TEXAS MEDICARE CARRIER - 04412
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
BEAUMONT
******
**A2001**1174.20*1115.49*1282.81
**A2002**344.73*327.49*376.61
**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**426.62*405.29*466.08
#**G0186**368.31*349.89*402.37
**G0339**2536.78*2409.94*2771.43
**G0340**1907.92*1812.52*2084.40
**G0398**125.46*119.19*137.07
**G0398*TC*87.80*83.41*95.92
**G0398*26*37.66*35.78*41.15
**G0399**88.14*83.73*96.29
**G0399*TC*46.62*44.29*50.93
**G0399*26*41.82*39.73*45.69
**G0400**90.59*86.06*98.97
**G0400*TC*51.73*49.14*56.51
**G0400*26*38.86*36.92*42.46
**G0460**726.81*690.47*794.04
#**G0460**116.32*110.50*127.08
**G0465**726.81*690.47*794.04
#**G0465**116.32*110.50*127.08
**G0498**133.64*126.96*146.00
**G6017**72.99*69.34*79.74
**0042T**211.60*201.02*231.17
**0054T**222.39*211.27*242.96
**0055T**222.39*211.27*242.96
**0071T**548.60*521.17*599.35
**0072T**548.60*521.17*599.35
**0075T**936.92*890.07*1023.58
**0075T*TC*936.92*890.07*1023.58
**0075T*26*936.92*890.07*1023.58
**0095T**601.79*571.70*657.46
**0098T**674.07*640.37*736.43
**0100T**1800.08*1710.08*1966.59
**0101T**294.43*279.71*321.67
#**0101T**214.78*204.04*234.65
**0102T**294.43*279.71*321.67
#**0102T**214.78*204.04*234.65
**0106T**30.55*29.02*33.37
**0107T**30.55*29.02*33.37
**0108T**30.55*29.02*33.37
**0109T**30.55*29.02*33.37
**0110T**30.55*29.02*33.37
**0164T**657.42*624.55*718.23
**0165T**673.68*640.00*736.00
**0184T**786.27*746.96*859.00
**0198T**78.65*74.72*85.93
#**0198T**30.55*29.02*33.37
**0200T**1628.56*1547.13*1779.20
#**0200T**388.34*368.92*424.26
**0201T**2442.84*2320.70*2668.81
#**0201T**582.51*553.38*636.39
**0207T**121.71*115.62*132.96
**0208T**34.28*32.57*37.46
**0209T**41.50*39.43*45.34
**0210T**26.17*24.86*28.59
**0211T**40.59*38.56*44.34
**0212T**34.73*32.99*37.94
#**0212T**30.22*28.71*33.02
**0213T**180.18*171.17*196.85
#**0213T**100.52*95.49*109.81
**0214T**91.69*87.11*100.18
#**0214T**56.82*53.98*62.08
**0215T**91.99*87.39*100.50
#**0215T**57.73*54.84*63.07
**0216T**165.34*157.07*180.63
#**0216T**86.29*81.98*94.28
**0217T**85.44*81.17*93.35
#**0217T**48.76*46.32*53.27
**0218T**85.44*81.17*93.35
#**0218T**49.67*47.19*54.27
**0219T**1258.47*1195.55*1374.88
**0220T**1236.52*1174.69*1350.89
**0221T**1522.35*1446.23*1663.16
**0222T**375.49*356.72*410.23
**0232T**726.81*690.47*794.04
#**0232T**116.32*110.50*127.08
**0234T**7757.71*7369.82*8475.29
#**0234T**564.98*536.73*617.24
**0235T**7757.71*7369.82*8475.29
#**0235T**564.98*536.73*617.24
**0236T**7899.65*7504.67*8630.37
#**0236T**654.33*621.61*714.85
**0237T**7899.65*7504.67*8630.37
#**0237T**654.33*621.61*714.85
**0238T**7899.65*7504.67*8630.37
#**0238T**654.33*621.61*714.85
**0266T**860.23*817.22*939.80
**0267T**152.65*145.02*166.77
**0268T**319.41*303.44*348.96
**0269T**813.68*773.00*888.95
**0270T**152.65*145.02*166.77
**0271T**319.41*303.44*348.96
**0272T**51.92*49.32*56.72
**0273T**67.11*63.75*73.31
**0274T**1059.26*1006.30*1157.25
**0278T**13.75*13.06*15.02
**0308T**1320.05*1254.05*1442.16
**0329T**78.65*74.72*85.93
#**0329T**30.55*29.02*33.37
**0330T**38.21*36.30*41.75
**0331T**168.01*159.61*183.55
**0332T**286.85*272.51*313.39
**0347T**136.24*129.43*148.84
**0348T**30.43*28.91*33.25
**0349T**32.17*30.56*35.14
**0350T**32.77*31.13*35.80
**0351T**155.64*147.86*170.04
**0352T**41.10*39.05*44.91
**0353T**155.64*147.86*170.04
**0354T**41.10*39.05*44.91
**0358T**24.36*23.14*26.61
**0362T**86.40*82.08*94.39
#**0362T**63.26*60.10*69.12
**0378T**23.84*22.65*26.05
**0394T**228.96*217.51*250.14
**0395T**558.83*530.89*610.52
**0397T**45.09*42.84*49.27
**0398T*26*1746.88*1659.54*1908.47
**0408T**488.73*464.29*533.93
**0409T**337.17*320.31*368.36
**0410T**350.05*332.55*382.43
**0411T**350.05*332.55*382.43
**0412T**219.20*208.24*239.48
**0413T**456.50*433.68*498.73
**0414T**351.57*333.99*384.09
**0415T**293.18*278.52*320.30
**0416T**323.30*307.14*353.21
**0417T**77.95*74.05*85.16
**0418T**51.92*49.32*56.72
**0419T**421.73*400.64*460.74
#**0419T**341.18*324.12*372.74
**0420T**601.92*571.82*657.59
#**0420T**502.42*477.30*548.90
**0421T**1490.54*1416.01*1628.41
#**0421T**664.23*631.02*725.67
**0437T**204.30*194.09*223.20
**0439T**66.71*63.37*72.88
**0440T**230.94*219.39*252.30
#**0440T**113.71*108.02*124.22
**0441T**230.94*219.39*252.30
#**0441T**113.71*108.02*124.22
**0442T**230.94*219.39*252.30
#**0442T**113.71*108.02*124.22
**0449T**717.32*681.45*783.67
**0464T**61.88*58.79*67.61
**0472T**62.56*59.43*68.34
**0473T**51.92*49.32*56.72
**0479T**60.30*57.29*65.88
**0480T**144.16*136.95*157.49
#**0480T**30.15*28.64*32.94
**0483T**1144.90*1087.66*1250.81
**0484T**1484.99*1410.74*1622.35
**0485T**22.08*20.98*24.13
**0485T*TC*7.98*7.58*8.72
**0485T*26*14.41*13.69*15.74
**0486T**44.16*41.95*48.24
**0486T*TC*15.65*14.87*17.10
**0486T*26*28.51*27.08*31.14
**0488T**59.84*56.85*65.38
#**0488T**48.12*45.71*52.57
**0505T**10143.86*9636.67*11082.17
#**0505T**535.97*509.17*585.55
**0507T**21.23*20.17*23.20
**0507T*TC*18.35*17.43*20.04
**0507T*26*2.88*2.74*3.15
**0510T**565.16*536.90*617.44
#**0510T**402.84*382.70*440.11
**0512T**294.43*279.71*321.67
#**0512T**214.78*204.04*234.65
**0513T**88.33*83.91*96.50
#**0513T**64.43*61.21*70.39
**0515T**488.73*464.29*533.93
**0516T**451.00*428.45*492.72
**0517T**319.41*303.44*348.96
**0518T**219.20*208.24*239.48
**0519T**320.21*304.20*349.83
**0520T**451.00*428.45*492.72
**0521T**51.92*49.32*56.72
**0521T*TC*32.48*30.86*35.49
**0521T*26*19.44*18.47*21.24
**0522T**62.56*59.43*68.34
**0522T*TC*33.08*31.43*36.14
**0522T*26*29.48*28.01*32.21
**0523T**142.10*135.00*155.25
**0524T**1493.34*1418.67*1631.47
#**0524T**170.46*161.94*186.23
**0525T**451.30*428.74*493.05
**0526T**350.05*332.55*382.43
**0527T**304.92*289.67*333.12
**0528T**62.56*59.43*68.34
**0528T*TC*33.08*31.43*36.14
**0528T*26*29.48*28.01*32.21
**0529T**51.92*49.32*56.72
**0529T*TC*32.48*30.86*35.49
**0529T*26*19.44*18.47*21.24
**0530T**599.48*569.51*654.94
**0531T**456.50*433.68*498.73
**0532T**320.21*304.20*349.83
**0540T**168.99*160.54*184.62
**0543T**1484.99*1410.74*1622.35
**0544T**1703.30*1618.14*1860.86
**0545T**1703.30*1618.14*1860.86
**0546T**67.08*63.73*73.29
**0552T**6.22*5.91*6.80
**0553T**2241.87*2129.78*2449.25
#**0553T**377.94*359.04*412.90
**0565T**577.54*548.66*630.96
#**0565T**487.67*463.29*532.78
**0566T**93.65*88.97*102.32
#**0566T**56.67*53.84*61.92
**0569T**1703.30*1618.14*1860.86
**0570T**400.38*380.36*437.41
**0571T**528.37*501.95*577.24
**0572T**430.42*408.90*470.24
**0573T**327.72*311.33*358.03
**0574T**380.60*361.57*415.81
**0575T**62.56*59.43*68.34
**0576T**51.92*49.32*56.72
**0577T**181.00*171.95*197.74
**0578T**28.15*26.74*30.75
**0579T**19.25*18.29*21.03
**0580T**202.31*192.19*221.02
**0581T**2057.59*1954.71*2247.92
#**0581T**201.77*191.68*220.43
**0582T**1513.83*1438.14*1653.86
#**0582T**365.29*347.03*399.08
**0583T**1522.66*1446.53*1663.51
#**0583T**125.24*118.98*136.83
**0587T**416.41*395.59*454.93
#**0587T**282.95*268.80*309.12
**0588T**341.90*324.81*373.53
#**0588T**220.16*209.15*240.52
**0589T**45.91*43.61*50.15
#**0589T**37.19*35.33*40.63
**0590T**53.80*51.11*58.78
#**0590T**38.47*36.55*42.03
**0596T**672.69*639.06*734.92
#**0596T**127.44*121.07*139.23
**0597T**672.69*639.06*734.92
#**0597T**127.44*121.07*139.23
**0598T**137.33*130.46*150.03
**0599T**91.60*87.02*100.07
**0600T**3274.44*3110.72*3577.33
#**0600T**697.21*662.35*761.70
**0601T**1391.94*1322.34*1520.69
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**181.67*172.59*198.48
**0611T**36.70*34.87*40.10
**0614T**351.04*333.49*383.51
**0615T**44.59*42.36*48.71
**0616T**626.12*594.81*684.03
**0617T**698.85*663.91*763.50
**0618T**845.66*803.38*923.89
**0619T**614.07*583.37*670.88
#**0619T**453.73*431.04*495.70
**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**239.33*227.36*261.46
#**0627T**95.05*90.30*103.85
**0628T**71.80*68.21*78.44
#**0628T**28.51*27.08*31.14
**0629T**239.33*227.36*261.46
#**0629T**95.05*90.30*103.85
**0630T**71.80*68.21*78.44
#**0630T**28.51*27.08*31.14
**0631T**75.13*71.37*82.08
**0632T**547.46*520.09*598.10
**0633T**185.71*176.42*202.88
*C*0633T*TC*96.20*91.39*105.10
**0633T*26*56.73*53.89*61.97
**0634T**185.71*176.42*202.88
**0634T*TC*128.98*122.53*140.91
**0634T*26*56.73*53.89*61.97
**0635T**185.71*176.42*202.88
**0635T*TC*128.98*122.53*140.91
**0635T*26*56.73*53.89*61.97
**0636T**185.71*176.42*202.88
**0636T*TC*128.98*122.53*140.91
**0636T*26*56.73*53.89*61.97
**0637T**185.71*176.42*202.88
**0637T*TC*128.98*122.53*140.91
**0637T*26*56.73*53.89*61.97
**0638T**185.71*176.42*202.88
**0638T*TC*128.98*122.53*140.91
**0638T*26*56.73*53.89*61.97
**0639T**75.13*71.37*82.08
**0640T**21.23*20.17*23.20
**0640T*TC*18.48*17.56*20.19
**0640T*26*2.88*2.74*3.15
**0644T**1064.31*1011.09*1162.75
#**0644T**230.78*219.24*252.13
**0646T**1703.30*1618.14*1860.86
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**55.53*52.75*60.66
**0652T**266.54*253.21*291.19
#**0652T**116.24*110.43*126.99
**0653T**347.22*329.86*379.34
#**0653T**131.40*124.83*143.55
**0654T**135.07*128.32*147.57
**0655T**1490.54*1416.01*1628.41
#**0655T**664.23*631.02*725.67
**0658T**85.68*81.40*93.61
**0659T**2456.48*2333.66*2683.71
#**0659T**416.70*395.87*455.25
**0671T**964.55*916.32*1053.77
**0673T**3117.58*2961.70*3405.96
#**0673T**349.48*332.01*381.81
**0699T**106.11*100.80*115.92
#**0699T**86.27*81.96*94.25
**0707T**344.95*327.70*376.86
#**0707T**261.69*248.61*285.90
**0714T**1286.34*1222.02*1405.32
#**0714T**340.70*323.67*372.22
**0730T**252.90*240.26*276.30
#**0730T**227.09*215.74*248.10
**0738T**67.74*64.35*74.00
**0739T**1490.54*1416.01*1628.41
#**0739T**664.23*631.02*725.67
**0740T**18.06*17.16*19.73
**0741T**42.70*40.57*46.66
**0742T**86.06*81.76*94.02
**0742T*TC*67.65*64.27*73.91
**0742T*26*18.40*17.48*20.10
**0743T**49.11*46.65*53.65
**0744T**851.99*809.39*930.80
**0745T**232.16*220.55*253.63
**0746T**215.51*204.73*235.44
**0747T**897.62*852.74*980.65
**0748T**175.06*166.31*191.26
**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**4.05*3.85*4.43
**0765T**7.78*7.39*8.50
**0771T**25.39*24.12*27.74
**0772T**25.39*24.12*27.74
**0773T**21.64*20.56*23.64
**0774T**21.64*20.56*23.64
**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*48.75*46.31*53.26
#**0777T*26*3.75*3.56*4.09
**0779T**396.09*376.29*432.73
**0779T*TC*371.24*352.68*405.58
**0779T*26*24.85*23.61*27.15
**0780T**21.64*20.56*23.64
**0783T**12.94*12.29*14.13
**0784T**1933.04*1836.39*2111.85
#**0784T**310.47*294.95*339.19
**0785T**226.08*214.78*247.00
#**0785T**137.41*130.54*150.12
**0786T**679.94*645.94*742.83
#**0786T**290.98*276.43*317.89
**0787T**226.08*214.78*247.00
#**0787T**137.41*130.54*150.12
**0788T**18.01*17.11*19.68
#**0788T**17.41*16.54*19.02
**0789T**25.11*23.85*27.43
#**0789T**21.76*20.67*23.77
**0790T**1844.62*1752.39*2015.25
**0791T**8.60*8.17*9.40
**0793T**547.46*520.09*598.10
**0794T**130.35*123.83*142.40
**0795T**676.50*642.68*739.08
**0796T**451.00*428.45*492.72
**0797T**451.00*428.45*492.72
**0798T**716.88*681.04*783.20
**0799T**477.92*454.02*522.12
**0800T**477.92*454.02*522.12
**0801T**928.93*882.48*1014.85
**0802T**464.46*441.24*507.43
**0803T**464.46*441.24*507.43
**0804T**73.17*69.51*79.94
**0804T*TC*38.19*36.28*41.72
**0804T*26*34.98*33.23*38.21
**0805T**2692.19*2557.58*2941.22
#**0805T**312.45*296.83*341.35
**0806T**3589.59*3410.11*3921.63
#**0806T**416.60*395.77*455.14
**0807T**39.50*37.53*43.16
**0807T*TC*25.26*24.00*27.60
**0807T*26*14.24*13.53*15.56
**0808T**39.50*37.53*43.16
**0808T*TC*25.26*24.00*27.60
**0808T*26*14.24*13.53*15.56
**0810T**1070.88*1017.34*1169.94
**0811T**18.06*17.16*19.73
**0813T**2355.62*2237.84*2573.52
#**0813T**172.77*164.13*188.75
**0814T**431.18*409.62*471.06
#**0814T**327.11*310.75*357.36
**0818T**341.90*324.81*373.53
#**0818T**220.16*209.15*240.52
**0820T**143.00*135.85*156.23
#**0820T**127.06*120.71*138.82
**0821T**143.00*135.85*156.23
#**0821T**127.06*120.71*138.82
**0822T**121.55*115.47*132.79
#**0822T**108.00*102.60*117.99
**0823T**676.50*642.68*739.08
**0824T**716.88*681.04*783.20
**0825T**928.93*882.48*1014.85
**0826T**62.56*59.43*68.34
**0826T*TC*33.08*31.43*36.14
**0826T*26*29.48*28.01*32.21
**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**21.23*20.17*23.20
**0859T*TC*18.35*17.43*20.04
**0859T*26*2.88*2.74*3.15
**0864T**294.43*279.71*321.67
#**0864T**214.78*204.04*234.65
**10011**392.07*372.47*428.34
#**10011**103.81*98.62*113.41
**10012**217.55*206.67*237.67
#**10012**69.66*66.18*76.11
**15847**335.39*318.62*366.41
**21742**1109.54*1054.06*1212.17
**21743**1275.51*1211.73*1393.49
**32855**335.50*318.73*366.54
**32856**435.15*413.39*475.40
**33928**3196.24*3036.43*3491.89
**33929**1197.21*1137.35*1307.95
**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
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**725.43*689.16*792.53
**53452**362.72*344.58*396.27
**53453**616.49*585.67*673.52
**53454**53.45*50.78*58.40
#**53454**33.91*32.21*37.04
**63043**550.03*522.53*600.91
**63044**488.74*464.30*533.95
**64596**1933.04*1836.39*2111.85
#**64596**310.47*294.95*339.19
**64597**579.91*550.91*633.55
#**64597**93.14*88.48*101.75
**64598**226.08*214.78*247.00
#**64598**137.41*130.54*150.12
**65757**113.39*107.72*123.88
**66983**626.12*594.81*684.03
**66987**730.62*694.09*798.20
**66988**604.56*574.33*660.48
*C*70170**228.26*216.85*249.38
*C*70170*TC*214.33*203.61*234.15
**70555**233.47*221.80*255.07
**70555*TC*119.89*113.90*130.99
*C*70557**627.27*595.91*685.30
*C*70557*TC*482.46*458.34*527.09
*C*70558**320.46*304.44*350.11
*C*70558*TC*160.83*152.79*175.71
*C*70559**311.61*296.03*340.43
*C*70559*TC*160.83*152.79*175.71
*C*74190**503.59*478.41*550.17
*C*74190*TC*482.46*458.34*527.09
**74235**134.17*127.46*146.58
**74235*TC*80.04*76.04*87.45
**74300**76.46*72.64*83.54
**74300*TC*63.84*60.65*69.75
**74301**23.59*22.41*25.77
**74301*TC*14.18*13.47*15.49
**74328**175.06*166.31*191.26
**74328*TC*153.07*145.42*167.23
**74329**129.06*122.61*141.00
**74329*TC*106.77*101.43*116.64
**74330**262.59*249.46*286.88
**74330*TC*236.69*224.86*258.59
**74340**86.58*82.25*94.59
**74340*TC*62.25*59.14*68.01
**74355**86.58*82.25*94.59
**74355*TC*51.90*49.31*56.71
**74360**86.58*82.25*94.59
**74360*TC*60.72*57.68*66.33
**74363**175.06*166.31*191.26
**74363*TC*135.47*128.70*148.01
*C*74445**147.43*140.06*161.07
*C*74445*TC*96.20*91.39*105.10
*C*74450**229.24*217.78*250.45
*C*74450*TC*214.33*203.61*234.15
*C*74470**506.19*480.88*553.01
*C*74470*TC*482.46*458.34*527.09
**74742**233.47*221.80*255.07
**74742*TC*205.61*195.33*224.63
*C*74775**242.53*230.40*264.96
*C*74775*TC*214.33*203.61*234.15
*C*75801**590.17*560.66*644.76
*C*75801*TC*549.49*522.02*600.32
*C*75803**1454.21*1381.50*1588.73
*C*75803*TC*1400.75*1330.71*1530.32
*C*75805**2824.89*2683.65*3086.20
*C*75805*TC*2787.95*2648.55*3045.83
*C*75807**2838.44*2696.52*3101.00
*C*75807*TC*2787.95*2648.55*3045.83
*C*75810**2834.46*2692.74*3096.65
*C*75810*TC*2787.95*2648.55*3045.83
**75894**813.02*772.37*888.23
**75894*TC*744.97*707.72*813.88
*C*75898**2874.66*2730.93*3140.57
*C*75898*TC*2787.95*2648.55*3045.83
**75970**397.40*377.53*434.16
**75970*TC*361.27*343.21*394.69
**76125**36.43*34.61*39.80
**76125*TC*23.81*22.62*26.01
**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*43.84*41.65*47.90
**76940**148.26*140.85*161.98
**76940*TC*52.43*49.81*57.28
**76941**107.66*102.28*117.62
**76941*TC*46.48*44.16*50.78
**76945**77.09*73.24*84.23
**76945*TC*46.66*44.33*50.98
*C*76975**253.06*240.41*276.47
*C*76975*TC*214.33*203.61*234.15
**76998**175.06*166.31*191.26
**76998*TC*130.41*123.89*142.47
**77013**382.17*363.06*417.52
**77013*TC*207.51*197.13*226.70
**77022**431.28*409.72*471.18
**77022*TC*241.12*229.06*263.42
**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**375.49*356.72*410.23
*C*78282*TC*360.72*342.68*394.08
**78414**514.99*489.24*562.63
**78414*TC*494.89*470.15*540.67
*C*78429**1443.79*1371.60*1577.34
*C*78429*TC*1368.28*1299.87*1494.85
*C*78430**1440.18*1368.17*1573.40
*C*78430*TC*1368.28*1299.87*1494.85
*C*78431**2149.72*2042.23*2348.56
*C*78431*TC*2065.94*1962.64*2257.04
*C*78432**1788.37*1698.95*1953.79
*C*78432*TC*1698.63*1613.70*1855.76
*C*78433**1888.80*1794.36*2063.51
*C*78433*TC*1790.61*1701.08*1956.24
**78434**634.39*602.67*693.07
**78434*TC*606.78*576.44*662.91
*C*78459**1311.95*1246.35*1433.30
*C*78459*TC*1242.04*1179.94*1356.93
*C*78491**1436.82*1364.98*1569.73
*C*78491*TC*1368.28*1299.87*1494.85
*C*78492**1448.73*1376.29*1582.73
*C*78492*TC*1368.28*1299.87*1494.85
*C*78608**1434.23*1362.52*1566.90
*C*78608*TC*1368.28*1299.87*1494.85
*C*78811**1309.93*1244.43*1431.09
*C*78811*TC*1242.04*1179.94*1356.93
*C*78812**1454.00*1381.30*1588.50
*C*78812*TC*1368.28*1299.87*1494.85
*C*78813**1456.03*1383.23*1590.71
*C*78813*TC*1368.28*1299.87*1494.85
*C*78814**1465.41*1392.14*1600.96
*C*78814*TC*1368.28*1299.87*1494.85
*C*78815**1476.42*1402.60*1612.99
*C*78815*TC*1368.28*1299.87*1494.85
*C*78816**1477.50*1403.63*1614.17
*C*78816*TC*1368.28*1299.87*1494.85
**79300**237.04*225.19*258.97
**79300*TC*175.63*166.85*191.88
**79445**237.04*225.19*258.97
**79445*TC*132.60*125.97*144.87
**86485**17.28*16.42*18.88
**90867**277.54*263.66*303.21
#**90867**130.10*123.60*142.14
**90868**188.45*179.03*205.88
#**90868**101.21*96.15*110.57
**90869**260.24*247.23*284.31
#**90869**151.78*144.19*165.82
**92978**224.36*213.14*245.11
**92978*TC*135.09*128.34*147.59
**92979**137.31*130.44*150.01
**92979*TC*66.45*63.13*72.60
*C*93315**602.19*572.08*657.89
*C*93315*TC*482.46*458.34*527.09
**93317**196.66*186.83*214.85
**93317*TC*113.29*107.63*123.77
*C*93318**578.85*549.91*632.40
*C*93318*TC*482.46*458.34*527.09
**93571**223.47*212.30*244.15
**93571*TC*155.52*147.74*169.90
**93572**135.23*128.47*147.74
**93572*TC*85.73*81.44*93.66
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.78*3276.34*3767.79
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.61*3278.08*3769.79
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.61*3278.08*3769.79
**93609**2134.69*2027.96*2332.15
**93609*TC*1878.84*1784.90*2052.64
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.29*3235.98*3721.38
**93612**3557.81*3379.92*3886.91
**93612*TC*3408.44*3238.02*3723.72
**93615**48.14*45.73*52.59
**93615*TC*14.71*13.97*16.07
**93619**7115.62*6759.84*7773.82
**93619*TC*6754.22*6416.51*7378.99
**93620**7115.62*6759.84*7773.82
**93620*TC*6535.77*6208.98*7140.33
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.51*6686.58*7689.57
**93622**7115.62*6759.84*7773.82
**93622*TC*6956.56*6608.73*7600.04
**93623**2134.69*2027.96*2332.15
**93623*TC*2071.73*1968.14*2263.36
**93624**3557.81*3379.92*3886.91
**93624*TC*3332.32*3165.70*3640.56
**93631**7115.62*6759.84*7773.82
**93631*TC*6743.48*6406.31*7367.26
**93640**1133.95*1077.25*1238.84
**93640*TC*968.33*919.91*1057.90
**93641**1133.95*1077.25*1238.84
**93641*TC*844.41*802.19*922.52
**93662**388.98*369.53*424.96
**93662*TC*322.65*306.52*352.50
**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
**96547**679.76*645.77*742.64
#**96547**127.59*121.21*139.39
**96548**339.88*322.89*371.32
#**96548**63.79*60.60*69.69
**97151**48.24*45.83*52.70
#**97151**43.13*40.97*47.12
**97152**41.00*38.95*44.79
#**97152**36.66*34.83*40.05
**97153**32.69*31.06*35.72
#**97153**28.93*27.48*31.60
**97154**4.45*4.23*4.86
#**97154**4.07*3.87*4.45
**97155**32.69*31.06*35.72
#**97155**28.93*27.48*31.60
**97156**34.51*32.78*37.70
#**97156**30.60*29.07*33.43
**97157**10.04*9.54*10.97
#**97157**9.14*8.68*9.98
**97158**5.18*4.92*5.66
#**97158**4.73*4.49*5.16
**98978**42.70*40.57*46.66
# - 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.