828.52*952.80
**0076T**1001.86*951.77*1094.54
**0095T**555.40*527.63*606.77
**0098T**622.24*591.13*679.80
**0101T**272.33*258.71*297.52
#**0101T**202.33*192.21*221.04
**0102T**272.33*258.71*297.52
#**0102T**202.33*192.21*221.04
**0106T**27.19*25.83*29.70
**0107T**27.19*25.83*29.70
**0108T**27.19*25.83*29.70
**0109T**27.19*25.83*29.70
**0110T**27.19*25.83*29.70
**0164T**607.00*576.65*663.15
**0165T**621.70*590.62*679.21
**0184T**737.68*700.80*805.92
**0198T**72.87*69.23*79.61
#**0198T**29.05*27.60*31.74
**0200T**1460.66*1387.63*1595.77
#**0200T**367.66*349.28*401.67
**0201T**2190.99*2081.44*2393.66
#**0201T**551.49*523.92*602.51
**0207T**128.90*122.46*140.83
**0208T**33.04*31.39*36.10
**0209T**39.93*37.93*43.62
**0210T**25.05*23.80*27.37
**0211T**38.83*36.89*42.42
**0212T**32.86*31.22*35.90
#**0212T**29.00*27.55*31.68
**0213T**166.99*158.64*182.44
#**0213T**95.34*90.57*104.16
**0214T**85.95*81.65*93.90
#**0214T**54.26*51.55*59.28
**0215T**85.70*81.42*93.63
#**0215T**54.56*51.83*59.60
**0216T**153.46*145.79*167.66
#**0216T**82.08*77.98*89.68
**0217T**79.48*75.51*86.84
#**0217T**46.41*44.09*50.70
**0218T**78.70*74.77*85.99
#**0218T**46.74*44.40*51.06
**0219T**1168.40*1109.98*1276.48
**0220T**1151.31*1093.74*1257.80
**0221T**1418.27*1347.36*1549.46
**0222T**349.25*331.79*381.56
**0232T**766.84*728.50*837.78
#**0232T**82.82*78.68*90.48
**0234T**6781.13*6442.07*7408.38
#**0234T**528.77*502.33*577.68
**0235T**6781.13*6442.07*7408.38
#**0235T**528.77*502.33*577.68
**0236T**6934.62*6587.89*7576.07
#**0236T**615.01*584.26*671.90
**0237T**6934.62*6587.89*7576.07
#**0237T**615.01*584.26*671.90
**0238T**6934.62*6587.89*7576.07
#**0238T**615.01*584.26*671.90
**0266T**804.19*763.98*878.58
**0267T**143.52*136.34*156.79
**0268T**297.94*283.04*325.50
**0269T**759.51*721.53*829.76
**0270T**143.52*136.34*156.79
**0271T**297.94*283.04*325.50
**0272T**47.75*45.36*52.16
**0273T**61.91*58.81*67.63
**0274T**987.89*938.50*1079.28
**0278T**13.30*12.64*14.54
**0308T**1238.41*1176.49*1352.96
**0329T**72.87*69.23*79.61
#**0329T**29.05*27.60*31.74
**0330T**39.25*37.29*42.88
**0331T**153.56*145.88*167.76
**0332T**259.38*246.41*283.37
**0347T**128.56*122.13*140.45
**0348T**28.19*26.78*30.80
**0349T**29.47*28.00*32.20
**0350T**30.30*28.79*33.11
**0351T**141.52*134.44*154.61
**0352T**39.30*37.34*42.94
**0353T**141.52*134.44*154.61
**0354T**39.30*37.34*42.94
**0358T**21.74*20.65*23.75
**0362T**81.74*77.65*89.30
#**0362T**60.24*57.23*65.81
**0378T**22.89*21.75*25.01
**0394T**212.05*201.45*231.67
**0395T**523.69*497.51*572.14
**0397T**42.56*40.43*46.49
**0408T**457.25*434.39*499.55
**0409T**314.72*298.98*343.83
**0410T**327.18*310.82*357.44
**0411T**327.18*310.82*357.44
**0412T**204.36*194.14*223.26
**0413T**427.17*405.81*466.68
**0414T**328.16*311.75*358.51
**0415T**274.33*260.61*299.70
**0416T**301.86*286.77*329.79
**0417T**72.03*68.43*78.69
**0418T**47.75*45.36*52.16
**0419T**395.47*375.70*432.06
#**0419T**322.99*306.84*352.87
**0420T**563.65*535.47*615.79
#**0420T**473.81*450.12*517.64
**0421T**1341.46*1274.39*1465.55
#**0421T**629.06*597.61*687.25
**0437T**192.53*182.90*210.34
**0439T**60.89*57.85*66.53
**0440T**214.22*203.51*234.04
#**0440T**108.67*103.24*118.73
**0441T**214.22*203.51*234.04
#**0441T**108.67*103.24*118.73
**0442T**214.22*203.51*234.04
#**0442T**108.67*103.24*118.73
**0449T**670.67*637.14*732.71
**0464T**56.19*53.38*61.39
**0472T**57.87*54.98*63.23
**0473T**47.75*45.36*52.16
**0479T**45.75*43.46*49.98
**0480T**60.22*57.21*65.79
#**0480T**22.88*21.74*25.00
**0483T**1072.10*1018.50*1171.28
**0484T**1392.87*1323.23*1521.71
**0485T**20.69*19.66*22.61
**0485T*TC*7.28*6.92*7.96
**0485T*26*13.67*12.99*14.94
**0486T**41.39*39.32*45.22
**0486T*TC*14.30*13.59*15.63
**0486T*26*27.09*25.74*29.60
**0488T**56.16*53.35*61.35
#**0488T**45.41*43.14*49.61
**0505T**9539.52*9062.54*10421.92
#**0505T**493.15*468.49*538.76
**0507T**19.20*18.24*20.98
**0507T*TC*16.51*15.68*18.03
**0507T*26*2.69*2.56*2.94
**0510T**522.35*496.23*570.66
#**0510T**378.49*359.57*413.51
**0512T**272.33*258.71*297.52
#**0512T**202.33*192.21*221.04
**0513T**81.70*77.62*89.26
#**0513T**60.70*57.67*66.32
**0515T**457.25*434.39*499.55
**0516T**421.45*400.38*460.44
**0517T**297.94*283.04*325.50
**0518T**204.36*194.14*223.26
**0519T**298.90*283.96*326.55
**0520T**421.45*400.38*460.44
**0521T**47.75*45.36*52.16
**0521T*TC*29.19*27.73*31.89
**0521T*26*18.57*17.64*20.29
**0522T**57.87*54.98*63.23
**0522T*TC*29.46*27.99*32.19
**0522T*26*28.41*26.99*31.04
**0523T**131.86*125.27*144.06
**0524T**1319.20*1253.24*1441.23
#**0524T**160.34*152.32*175.17
**0525T**423.05*401.90*462.19
**0526T**327.18*310.82*357.44
**0527T**285.98*271.68*312.43
**0528T**57.87*54.98*63.23
**0528T*TC*29.46*27.99*32.19
**0528T*26*28.41*26.99*31.04
**0529T**47.75*45.36*52.16
**0529T*TC*29.19*27.73*31.89
**0529T*26*18.57*17.64*20.29
**0530T**560.52*532.49*612.36
**0531T**427.17*405.81*466.68
**0532T**298.90*283.96*326.55
**0543T**1392.87*1323.23*1521.71
**0544T**1593.21*1513.55*1740.58
**0545T**1593.21*1513.55*1740.58
**0546T**62.79*59.65*68.60
**0552T**6.05*5.75*6.61
**0565T**540.05*513.05*590.01
#**0565T**459.02*436.07*501.48
**0566T**86.96*82.61*95.00
#**0566T**53.61*50.93*58.57
**0569T**1593.21*1513.55*1740.58
**0570T**375.08*356.33*409.78
**0571T**494.37*469.65*540.10
**0572T**402.73*382.59*439.98
**0573T**307.54*292.16*335.98
**0574T**355.08*337.33*387.93
**0575T**57.87*54.98*63.23
**0576T**47.75*45.36*52.16
**0577T**170.29*161.78*186.05
**0578T**26.74*25.40*29.21
**0579T**16.51*15.68*18.03
**0580T**189.06*179.61*206.55
**0581T**1817.76*1726.87*1985.90
#**0581T**189.01*179.56*206.49
**0582T**1347.92*1280.52*1472.60
#**0582T**345.04*327.79*376.96
**0583T**1259.54*1196.56*1376.04
#**0583T**117.98*112.08*128.89
**0587T**365.05*346.80*398.82
#**0587T**266.94*253.59*291.63
**0588T**295.27*280.51*322.59
#**0588T**207.91*197.51*227.14
**0589T**42.98*40.83*46.95
#**0589T**35.26*33.50*38.53
**0590T**50.49*47.97*55.17
#**0590T**36.16*34.35*39.50
**0596T**2235.23*2123.47*2441.99
#**0596T**121.74*115.65*133.00
**0597T**121.74*115.65*133.00
**0598T**124.24*118.03*135.73
**0599T**84.44*80.22*92.25
**0600T**2938.52*2791.59*3210.33
#**0600T**666.26*632.95*727.89
**0601T**1302.63*1237.50*1423.13
**0604T**16.76*15.92*18.31
**0605T**36.63*34.80*40.02
**0606T**52.01*49.41*56.82
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**166.68*158.35*182.10
**0611T**34.67*32.94*37.88
**0614T**327.98*311.58*358.32
**0615T**41.71*39.62*45.56
**0619T**557.75*529.86*609.34
#**0619T**429.87*408.38*469.64
**0620T**1414.22*1343.51*1545.04
**0627T**218.43*207.51*238.64
#**0627T**90.01*85.51*98.34
**0628T**65.53*62.25*71.59
#**0628T**27.00*25.65*29.50
**0629T**218.43*207.51*238.64
#**0629T**90.01*85.51*98.34
**0630T**65.53*62.25*71.59
#**0630T**27.00*25.65*29.50
**0631T**68.58*65.15*74.92
**0632T**512.63*487.00*560.05
**0633T**170.30*161.79*186.06
*C*0633T*TC*90.64*86.11*99.03
**0633T*26*54.33*51.61*59.35
**0634T**170.30*161.79*186.06
**0634T*TC*115.97*110.17*126.70
**0634T*26*54.33*51.61*59.35
**0635T**170.30*161.79*186.06
**0635T*TC*115.97*110.17*126.70
**0635T*26*54.33*51.61*59.35
**0636T**170.30*161.79*186.06
**0636T*TC*115.97*110.17*126.70
**0636T*26*54.33*51.61*59.35
**0637T**170.30*161.79*186.06
**0637T*TC*115.97*110.17*126.70
**0637T*26*54.33*51.61*59.35
**0638T**170.30*161.79*186.06
**0638T*TC*115.97*110.17*126.70
**0638T*26*54.33*51.61*59.35
**0639T**68.58*65.15*74.92
**0640T**19.20*18.24*20.98
**0640T*TC*16.51*15.68*18.03
**0640T*26*2.69*2.56*2.94
**0644T**953.39*905.72*1041.58
#**0644T**218.11*207.20*238.28
**0646T**1593.21*1513.55*1740.58
**0650T**50.91*48.36*55.61
**0652T**244.63*232.40*267.26
#**0652T**109.86*104.37*120.03
**0653T**314.91*299.16*344.03
#**0653T**123.65*117.47*135.09
**0654T**127.60*121.22*139.40
**0655T**1341.46*1274.39*1465.55
#**0655T**629.06*597.61*687.25
**0658T**77.97*74.07*85.18
**0659T**2171.41*2062.84*2372.27
#**0659T**391.63*372.05*427.86
**0660T**670.67*637.14*732.71
**0671T**900.95*855.90*984.29
**0673T**2779.98*2640.98*3037.13
#**0673T**331.62*315.04*362.30
**0699T**99.44*94.47*108.64
#**0699T**82.08*77.98*89.68
**0707T**312.41*296.79*341.31
#**0707T**240.21*228.20*262.43
**0714T**1147.77*1090.38*1253.94
#**0714T**322.10*306.00*351.90
**0738T**64.49*61.27*70.46
**0739T**1341.46*1274.39*1465.55
#**0739T**629.06*597.61*687.25
**0740T**16.76*15.92*18.31
**0741T**36.63*34.80*40.02
**0742T**77.81*73.92*85.01
**0742T*TC*60.24*57.23*65.81
**0742T*26*17.58*16.70*19.21
**0743T**46.00*43.70*50.26
**0744T**797.78*757.89*871.57
**0745T**214.22*203.51*234.04
**0746T**207.75*197.36*226.96
**0747T**808.13*767.72*882.88
**0748T**164.05*155.85*179.23
**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**3.78*3.59*4.13
**0765T**7.40*7.03*8.08
**0771T**23.98*22.78*26.20
**0772T**23.98*22.78*26.20
**0773T**20.13*19.12*21.99
**0774T**20.13*19.12*21.99
**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*3.75*3.56*4.09
**0779T**347.17*329.81*379.28
**0779T*TC*323.52*307.34*353.44
**0779T*26*23.66*22.48*25.85
**0780T**20.13*19.12*21.99
**0783T**11.82*11.23*12.91
**0784T**1719.65*1633.67*1878.72
#**0784T**296.22*281.41*323.62
**0785T**207.19*196.83*226.35
#**0785T**129.20*122.74*141.15
**0786T**614.13*583.42*670.93
#**0786T**274.60*260.87*300.00
**0787T**207.19*196.83*226.35
#**0787T**129.20*122.74*141.15
**0788T**17.03*16.18*18.61
#**0788T**16.75*15.91*18.30
**0789T**21.28*20.22*23.25
#**0789T**20.94*19.89*22.87
**0790T**1746.53*1659.20*1908.08
**0791T**8.09*7.69*8.84
**0793T**512.63*487.00*560.05
**0794T**130.35*123.83*142.40
**0795T**632.17*600.56*690.64
**0796T**421.45*400.38*460.44
**0797T**421.45*400.38*460.44
**0798T**670.43*636.91*732.45
**0799T**446.95*424.60*488.29
**0800T**445.80*423.51*487.04
**0801T**868.40*824.98*948.73
**0802T**434.20*412.49*474.36
**0803T**434.20*412.49*474.36
**0804T**67.54*64.16*73.78
**0804T*TC*34.15*32.44*37.31
**0804T*26*33.40*31.73*36.49
**0805T**2385.77*2266.48*2606.45
#**0805T**296.51*281.68*323.93
**0806T**3181.03*3021.98*3475.28
#**0806T**395.34*375.57*431.91
**0807T**36.88*35.04*40.30
**0807T*TC*23.12*21.96*25.25
**0807T*26*13.76*13.07*15.03
**0808T**36.88*35.04*40.30
**0808T*TC*23.12*21.96*25.25
**0808T*26*13.76*13.07*15.03
**0810T**1005.68*955.40*1098.71
**0811T**16.76*15.92*18.31
**0813T**2010.14*1909.63*2196.07
#**0813T**159.81*151.82*174.59
**0814T**366.40*348.08*400.29
#**0814T**276.14*262.33*301.68
**0820T**142.65*135.52*155.85
#**0820T**127.21*120.85*138.98
**0821T**142.65*135.52*155.85
#**0821T**127.21*120.85*138.98
**0822T**121.25*115.19*132.47
#**0822T**108.13*102.72*118.13
**0823T**632.17*600.56*690.64
**0824T**670.43*636.91*732.45
**0825T**868.40*824.98*948.73
**0826T**57.87*54.98*63.23
**0826T*TC*29.46*27.99*32.19
**0826T*26*28.41*26.99*31.04
**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**19.20*18.24*20.98
**0859T*TC*16.51*15.68*18.03
**0859T*26*2.69*2.56*2.94
**0864T**272.33*258.71*297.52
#**0864T**202.33*192.21*221.04
**0867T**1434.71*1362.97*1567.42
#**0867T**402.62*382.49*439.86
**0868T**347.17*329.81*379.28
**0868T*TC*323.52*307.34*353.44
**0868T*26*23.66*22.48*25.85
**0869T**312.41*296.79*341.31
#**0869T**240.21*228.20*262.43
**0876T**123.38*117.21*134.79
**0876T*TC*100.79*95.75*110.11
**0876T*26*24.54*23.31*26.81
**0884T**849.18*806.72*927.73
#**0884T**169.16*160.70*184.81
**0885T**569.86*541.37*622.58
#**0885T**272.77*259.13*298.00
**0886T**461.90*438.81*504.63
#**0886T**94.88*90.14*103.66
**0897T**49.79*47.30*54.40
**0897T*TC*44.04*41.84*48.12
**0897T*26*7.40*7.03*8.08
**0898T**59.30*56.34*64.79
**0898T*TC*50.65*48.12*55.34
**0898T*26*8.65*8.22*9.45
**0899T**111.42*105.85*121.73
**0899T*TC*71.16*67.60*77.74
**0899T*26*38.60*36.67*42.17
**0900T**109.77*104.28*119.92
**0900T*TC*71.16*67.60*77.74
**0900T*26*38.60*36.67*42.17
**10011**355.81*338.02*388.72
#**10011**98.69*93.76*107.82
**10012**201.35*191.28*219.97
#**10012**66.58*63.25*72.74
**15847**316.09*300.29*345.33
**21088**1686.18*1601.87*1842.15
**21742**1041.11*989.05*1137.41
**21743**1223.27*1162.11*1336.43
**32855**330.90*314.36*361.51
**32856**405.99*385.69*443.54
**33928**2987.67*2838.29*3264.03
**33929**1119.31*1063.34*1222.84
**33933**507.00*481.65*553.90
**33944**406.82*386.48*444.45
**34841**2457.23*2334.37*2684.53
**34842**2822.59*2681.46*3083.68
**34843**3070.96*2917.41*3355.02
**34844**3319.32*3153.35*3626.35
**34845**2457.23*2334.37*2684.53
**34846**2822.59*2681.46*3083.68
**34847**3070.96*2917.41*3355.02
**34848**3319.32*3153.35*3626.35
**43647**718.12*682.21*784.54
**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
**50323**190.52*180.99*208.14
**50325**276.55*262.72*302.13
**53451**686.59*652.26*750.10
**53452**343.30*326.14*375.06
**53453**583.49*554.32*637.47
**53454**50.07*47.57*54.71
#**53454**32.15*30.54*35.12
**63043**503.53*478.35*550.10
**63044**474.82*451.08*518.74
**64596**1719.65*1633.67*1878.72
#**64596**296.22*281.41*323.62
**64597**516.09*490.29*563.83
#**64597**89.06*84.61*97.30
**64598**207.19*196.83*226.35
#**64598**129.20*122.74*141.15
**65757**110.40*104.88*120.61
**66983**589.20*559.74*643.70
**66987**689.26*654.80*753.02
**66988**570.25*541.74*623.00
*C*70170**219.07*208.12*239.34
*C*70170*TC*205.84*195.55*224.88
**70555**241.72*229.63*264.07
**70555*TC*132.63*126.00*144.90
*C*70557**604.65*574.42*660.58
*C*70557*TC*467.10*443.75*510.31
*C*70558**303.71*288.52*331.80
*C*70558*TC*151.55*143.97*165.57
*C*70559**296.19*281.38*323.59
*C*70559*TC*151.55*143.97*165.57
*C*74190**487.23*462.87*532.30
*C*74190*TC*467.10*443.75*510.31
**74235**127.97*121.57*139.81
**74235*TC*76.11*72.30*83.15
**74300**72.61*68.98*79.33
**74300*TC*60.62*57.59*66.23
**74301**22.31*21.19*24.37
**74301*TC*13.06*12.41*14.27
**74328**175.06*166.31*191.26
**74328*TC*154.12*146.41*168.37
**74329**122.25*116.14*133.56
**74329*TC*101.04*95.99*110.39
**74330**262.59*249.46*286.88
**74330*TC*237.92*226.02*259.92
**74340**86.58*82.25*94.59
**74340*TC*62.73*59.59*68.53
**74355**86.58*82.25*94.59
**74355*TC*53.29*50.63*58.22
**74360**86.58*82.25*94.59
**74360*TC*62.06*58.96*67.80
**74363**175.06*166.31*191.26
**74363*TC*138.49*131.57*151.31
*C*74445**139.81*132.82*152.74
*C*74445*TC*90.64*86.11*99.03
*C*74450**220.07*209.07*240.43
*C*74450*TC*205.84*195.55*224.88
*C*74470**490.27*465.76*535.62
*C*74470*TC*467.10*443.75*510.31
**74742**233.47*221.80*255.07
**74742*TC*206.93*196.58*226.07
*C*74775**232.98*221.33*254.53
*C*74775*TC*205.84*195.55*224.88
*C*75801**565.43*537.16*617.73
*C*75801*TC*526.63*500.30*575.35
*C*75803**1374.30*1305.59*1501.43
*C*75803*TC*1323.37*1257.20*1445.78
*C*75805**2717.22*2581.36*2968.56
*C*75805*TC*2681.76*2547.67*2929.82
*C*75807**2729.89*2593.40*2982.41
*C*75807*TC*2681.76*2547.67*2929.82
*C*75810**2726.63*2590.30*2978.85
*C*75810*TC*2681.76*2547.67*2929.82
**75894**763.97*725.77*834.64
**75894*TC*699.48*664.51*764.19
*C*75898**2763.37*2625.20*3018.98
*C*75898*TC*2681.76*2547.67*2929.82
**75970**373.86*355.17*408.45
**75970*TC*339.43*322.46*370.83
**76125**34.62*32.89*37.82
**76125*TC*22.36*21.24*24.43
**76390**178.08*169.18*194.56
**76390*TC*129.67*123.19*141.67
**76390*26*48.41*45.99*52.89
**76932**74.34*70.62*81.21
**76932*TC*42.41*40.29*46.33
**76940**141.12*134.06*154.17
**76940*TC*49.63*47.15*54.22
**76941**103.45*98.28*113.02
**76941*TC*45.03*42.78*49.20
**76945**73.53*69.85*80.33
**76945*TC*44.44*42.22*48.55
*C*76975**242.71*230.57*265.16
*C*76975*TC*205.84*195.55*224.88
**76998**175.06*166.31*191.26
**76998*TC*132.83*126.19*145.12
**77013**363.03*344.88*396.61
**77013*TC*195.24*185.48*213.30
**77022**412.14*391.53*450.26
**77022*TC*229.34*217.87*250.55
**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**356.45*338.63*389.42
*C*78282*TC*342.26*325.15*373.92
**78414**514.99*489.24*562.63
**78414*TC*495.78*470.99*541.64
*C*78429**1315.40*1249.63*1437.07
*C*78429*TC*1242.62*1180.49*1357.56
*C*78430**1311.41*1245.84*1432.72
*C*78430*TC*1242.62*1180.49*1357.56
*C*78431**1997.61*1897.73*2182.39
*C*78431*TC*1917.27*1821.41*2094.62
*C*78432**1664.90*1581.66*1818.91
*C*78432*TC*1576.64*1497.81*1722.48
*C*78433**1756.20*1668.39*1918.65
*C*78433*TC*1661.79*1578.70*1815.51
**78434**599.53*569.55*654.98
**78434*TC*572.87*544.23*625.86
*C*78459**1179.64*1120.66*1288.76
*C*78459*TC*1112.26*1056.65*1215.15
*C*78491**1308.65*1243.22*1429.70
*C*78491*TC*1242.62*1180.49*1357.56
*C*78492**1319.17*1253.21*1441.19
*C*78492*TC*1242.62*1180.49*1357.56
*C*78608**1305.88*1240.59*1426.68
*C*78608*TC*1242.62*1180.49*1357.56
*C*78811**1177.62*1118.74*1286.55
*C*78811*TC*1112.26*1056.65*1215.15
*C*78812**1324.67*1258.44*1447.21
*C*78812*TC*1242.62*1180.49*1357.56
*C*78813**1326.39*1260.07*1449.08
*C*78813*TC*1242.62*1180.49*1357.56
*C*78814**1335.83*1269.04*1459.40
*C*78814*TC*1242.62*1180.49*1357.56
*C*78815**1346.85*1279.51*1471.44
*C*78815*TC*1242.62*1180.49*1357.56
*C*78816**1347.74*1280.35*1472.40
*C*78816*TC*1242.62*1180.49*1357.56
**79300**237.04*225.19*258.97
**79300*TC*177.62*168.74*194.05
**79445**237.04*225.19*258.97
**79445*TC*136.14*129.33*148.73
**86485**15.20*14.44*16.61
**90867**256.93*244.08*280.69
#**90867**121.76*115.67*133.02
**90868**175.58*166.80*191.82
#**90868**101.61*96.53*111.01
**90869**209.20*198.74*228.55
#**90869**141.95*134.85*155.08
**92978**213.79*203.10*233.57
**92978*TC*129.76*123.27*141.76
**92979**131.44*124.87*143.60
**92979*TC*64.37*61.15*70.32
*C*93315**581.18*552.12*634.94
*C*93315*TC*467.10*443.75*510.31
**93317**187.71*178.32*205.07
**93317*TC*107.85*102.46*117.83
*C*93318**559.66*531.68*611.43
*C*93318*TC*467.10*443.75*510.31
**93571**212.95*202.30*232.65
**93571*TC*148.87*141.43*162.64
**93572**129.51*123.03*141.48
**93572*TC*83.05*78.90*90.74
**93600**3557.81*3379.92*3886.91
**93600*TC*3455.60*3282.82*3775.24
**93602**3557.81*3379.92*3886.91
**93602*TC*3456.67*3283.84*3776.42
**93603**3557.81*3379.92*3886.91
**93603*TC*3456.67*3283.84*3776.42
**93609**2134.69*2027.96*2332.15
**93609*TC*1894.48*1799.76*2069.72
**93610**3557.81*3379.92*3886.91
**93610*TC*3415.32*3244.55*3731.23
**93612**3557.81*3379.92*3886.91
**93612*TC*3416.59*3245.76*3732.62
**93615**44.70*42.47*48.84
**93615*TC*13.22*12.56*14.44
**93619**7115.62*6759.84*7773.82
**93619*TC*6777.21*6438.35*7404.10
**93620**7115.62*6759.84*7773.82
**93620*TC*6570.87*6242.33*7178.68
**93621**7115.62*6759.84*7773.82
**93621*TC*7043.33*6691.16*7694.83
**93622**7115.62*6759.84*7773.82
**93622*TC*6965.72*6617.43*7610.04
**93623**2134.69*2027.96*2332.15
**93623*TC*2086.39*1982.07*2279.38
**93624**3557.81*3379.92*3886.91
**93624*TC*3346.03*3178.73*3655.54
**93631**7115.62*6759.84*7773.82
**93631*TC*6767.61*6429.23*7393.61
**93640**1133.95*1077.25*1238.84
**93640*TC*978.35*929.43*1068.84
**93641**1133.95*1077.25*1238.84
**93641*TC*863.00*819.85*942.83
**93662**330.56*314.03*361.13
**93662*TC*269.33*255.86*294.24
**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*546.58*519.25*597.14
**95966**1820.86*1729.82*1989.29
**95966*TC*1646.37*1564.05*1798.66
**96020**376.39*357.57*411.21
**97151**47.59*45.21*51.99
#**97151**41.41*39.34*45.24
**97152**39.18*37.22*42.80
#**97152**35.20*33.44*38.46
**97153**32.69*31.06*35.72
#**97153**29.11*27.65*31.80
**97154**4.21*4.00*4.60
#**97154**3.86*3.67*4.22
**97155**31.28*29.72*34.18
#**97155**27.84*26.45*30.42
**97156**33.04*31.39*36.10
#**97156**29.45*27.98*32.18
**97157**9.57*9.09*10.45
#**97157**8.74*8.30*9.55
**97158**4.91*4.66*5.36
#**97158**4.50*4.28*4.92
**98978**36.63*34.80*40.02
# - 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 2024 BY THE AMERICAN MEDICAL ASSOCIATION.