TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2025
BEAUMONT
******
**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**465.40*442.13*508.45
#**G0186**400.85*380.81*437.93
**G0339**2536.78*2409.94*2771.43
**G0340**1907.92*1812.52*2084.40
**G0398**115.19*109.43*125.84
**G0398*TC*78.89*74.95*86.19
**G0398*26*36.30*34.49*39.66
**G0399**87.11*82.75*95.16
**G0399*TC*46.47*44.15*50.77
**G0399*26*40.64*38.61*44.40
**G0400**88.03*83.63*96.17
**G0400*TC*50.27*47.76*54.92
**G0400*26*37.76*35.87*41.25
**G0460**706.26*670.95*771.59
#**G0460**113.03*107.38*123.49
**G0498**129.86*123.37*141.88
**G0552**128.87*122.43*140.79
**G6017**72.08*68.48*78.75
**0042T**205.91*195.61*224.95
**0054T**217.26*206.40*237.36
**0055T**217.26*206.40*237.36
**0071T**525.18*498.92*573.76
**0072T**525.18*498.92*573.76
**0075T*26*909.50*864.03*993.63
**0076T**999.26*949.30*1091.70
**0095T**587.16*557.80*641.47
**0098T**657.84*624.95*718.69
**0101T**283.16*269.00*309.35
#**0101T**208.97*198.52*228.30
**0102T**283.16*269.00*309.35
#**0102T**208.97*198.52*228.30
**0106T**28.81*27.37*31.48
**0107T**28.81*27.37*31.48
**0108T**28.81*27.37*31.48
**0109T**28.81*27.37*31.48
**0110T**28.81*27.37*31.48
**0164T**641.75*609.66*701.11
**0165T**657.27*624.41*718.07
**0184T**767.52*729.14*838.51
**0198T**76.13*72.32*83.17
#**0198T**29.69*28.21*32.44
**0200T**1538.38*1461.46*1680.68
#**0200T**379.95*360.95*415.09
**0201T**2307.56*2192.18*2521.01
#**0201T**569.93*541.43*622.64
**0207T**128.90*122.46*140.83
**0208T**35.06*33.31*38.31
**0209T**42.37*40.25*46.29
**0210T**26.59*25.26*29.05
**0211T**41.20*39.14*45.01
**0212T**33.75*32.06*36.87
#**0212T**29.66*28.18*32.41
**0213T**174.20*165.49*190.31
#**0213T**98.25*93.34*107.34
**0214T**89.41*84.94*97.68
#**0214T**55.82*53.03*60.98
**0215T**89.10*84.65*97.35
#**0215T**56.09*53.29*61.28
**0216T**160.39*152.37*175.23
#**0216T**84.74*80.50*92.58
**0217T**82.73*78.59*90.38
#**0217T**47.68*45.30*52.10
**0218T**81.82*77.73*89.39
#**0218T**47.94*45.54*52.37
**0219T**1230.68*1169.15*1344.52
**0220T**1211.47*1150.90*1323.54
**0221T**1486.18*1411.87*1623.65
**0222T**366.62*348.29*400.53
**0232T**809.76*769.27*884.66
#**0232T**84.79*80.55*92.63
**0234T**7174.96*6816.21*7838.64
#**0234T**548.34*520.92*599.06
**0235T**7174.96*6816.21*7838.64
#**0235T**548.34*520.92*599.06
**0236T**7334.83*6968.09*8013.30
#**0236T**636.94*605.09*695.85
**0237T**7334.83*6968.09*8013.30
#**0237T**636.94*605.09*695.85
**0238T**7334.83*6968.09*8013.30
#**0238T**636.94*605.09*695.85
**0266T**837.90*796.01*915.41
**0267T**148.92*141.47*162.69
**0268T**310.63*295.10*339.37
**0269T**791.79*752.20*865.03
**0270T**148.92*141.47*162.69
**0271T**310.63*295.10*339.37
**0272T**49.86*47.37*54.48
**0273T**64.33*61.11*70.28
**0274T**1039.28*987.32*1135.42
**0278T**13.65*12.97*14.92
**0308T**1280.98*1216.93*1399.47
**0329T**76.13*72.32*83.17
#**0329T**29.69*28.21*32.44
**0330T**39.25*37.29*42.88
**0331T**161.51*153.43*176.44
**0332T**272.58*258.95*297.79
**0347T**133.57*126.89*145.92
**0348T**29.57*28.09*32.30
**0349T**30.97*29.42*33.83
**0350T**31.85*30.26*34.80
**0351T**148.61*141.18*162.36
**0352T**40.23*38.22*43.95
**0353T**148.61*141.18*162.36
**0354T**40.23*38.22*43.95
**0358T**23.09*21.94*25.23
**0362T**84.55*80.32*92.37
#**0362T**61.76*58.67*67.47
**0378T**23.46*22.29*25.63
**0394T**223.06*211.91*243.70
**0395T**548.89*521.45*599.67
**0397T**43.51*41.33*47.53
**0408T**476.35*452.53*520.41
**0409T**328.24*311.83*358.60
**0410T**341.31*324.24*372.88
**0411T**341.31*324.24*372.88
**0412T**213.57*202.89*233.32
**0413T**445.35*423.08*486.54
**0414T**342.19*325.08*373.84
**0415T**286.04*271.74*312.50
**0416T**315.31*299.54*344.47
**0417T**74.87*71.13*81.80
**0418T**49.86*47.37*54.48
**0419T**412.15*391.54*450.27
#**0419T**335.33*318.56*366.34
**0420T**587.20*557.84*641.52
#**0420T**491.97*467.37*537.48
**0421T**1404.56*1334.33*1534.48
#**0421T**649.51*617.03*709.58
**0437T**199.96*189.96*218.45
**0439T**63.90*60.71*69.82
**0440T**224.12*212.91*244.85
#**0440T**112.25*106.64*122.64
**0441T**224.12*212.91*244.85
#**0441T**112.25*106.64*122.64
**0442T**224.12*212.91*244.85
#**0442T**112.25*106.64*122.64
**0449T**695.17*660.41*759.47
**0464T**58.96*56.01*64.41
**0472T**60.21*57.20*65.78
**0473T**49.86*47.37*54.48
**0479T**47.06*44.71*51.42
**0480T**63.11*59.95*68.94
#**0480T**23.53*22.35*25.70
**0483T**1115.10*1059.35*1218.25
**0484T**1448.55*1376.12*1582.54
**0485T**21.45*20.38*23.44
**0485T*TC*7.75*7.36*8.46
**0485T*26*14.01*13.31*15.31
**0486T**42.91*40.76*46.87
**0486T*TC*15.20*14.44*16.61
**0486T*26*27.70*26.32*30.27
**0488T**57.84*54.95*63.19
#**0488T**46.45*44.13*50.75
**0505T**10143.86*9636.67*11082.17
#**0505T**535.97*509.17*585.55
**0507T**20.34*19.32*22.22
**0507T*TC*17.54*16.66*19.16
**0507T*26*2.80*2.66*3.06
**0510T**546.51*519.18*597.06
#**0510T**394.04*374.34*430.49
**0512T**283.16*269.00*309.35
#**0512T**208.97*198.52*228.30
**0513T**84.95*80.70*92.81
#**0513T**62.69*59.56*68.49
**0515T**476.35*452.53*520.41
**0516T**439.10*417.15*479.72
**0517T**310.63*295.10*339.37
**0518T**213.57*202.89*233.32
**0519T**311.70*296.12*340.54
**0520T**439.10*417.15*479.72
**0521T**49.86*47.37*54.48
**0521T*TC*30.98*29.43*33.84
**0521T*26*18.89*17.95*20.64
**0522T**60.21*57.20*65.78
**0522T*TC*31.27*29.71*34.17
**0522T*26*28.94*27.49*31.61
**0523T**138.08*131.18*150.86
**0524T**1394.45*1324.73*1523.44
#**0524T**166.22*157.91*181.60
**0525T**440.88*418.84*481.67
**0526T**341.31*324.24*372.88
**0527T**298.35*283.43*325.94
**0528T**60.21*57.20*65.78
**0528T*TC*31.27*29.71*34.17
**0528T*26*28.94*27.49*31.61
**0529T**49.86*47.37*54.48
**0529T*TC*30.98*29.43*33.84
**0529T*26*18.89*17.95*20.64
**0530T**584.55*555.32*638.62
**0531T**445.35*423.08*486.54
**0532T**311.70*296.12*340.54
**0543T**1448.55*1376.12*1582.54
**0544T**1657.63*1574.75*1810.96
**0545T**1657.63*1574.75*1810.96
**0546T**65.18*61.92*71.21
**0552T**6.34*6.02*6.92
**0565T**564.72*536.48*616.95
#**0565T**478.85*454.91*523.15
**0566T**90.72*86.18*99.11
#**0566T**55.38*52.61*60.50
**0569T**1657.63*1574.75*1810.96
**0570T**389.93*370.43*425.99
**0571T**515.17*489.41*562.82
**0572T**419.72*398.73*458.54
**0573T**320.79*304.75*350.46
**0574T**370.07*351.57*404.31
**0575T**60.21*57.20*65.78
**0576T**49.86*47.37*54.48
**0577T**174.99*166.24*191.18
**0578T**27.35*25.98*29.88
**0579T**17.54*16.66*19.16
**0580T**197.46*187.59*215.73
**0581T**1923.47*1827.30*2101.40
#**0581T**197.22*187.36*215.46
**0582T**1420.18*1349.17*1551.55
#**0582T**357.27*339.41*390.32
**0583T**1332.84*1266.20*1456.13
#**0583T**122.95*116.80*134.32
**0587T**380.08*361.08*415.24
#**0587T**276.10*262.30*301.65
**0588T**307.98*292.58*336.47
#**0588T**215.38*204.61*235.30
**0589T**44.30*42.09*48.40
#**0589T**36.12*34.31*39.46
**0590T**52.26*49.65*57.10
#**0590T**37.08*35.23*40.51
**0596T**2235.23*2123.47*2441.99
#**0596T**123.83*117.64*135.29
**0597T**123.83*117.64*135.29
**0598T**131.34*124.77*143.49
**0599T**89.13*84.67*97.37
**0600T**3092.19*2937.58*3378.22
#**0600T**683.91*649.71*747.17
**0601T**1358.35*1290.43*1483.99
**0604T**17.85*16.96*19.50
**0605T**38.86*36.92*42.46
**0606T**54.25*51.54*59.27
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**174.18*165.47*190.29
**0611T**36.83*34.99*40.24
**0614T**341.96*324.86*373.59
**0615T**43.04*40.89*47.02
**0619T**580.53*551.50*634.23
#**0619T**445.01*422.76*486.17
**0620T**1414.22*1343.51*1545.04
**0627T**228.75*217.31*249.91
#**0627T**92.64*88.01*101.21
**0628T**68.63*65.20*74.98
#**0628T**27.79*26.40*30.36
**0629T**228.75*217.31*249.91
#**0629T**92.64*88.01*101.21
**0630T**68.63*65.20*74.98
#**0630T**27.79*26.40*30.36
**0631T**72.42*68.80*79.12
**0632T**533.43*506.76*582.77
**0633T**178.41*169.49*194.91
*C*0633T*TC*96.11*91.30*105.00
**0633T*26*55.42*52.65*60.55
**0634T**178.41*169.49*194.91
**0634T*TC*123.00*116.85*134.38
**0634T*26*55.42*52.65*60.55
**0635T**178.41*169.49*194.91
**0635T*TC*123.00*116.85*134.38
**0635T*26*55.42*52.65*60.55
**0636T**178.41*169.49*194.91
**0636T*TC*123.00*116.85*134.38
**0636T*26*55.42*52.65*60.55
**0637T**178.41*169.49*194.91
**0637T*TC*123.00*116.85*134.38
**0637T*26*55.42*52.65*60.55
**0638T**178.41*169.49*194.91
**0638T*TC*123.00*116.85*134.38
**0638T*26*55.42*52.65*60.55
**0639T**72.42*68.80*79.12
**0640T**20.34*19.32*22.22
**0640T*TC*17.54*16.66*19.16
**0640T*26*2.80*2.66*3.06
**0644T**1005.32*955.05*1098.31
#**0644T**226.02*214.72*246.93
**0646T**1657.63*1574.75*1810.96
**0650T**53.08*50.43*57.99
**0652T**256.39*243.57*280.11
#**0652T**113.55*107.87*124.05
**0653T**330.38*313.86*360.94
#**0653T**127.67*121.29*139.48
**0654T**131.84*125.25*144.04
**0655T**1404.56*1334.33*1534.48
#**0655T**649.51*617.03*709.58
**0658T**82.68*78.55*90.33
**0659T**2292.71*2178.07*2504.78
#**0659T**406.40*386.08*443.99
**0660T**695.17*660.41*759.47
**0671T**933.75*887.06*1020.12
**0673T**2937.44*2790.57*3209.16
#**0673T**342.52*325.39*374.20
**0699T**103.12*97.96*112.65
#**0699T**84.72*80.48*92.55
**0707T**326.98*310.63*357.22
#**0707T**250.45*237.93*273.62
**0714T**1208.78*1148.34*1320.59
#**0714T**333.68*317.00*364.55
**0738T**66.09*62.79*72.21
**0739T**1404.56*1334.33*1534.48
#**0739T**649.51*617.03*709.58
**0740T**17.85*16.96*19.50
**0741T**38.86*36.92*42.46
**0742T**81.77*77.68*89.33
**0742T*TC*63.90*60.71*69.82
**0742T*26*17.88*16.99*19.54
**0743T**48.30*45.89*52.77
**0744T**830.77*789.23*907.61
**0745T**227.34*215.97*248.37
**0746T**212.61*201.98*232.28
**0747T**857.67*814.79*937.01
**0748T**170.43*161.91*186.20
**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**3.94*3.74*4.30
**0765T**7.56*7.18*8.26
**0771T**24.68*23.45*26.97
**0772T**24.68*23.45*26.97
**0773T**21.03*19.98*22.98
**0774T**21.03*19.98*22.98
**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**367.08*348.73*401.04
**0779T*TC*342.93*325.78*374.65
**0779T*26*24.15*22.94*26.38
**0780T**21.03*19.98*22.98
**0783T**12.57*11.94*13.73
**0784T**1814.15*1723.44*1981.96
#**0784T**305.51*290.23*333.76
**0785T**216.75*205.91*236.80
#**0785T**134.09*127.39*146.50
**0786T**643.46*611.29*702.98
#**0786T**283.60*269.42*309.83
**0787T**216.75*205.91*236.80
#**0787T**134.09*127.39*146.50
**0788T**17.50*16.63*19.12
#**0788T**17.21*16.35*18.80
**0789T**21.87*20.78*23.90
#**0789T**21.51*20.43*23.49
**0790T**1797.08*1707.23*1963.31
**0791T**8.35*7.93*9.12
**0793T**533.43*506.76*582.77
**0794T**130.35*123.83*142.40
**0795T**658.65*625.72*719.58
**0796T**439.10*417.15*479.72
**0797T**439.10*417.15*479.72
**0798T**698.33*663.41*762.92
**0799T**465.55*442.27*508.61
**0800T**464.41*441.19*507.37
**0801T**904.65*859.42*988.33
**0802T**452.33*429.71*494.17
**0803T**452.33*429.71*494.17
**0804T**70.22*66.71*76.72
**0804T*TC*36.23*34.42*39.58
**0804T*26*33.99*32.29*37.13
**0805T**2519.70*2393.72*2752.78
#**0805T**305.37*290.10*333.62
**0806T**3359.59*3191.61*3670.35
#**0806T**407.16*386.80*444.82
**0807T**38.68*36.75*42.26
**0807T*TC*24.55*23.32*26.82
**0807T*26*14.13*13.42*15.43
**0808T**38.68*36.75*42.26
**0808T*TC*24.55*23.32*26.82
**0808T*26*14.13*13.42*15.43
**0810T**1039.72*987.73*1135.89
**0811T**17.85*16.96*19.50
**0813T**2126.68*2020.35*2323.40
#**0813T**165.60*157.32*180.92
**0814T**383.38*364.21*418.84
#**0814T**287.72*273.33*314.33
**0820T**144.97*137.72*158.38
#**0820T**128.62*122.19*140.52
**0821T**144.97*137.72*158.38
#**0821T**128.62*122.19*140.52
**0822T**123.23*117.07*134.63
#**0822T**109.32*103.85*119.43
**0823T**658.65*625.72*719.58
**0824T**698.33*663.41*762.92
**0825T**904.65*859.42*988.33
**0826T**60.21*57.20*65.78
**0826T*TC*31.27*29.71*34.17
**0826T*26*28.94*27.49*31.61
**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**20.34*19.32*22.22
**0859T*TC*17.54*16.66*19.16
**0859T*26*2.80*2.66*3.06
**0864T**283.16*269.00*309.35
#**0864T**208.97*198.52*228.30
**0867T**1510.97*1435.42*1650.73
#**0867T**417.10*396.25*455.69
**0868T**367.08*348.73*401.04
**0868T*TC*342.93*325.78*374.65
**0868T*26*24.15*22.94*26.38
**0869T**326.98*310.63*357.22
#**0869T**250.45*237.93*273.62
**0876T**130.23*123.72*142.28
**0876T*TC*106.95*101.60*116.84
**0876T*26*25.22*23.96*27.55
**0884T**895.68*850.90*978.54
#**0884T**174.95*166.20*191.13
**0885T**596.59*566.76*651.77
#**0885T**281.72*267.63*307.77
**0886T**489.80*465.31*535.11
#**0886T**98.30*93.39*107.40
**0897T**52.57*49.94*57.43
**0897T*TC*46.76*44.42*51.08
**0897T*26*7.56*7.18*8.26
**0898T**62.59*59.46*68.38
**0898T*TC*53.77*51.08*58.74
**0898T*26*8.82*8.38*9.64
**0899T**116.54*110.71*127.32
**0899T*TC*75.46*71.69*82.44
**0899T*26*39.33*37.36*42.96
**0900T**114.79*109.05*125.41
**0900T*TC*75.46*71.69*82.44
**0900T*26*39.33*37.36*42.96
**10011**373.68*355.00*408.25
#**10011**101.16*96.10*110.52
**10012**211.11*200.55*230.63
#**10012**68.28*64.87*74.60
**15847**329.40*312.93*359.87
**21742**1082.86*1028.72*1183.03
**21743**1281.09*1217.04*1399.60
**32855**335.50*318.73*366.54
**32856**422.85*401.71*461.97
**33928**3105.89*2950.60*3393.19
**33929**1163.36*1105.19*1270.97
**33933**514.67*488.94*562.28
**33944**514.67*488.94*562.28
**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**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
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**709.28*673.82*774.89
**53452**354.64*336.91*387.45
**53453**602.84*572.70*658.61
**53454**51.92*49.32*56.72
#**53454**32.94*31.29*35.98
**63043**534.48*507.76*583.92
**63044**488.74*464.30*533.95
**64596**1814.15*1723.44*1981.96
#**64596**305.51*290.23*333.76
**64597**544.44*517.22*594.80
#**64597**91.85*87.26*100.35
**64598**216.75*205.91*236.80
#**64598**134.09*127.39*146.50
**65757**114.29*108.58*124.87
**66983**608.42*578.00*664.70
**66987**709.97*674.47*775.64
**66988**587.47*558.10*641.82
*C*70170**231.73*220.14*253.16
*C*70170*TC*218.20*207.29*238.38
**70555**241.72*229.63*264.07
**70555*TC*130.46*123.94*142.53
*C*70557**635.83*604.04*694.65
*C*70557*TC*495.10*470.35*540.90
*C*70558**316.38*300.56*345.64
*C*70558*TC*160.66*152.63*175.52
*C*70559**308.97*293.52*337.55
*C*70559*TC*160.66*152.63*175.52
*C*74190**515.64*489.86*563.34
*C*74190*TC*495.10*470.35*540.90
**74235**134.17*127.46*146.58
**74235*TC*81.29*77.23*88.81
**74300**76.46*72.64*83.54
**74300*TC*64.19*60.98*70.13
**74301**23.59*22.41*25.77
**74301*TC*14.15*13.44*15.46
**74328**175.06*166.31*191.26
**74328*TC*153.69*146.01*167.91
**74329**129.06*122.61*141.00
**74329*TC*107.40*102.03*117.33
**74330**262.59*249.46*286.88
**74330*TC*237.44*225.57*259.41
**74340**86.58*82.25*94.59
**74340*TC*62.64*59.51*68.44
**74355**86.58*82.25*94.59
**74355*TC*52.59*49.96*57.45
**74360**86.58*82.25*94.59
**74360*TC*61.46*58.39*67.15
**74363**175.06*166.31*191.26
**74363*TC*137.75*130.86*150.49
*C*74445**146.19*138.88*159.71
*C*74445*TC*96.11*91.30*105.00
*C*74450**232.69*221.06*254.22
*C*74450*TC*218.20*207.29*238.38
*C*74470**518.75*492.81*566.73
*C*74470*TC*495.10*470.35*540.90
**74742**233.47*221.80*255.07
**74742*TC*206.39*196.07*225.48
*C*74775**245.90*233.61*268.65
*C*74775*TC*218.20*207.29*238.38
*C*75801**598.31*568.39*653.65
*C*75801*TC*558.20*530.29*609.83
*C*75803**1454.56*1381.83*1589.10
*C*75803*TC*1402.63*1332.50*1532.38
*C*75805**2878.52*2734.59*3144.78
*C*75805*TC*2842.33*2700.21*3105.24
*C*75807**2891.38*2746.81*3158.83
*C*75807*TC*2842.33*2700.21*3105.24
*C*75810**2888.11*2743.70*3155.26
*C*75810*TC*2842.33*2700.21*3105.24
**75894**813.02*772.37*888.23
**75894*TC*746.00*708.70*815.01
*C*75898**2927.18*2780.82*3197.94
*C*75898*TC*2842.33*2700.21*3105.24
**75970**397.40*377.53*434.16
**75970*TC*362.30*344.19*395.82
**76125**36.43*34.61*39.80
**76125*TC*23.87*22.68*26.08
**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*45.11*42.85*49.28
**76940**148.26*140.85*161.98
**76940*TC*53.96*51.26*58.95
**76941**107.66*102.28*117.62
**76941*TC*48.21*45.80*52.67
**76945**77.09*73.24*84.23
**76945*TC*47.52*45.14*51.91
*C*76975**255.84*243.05*279.51
*C*76975*TC*218.20*207.29*238.38
**76998**175.06*166.31*191.26
**76998*TC*131.38*124.81*143.53
**77013**382.17*363.06*417.52
**77013*TC*210.98*200.43*230.49
**77022**431.28*409.72*471.18
**77022*TC*244.72*232.48*267.35
**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**377.14*358.28*412.02
*C*78282*TC*362.79*344.65*396.35
**78414**514.99*489.24*562.63
**78414*TC*495.45*470.68*541.28
*C*78429**1390.99*1321.44*1519.66
*C*78429*TC*1317.04*1251.19*1438.87
*C*78430**1386.89*1317.55*1515.18
*C*78430*TC*1317.04*1251.19*1438.87
*C*78431**2113.76*2008.07*2309.28
*C*78431*TC*2032.08*1930.48*2220.05
*C*78432**1760.89*1672.85*1923.78
*C*78432*TC*1671.05*1587.50*1825.63
*C*78433**1857.30*1764.44*2029.11
*C*78433*TC*1761.31*1673.24*1924.23
**78434**634.39*602.67*693.07
**78434*TC*607.27*576.91*663.45
*C*78459**1247.39*1185.02*1362.77
*C*78459*TC*1178.89*1119.95*1287.94
*C*78491**1384.22*1315.01*1512.26
*C*78491*TC*1317.04*1251.19*1438.87
*C*78492**1394.91*1325.16*1523.93
*C*78492*TC*1317.04*1251.19*1438.87
*C*78608**1381.41*1312.34*1509.19
*C*78608*TC*1317.04*1251.19*1438.87
*C*78811**1245.43*1183.16*1360.63
*C*78811*TC*1178.89*1119.95*1287.94
*C*78812**1400.62*1330.59*1530.18
*C*78812*TC*1317.04*1251.19*1438.87
*C*78813**1402.30*1332.19*1532.02
*C*78813*TC*1317.04*1251.19*1438.87
*C*78814**1412.01*1341.41*1542.62
*C*78814*TC*1317.04*1251.19*1438.87
*C*78815**1423.30*1352.14*1554.96
*C*78815*TC*1317.04*1251.19*1438.87
*C*78816**1424.05*1352.85*1555.78
*C*78816*TC*1317.04*1251.19*1438.87
**79300**237.04*225.19*258.97
**79300*TC*177.08*168.23*193.46
**79445**237.04*225.19*258.97
**79445*TC*134.06*127.36*146.46
**86485**17.28*16.42*18.88
**90867**269.69*256.21*294.64
#**90867**126.42*120.10*138.12
**90868**183.12*173.96*200.05
#**90868**104.72*99.48*114.40
**90869**218.75*207.81*238.98
#**90869**147.49*140.12*161.14
**92978**224.36*213.14*245.11
**92978*TC*137.32*130.45*150.02
**92979**137.31*130.44*150.01
**92979*TC*67.86*64.47*74.14
*C*93315**611.15*580.59*667.68
*C*93315*TC*495.10*470.35*540.90
**93317**196.66*186.83*214.85
**93317*TC*115.06*109.31*125.71
*C*93318**589.69*560.21*644.24
*C*93318*TC*495.10*470.35*540.90
**93571**223.47*212.30*244.15
**93571*TC*157.15*149.29*171.68
**93572**135.23*128.47*147.74
**93572*TC*87.15*82.79*95.21
**93600**3557.81*3379.92*3886.91
**93600*TC*3451.86*3279.27*3771.16
**93602**3557.81*3379.92*3886.91
**93602*TC*3453.05*3280.40*3772.46
**93603**3557.81*3379.92*3886.91
**93603*TC*3453.05*3280.40*3772.46
**93609**2134.69*2027.96*2332.15
**93609*TC*1885.81*1791.52*2060.25
**93610**3557.81*3379.92*3886.91
**93610*TC*3410.27*3239.76*3725.72
**93612**3557.81*3379.92*3886.91
**93612*TC*3411.79*3241.20*3727.38
**93615**48.14*45.73*52.59
**93615*TC*15.17*14.41*16.57
**93619**7115.62*6759.84*7773.82
**93619*TC*6765.08*6426.83*7390.85
**93620**7115.62*6759.84*7773.82
**93620*TC*6551.02*6223.47*7156.99
**93621**7115.62*6759.84*7773.82
**93621*TC*7040.71*6688.67*7691.97
**93622**7115.62*6759.84*7773.82
**93622*TC*6960.16*6612.15*7603.97
**93623**2134.69*2027.96*2332.15
**93623*TC*2084.62*1980.39*2277.45
**93624**3557.81*3379.92*3886.91
**93624*TC*3338.42*3171.50*3647.23
**93631**7115.62*6759.84*7773.82
**93631*TC*6754.89*6417.15*7379.72
**93640**1133.95*1077.25*1238.84
**93640*TC*972.72*924.08*1062.69
**93641**1133.95*1077.25*1238.84
**93641*TC*853.25*810.59*932.18
**93662**350.66*333.13*383.10
**93662*TC*286.61*272.28*313.12
**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*522.29*496.18*570.61
**95966**530.43*503.91*579.50
**95966*TC*347.12*329.76*379.22
**95967**446.09*423.79*487.36
**95967*TC*287.82*273.43*314.44
**96020**374.66*355.93*409.32
**97151**48.34*45.92*52.81
#**97151**41.91*39.81*45.78
**97152**39.84*37.85*43.53
#**97152**35.62*33.84*38.92
**97153**33.19*31.53*36.26
#**97153**29.40*27.93*32.12
**97154**4.32*4.10*4.72
#**97154**3.95*3.75*4.31
**97155**31.77*30.18*34.71
#**97155**28.12*26.71*30.72
**97156**33.53*31.85*36.63
#**97156**29.73*28.24*32.48
**97157**9.76*9.27*10.66
#**97157**8.88*8.44*9.71
**97158**5.03*4.78*5.50
#**97158**4.59*4.36*5.01
**98978**38.86*36.92*42.46
# - 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.