COLORADO MEDICARE CARRIER - 04112
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**A2001**1174.20*1115.49*1282.81
**A2002**180.18*171.17*196.85
**A2004**13.78*13.09*15.05
**A2005**267.80*254.41*292.57
**A2007**84.75*80.51*92.59
**A2008**92.91*88.26*101.50
**A2013**1313.25*1247.59*1434.73
**A2014**61.16*58.10*66.82
**A2015**1236.00*1174.20*1350.33
**A2019**580.92*551.87*634.65
**A2021**1387.93*1318.53*1516.31
**A2022**1339.00*1272.05*1462.86
**A2023**15.45*14.68*16.88
**A2024**2008.50*1908.08*2194.29
**A2025**257.50*244.63*281.32
**G0186**464.28*441.07*507.23
#**G0186**397.39*377.52*434.15
**G0339**2842.14*2700.03*3105.03
**G0340**2137.47*2030.60*2335.19
**G0398**139.05*132.10*151.92
**G0398*TC*100.53*95.50*109.83
**G0398*26*38.52*36.59*42.08
**G0399**95.84*91.05*104.71
**G0399*TC*53.30*50.64*58.24
**G0399*26*42.89*40.75*46.86
**G0400**99.06*94.11*108.23
**G0400*TC*59.16*56.20*64.63
**G0400*26*39.90*37.91*43.60
**G0460**818.70*777.77*894.44
#**G0460**118.42*112.50*129.38
**G0465**818.70*777.77*894.44
#**G0465**118.42*112.50*129.38
**G0498**151.57*143.99*165.59
**G6017**79.00*75.05*86.31
**0042T**232.15*220.54*253.62
**0054T**223.43*212.26*244.10
**0055T**223.43*212.26*244.10
**0071T**569.36*540.89*622.02
**0072T**569.36*540.89*622.02
**0075T**939.50*892.53*1026.41
**0075T*TC*939.50*892.53*1026.41
**0075T*26*941.24*894.18*1028.31
**0076T**1049.38*996.91*1146.45
**0076T*TC*839.51*797.53*917.16
**0076T*26*209.86*199.37*229.28
**0095T**611.27*580.71*667.82
**0098T**683.54*649.36*746.76
**0100T**1903.26*1808.10*2079.32
**0101T**317.15*301.29*346.48
#**0101T**225.78*214.49*246.66
**0102T**317.15*301.29*346.48
#**0102T**225.78*214.49*246.66
**0106T**34.60*32.87*37.80
**0107T**34.60*32.87*37.80
**0108T**34.60*32.87*37.80
**0109T**34.60*32.87*37.80
**0110T**34.60*32.87*37.80
**0164T**668.79*635.35*730.65
**0165T**685.04*650.79*748.41
**0174T**9.77*9.28*10.67
**0184T**819.59*778.61*895.40
**0198T**86.88*82.54*94.92
#**0198T**31.71*30.12*34.64
**0200T**1820.43*1729.41*1988.82
#**0200T**397.80*377.91*434.60
**0201T**2730.64*2594.11*2983.23
#**0201T**596.69*566.86*651.89
**0207T**121.70*115.62*132.96
**0208T**39.23*37.27*42.86
**0209T**47.51*45.13*51.90
**0210T**29.92*28.42*32.68
**0211T**46.47*44.15*50.77
**0212T**36.55*34.72*39.93
#**0212T**31.38*29.81*34.28
**0213T**195.62*185.84*213.72
#**0213T**104.25*99.04*113.90
**0214T**98.08*93.18*107.16
#**0214T**58.09*55.19*63.47
**0215T**98.43*93.51*107.54
#**0215T**59.12*56.16*64.58
**0216T**180.43*171.41*197.12
#**0216T**89.75*85.26*98.05
**0217T**91.92*87.32*100.42
#**0217T**49.85*47.36*54.46
**0218T**91.92*87.32*100.42
#**0218T**50.89*48.35*55.60
**0219T**1297.91*1233.01*1417.96
**0220T**1276.62*1212.79*1394.71
**0221T**1563.23*1485.07*1707.83
**0222T**378.54*359.61*413.55
**0232T**818.70*777.77*894.44
#**0232T**118.42*112.50*129.38
**0234T**8815.16*8374.40*9630.56
#**0234T**564.18*535.97*616.37
**0235T**8815.16*8374.40*9630.56
#**0235T**564.18*535.97*616.37
**0236T**8965.10*8516.85*9794.38
#**0236T**653.78*621.09*714.25
**0237T**8965.10*8516.85*9794.38
#**0237T**653.78*621.09*714.25
**0238T**8965.10*8516.85*9794.38
#**0238T**653.78*621.09*714.25
**0253T**888.74*844.30*970.95
**0266T**878.63*834.70*959.91
**0267T**153.59*145.91*167.80
**0268T**328.06*311.66*358.41
**0269T**833.53*791.85*910.63
**0270T**153.59*145.91*167.80
**0271T**328.06*311.66*358.41
**0272T**57.14*54.28*62.42
**0273T**72.73*69.09*79.45
**0274T**1093.46*1038.79*1194.61
**0278T**14.38*13.66*15.71
**0308T**1397.93*1328.03*1527.23
**0329T**86.88*82.54*94.92
#**0329T**31.71*30.12*34.64
**0330T**38.21*36.30*41.75
**0331T**187.94*178.54*205.32
**0332T**320.99*304.94*350.68
**0347T**138.88*131.94*151.73
**0348T**33.69*32.01*36.81
**0349T**35.79*34.00*39.10
**0350T**36.48*34.66*39.86
**0351T**174.03*165.33*190.13
**0352T**42.73*40.59*46.68
**0353T**174.03*165.33*190.13
**0354T**42.73*40.59*46.68
**0358T**27.85*26.46*30.43
**0362T**91.47*86.90*99.94
#**0362T**64.92*61.67*70.92
**0378T**24.59*23.36*26.86
**0394T**256.38*243.56*280.09
**0395T**618.90*587.96*676.15
**0397T**46.56*44.23*50.86
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**498.98*474.03*545.13
**0409T**346.68*329.35*378.75
**0410T**360.91*342.86*394.29
**0411T**360.91*342.86*394.29
**0412T**228.64*217.21*249.79
**0413T**468.28*444.87*511.60
**0414T**361.32*343.25*394.74
**0415T**300.57*285.54*328.37
**0416T**335.57*318.79*366.61
**0417T**84.65*80.42*92.48
**0418T**57.14*54.28*62.42
**0419T**454.15*431.44*496.16
#**0419T**361.74*343.65*395.20
**0420T**642.32*610.20*701.73
#**0420T**528.19*501.78*577.05
**0421T**1633.33*1551.66*1784.41
#**0421T**685.49*651.22*748.90
**0437T**209.00*198.55*228.33
**0439T**72.89*69.25*79.64
**0440T**252.75*240.11*276.13
#**0440T**118.28*112.37*129.23
**0441T**252.75*240.11*276.13
#**0441T**118.28*112.37*129.23
**0442T**252.75*240.11*276.13
#**0442T**118.28*112.37*129.23
**0449T**765.25*726.99*836.04
**0464T**68.99*65.54*75.37
**0472T**68.12*64.71*74.42
**0473T**57.14*54.28*62.42
**0479T**62.76*59.62*68.56
**0480T**79.48*75.51*86.84
#**0480T**31.38*29.81*34.28
**0483T**1149.38*1091.91*1255.70
**0484T**1489.89*1415.40*1627.71
**0485T**23.84*22.65*26.05
**0485T*TC*9.06*8.61*9.90
**0485T*26*15.04*14.29*16.43
**0486T**47.67*45.29*52.08
**0486T*TC*17.86*16.97*19.52
**0486T*26*29.82*28.33*32.58
**0488T**62.83*59.69*68.64
#**0488T**49.38*46.91*53.95
**0505T**11147.17*10589.81*12178.28
#**0505T**561.88*533.79*613.86
**0507T**23.91*22.71*26.12
**0507T*TC*20.96*19.91*22.90
**0507T*26*2.96*2.81*3.23
**0510T**607.80*577.41*664.02
#**0510T**421.61*400.53*460.61
**0512T**317.15*301.29*346.48
#**0512T**225.78*214.49*246.66
**0513T**95.14*90.38*103.94
#**0513T**67.73*64.34*73.99
**0515T**498.98*474.03*545.13
**0516T**460.88*437.84*503.52
**0517T**328.06*311.66*358.41
**0518T**228.64*217.21*249.79
**0519T**329.14*312.68*359.58
**0520T**460.88*437.84*503.52
**0521T**57.14*54.28*62.42
**0521T*TC*37.16*35.30*40.60
**0521T*26*19.98*18.98*21.83
**0522T**68.12*64.71*74.42
**0522T*TC*37.85*35.96*41.35
**0522T*26*30.27*28.76*33.07
**0523T**153.18*145.52*167.35
**0524T**1688.33*1603.91*1844.50
#**0524T**170.88*162.34*186.69
**0525T**461.23*438.17*503.90
**0526T**360.91*342.86*394.29
**0527T**313.39*297.72*342.38
**0528T**68.12*64.71*74.42
**0528T*TC*37.85*35.96*41.35
**0528T*26*30.27*28.76*33.07
**0529T**57.14*54.28*62.42
**0529T*TC*37.16*35.30*40.60
**0529T*26*19.98*18.98*21.83
**0530T**615.87*585.08*672.84
**0531T**468.28*444.87*511.60
**0532T**329.14*312.68*359.58
**0540T**176.50*167.68*192.83
**0543T**1489.89*1415.40*1627.71
**0544T**1719.47*1633.50*1878.53
**0545T**1719.47*1633.50*1878.53
**0546T**72.88*69.24*79.63
**0552T**6.73*6.39*7.35
**0553T**2514.91*2389.16*2747.53
#**0553T**376.83*357.99*411.69
**0565T**616.29*585.48*673.30
#**0565T**513.20*487.54*560.67
**0566T**100.36*95.34*109.64
#**0566T**57.95*55.05*63.31
**0569T**1719.47*1633.50*1878.53
**0570T**401.78*381.69*438.94
**0571T**540.26*513.25*590.24
**0572T**439.28*417.32*479.92
**0573T**336.60*319.77*367.74
**0574T**389.21*369.75*425.21
**0575T**68.12*64.71*74.42
**0576T**57.14*54.28*62.42
**0577T**190.97*181.42*208.63
**0578T**28.82*27.38*31.49
**0579T**21.99*20.89*24.02
**0580T**209.98*199.48*229.40
**0581T**2332.49*2215.87*2548.25
#**0581T**203.72*193.53*222.56
**0582T**1699.15*1614.19*1856.32
#**0582T**381.69*362.61*417.00
**0583T**1496.16*1421.35*1634.55
#**0583T**133.60*126.92*145.96
**0587T**444.63*422.40*485.76
#**0587T**291.54*276.96*318.50
**0588T**367.48*349.11*401.48
#**0588T**227.84*216.45*248.92
**0589T**47.98*45.58*52.42
#**0589T**37.98*36.08*41.49
**0590T**56.84*54.00*62.10
#**0590T**39.26*37.30*42.90
**0596T**2235.23*2123.47*2441.99
#**0596T**128.60*122.17*140.50
**0597T**672.69*639.06*734.92
#**0597T**128.60*122.17*140.50
**0598T**156.01*148.21*170.44
**0599T**103.69*98.51*113.29
**0600T**3664.19*3480.98*4003.13
#**0600T**707.91*672.51*773.39
**0601T**1415.58*1344.80*1546.52
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**199.82*189.83*218.30
**0611T**41.92*39.82*45.79
**0614T**360.60*342.57*393.96
**0615T**47.41*45.04*51.80
**0616T**663.15*629.99*724.49
**0617T**741.40*704.33*809.98
**0618T**897.85*852.96*980.90
**0619T**656.79*623.95*717.54
#**0619T**473.07*449.42*516.83
**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**263.58*250.40*287.96
#**0627T**98.08*93.18*107.16
**0628T**79.07*75.12*86.39
#**0628T**29.42*27.95*32.14
**0629T**263.58*250.40*287.96
#**0629T**98.08*93.18*107.16
**0630T**79.07*75.12*86.39
#**0630T**29.42*27.95*32.14
**0631T**84.43*80.21*92.24
**0632T**553.90*526.21*605.14
**0633T**205.82*195.53*224.86
*C*0633T*TC*110.26*104.75*120.46
**0633T*26*58.05*55.15*63.42
**0634T**205.82*195.53*224.86
**0634T*TC*147.77*140.38*161.44
**0634T*26*58.05*55.15*63.42
**0635T**205.82*195.53*224.86
**0635T*TC*147.77*140.38*161.44
**0635T*26*58.05*55.15*63.42
**0636T**205.82*195.53*224.86
**0636T*TC*147.77*140.38*161.44
**0636T*26*58.05*55.15*63.42
**0637T**205.82*195.53*224.86
**0637T*TC*147.77*140.38*161.44
**0637T*26*58.05*55.15*63.42
**0638T**205.82*195.53*224.86
**0638T*TC*147.77*140.38*161.44
**0638T*26*58.05*55.15*63.42
**0639T**84.43*80.21*92.24
**0640T**23.91*22.71*26.12
**0640T*TC*20.96*19.91*22.90
**0640T*26*2.96*2.81*3.23
**0644T**1186.20*1126.89*1295.92
#**0644T**230.08*218.58*251.37
**0646T**1719.47*1633.50*1878.53
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**60.73*57.69*66.34
**0652T**292.56*277.93*319.62
#**0652T**120.16*114.15*131.27
**0653T**383.19*364.03*418.63
#**0653T**135.62*128.84*148.17
**0654T**139.05*132.10*151.92
**0655T**1633.33*1551.66*1784.41
#**0655T**685.49*651.22*748.90
**0658T**98.19*93.28*107.27
**0659T**2755.13*2617.37*3009.98
#**0659T**415.69*394.91*454.15
**0671T**1028.55*977.12*1123.69
**0673T**3529.96*3353.46*3856.48
#**0673T**354.73*336.99*387.54
**0699T**113.26*107.60*123.74
#**0699T**90.50*85.98*98.88
**0707T**377.56*358.68*412.48
#**0707T**282.05*267.95*308.14
**0714T**1441.48*1369.41*1574.82
#**0714T**356.75*338.91*389.75
**0730T**269.50*256.03*294.43
#**0730T**240.88*228.84*263.17
**0738T**70.24*66.73*76.74
**0739T**1633.33*1551.66*1784.41
#**0739T**685.49*651.22*748.90
**0740T**20.54*19.51*22.44
**0741T**48.89*46.45*53.42
**0742T**96.30*91.49*105.21
**0742T*TC*77.47*73.60*84.64
**0742T*26*18.83*17.89*20.57
**0743T**54.50*51.78*59.55
**0744T**852.01*809.41*930.82
**0745T**265.66*252.38*290.24
**0746T**223.36*212.19*244.02
**0747T**1027.37*976.00*1122.40
**0748T**181.48*172.41*198.27
**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**444.55*422.32*485.67
**0756T**114.56*108.83*125.15
**0757T**83.63*79.45*91.37
**0758T**92.28*87.67*100.82
**0759T**138.29*131.38*151.09
**0760T**101.57*96.49*110.96
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**119.97*113.97*131.07
**0764T**4.33*4.11*4.73
**0765T**7.95*7.55*8.68
**0771T**25.81*24.52*28.20
**0772T**25.81*24.52*28.20
**0773T**23.80*22.61*26.00
**0774T**23.80*22.61*26.00
**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**451.38*428.81*493.13
**0779T*TC*425.75*404.46*465.13
**0779T*26*25.64*24.36*28.01
**0780T**23.80*22.61*26.00
**0783T**14.75*14.01*16.11
**0784T**2181.90*2072.81*2383.73
#**0784T**320.69*304.66*350.36
**0785T**245.68*233.40*268.41
#**0785T**143.97*136.77*157.29
**0786T**745.06*707.81*813.98
#**0786T**298.89*283.95*326.54
**0787T**245.68*233.40*268.41
#**0787T**143.97*136.77*157.29
**0788T**18.57*17.64*20.29
#**0788T**17.88*16.99*19.54
**0789T**25.45*24.18*27.81
#**0789T**22.35*21.23*24.41
**0790T**1895.95*1801.15*2071.32
**0791T**9.07*8.62*9.91
**0793T**553.90*526.21*605.14
**0794T**130.35*123.83*142.40
**0795T**691.32*656.75*755.26
**0796T**460.88*437.84*503.52
**0797T**460.88*437.84*503.52
**0798T**728.51*692.08*795.89
**0799T**485.67*461.39*530.60
**0800T**485.67*461.39*530.60
**0801T**946.56*899.23*1034.11
**0802T**473.28*449.62*517.06
**0803T**473.28*449.62*517.06
**0804T**79.67*75.69*87.04
**0804T*TC*43.72*41.53*47.76
**0804T*26*35.96*34.16*39.28
**0805T**3044.94*2892.69*3326.59
#**0805T**315.19*299.43*344.34
**0806T**4059.92*3856.92*4435.46
#**0806T**420.25*399.24*459.13
**0807T**43.40*41.23*47.41
**0807T*TC*28.89*27.45*31.57
**0807T*26*14.51*13.78*15.85
**0808T**43.40*41.23*47.41
**0808T*TC*28.89*27.45*31.57
**0808T*26*14.51*13.78*15.85
**0810T**1132.22*1075.61*1236.95
**0811T**20.54*19.51*22.44
**0813T**2679.72*2545.73*2927.59
#**0813T**175.81*167.02*192.07
**0814T**471.94*448.34*515.59
#**0814T**352.56*334.93*385.17
**0818T**367.48*349.11*401.48
#**0818T**227.84*216.45*248.92
**0820T**146.14*138.83*159.65
#**0820T**127.86*121.47*139.69
**0821T**146.14*138.83*159.65
#**0821T**127.86*121.47*139.69
**0822T**124.22*118.01*135.71
#**0822T**108.68*103.25*118.74
**0823T**691.32*656.75*755.26
**0824T**728.51*692.08*795.89
**0825T**946.56*899.23*1034.11
**0826T**68.12*64.71*74.42
**0826T*TC*37.85*35.96*41.35
**0826T*26*30.27*28.76*33.07
**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**23.91*22.71*26.12
**0859T*TC*20.96*19.91*22.90
**0859T*26*2.96*2.81*3.23
**0864T**317.15*301.29*346.48
#**0864T**225.78*214.49*246.66
**10011**436.04*414.24*476.38
#**10011**105.38*100.11*115.13
**10012**239.10*227.15*261.22
#**10012**69.46*65.99*75.89
**15847**348.93*331.48*381.20
**21742**1128.69*1072.26*1233.10
**21743**1292.27*1227.66*1411.81
**32855**347.84*330.45*380.02
**32856**436.58*414.75*476.96
**33928**3189.10*3029.65*3484.10
**33929**1194.78*1135.04*1305.30
**33933**532.60*505.97*581.87
**33944**532.60*505.97*581.87
**34841**2112.36*2006.74*2307.75
**34842**2338.16*2221.25*2554.44
**34843**2563.92*2435.72*2801.08
**34844**2789.70*2650.22*3047.75
**34845**2112.36*2006.74*2307.75
**34846**2338.16*2221.25*2554.44
**34847**2563.92*2435.72*2801.08
**34848**2789.70*2650.22*3047.75
**43496**2094.80*1990.06*2288.57
**43647**442.49*420.37*483.43
**43648**531.61*505.03*580.78
#**43648**239.35*227.38*261.49
**43881**674.08*640.38*736.44
#**43881**616.93*586.08*673.99
**43882**716.29*680.48*782.55
#**43882**654.79*622.05*715.36
**47143**422.52*401.39*461.60
**47144**501.75*476.66*548.16
**47145**475.32*451.55*519.28
**48551**266.59*253.26*291.25
**49906**2022.59*1921.46*2209.68
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**750.39*712.87*819.80
**53452**375.19*356.43*409.89
**53453**637.85*605.96*696.85
**53454**57.14*54.28*62.42
#**53454**34.73*32.99*37.94
**54440**736.45*699.63*804.57
**63043**561.23*533.17*613.15
**63044**511.75*486.16*559.08
**64596**2181.90*2072.81*2383.73
#**64596**320.69*304.66*350.36
**64597**654.57*621.84*715.12
#**64597**96.21*91.40*105.11
**64598**245.68*233.40*268.41
#**64598**143.97*136.77*157.29
**65757**119.32*113.35*130.35
**66983**663.15*629.99*724.49
**66987**760.48*722.46*830.83
**66988**635.06*603.31*693.81
*C*70170**260.00*247.00*284.05
*C*70170*TC*245.77*233.48*268.50
**70555**233.47*221.80*255.07
**70555*TC*117.42*111.55*128.28
*C*70557**703.25*668.09*768.30
*C*70557*TC*553.32*525.65*604.50
*C*70558**349.66*332.18*382.01
*C*70558*TC*184.39*175.17*201.45
*C*70559**338.43*321.51*369.74
*C*70559*TC*184.39*175.17*201.45
*C*74190**574.81*546.07*627.98
*C*74190*TC*553.32*525.65*604.50
**74235**148.36*140.94*162.08
**74235*TC*92.98*88.33*101.58
**74300**87.20*82.84*95.27
**74300*TC*74.30*70.59*81.18
**74301**26.73*25.39*29.20
**74301*TC*17.11*16.25*18.69
**74328**175.06*166.31*191.26
**74328*TC*152.45*144.83*166.55
**74329**144.99*137.74*158.40
**74329*TC*122.04*115.94*133.33
**74330**262.59*249.46*286.88
**74330*TC*236.05*224.25*257.89
**74340**86.58*82.25*94.59
**74340*TC*61.74*58.65*67.45
**74355**86.58*82.25*94.59
**74355*TC*51.10*48.55*55.83
**74360**86.58*82.25*94.59
**74360*TC*60.16*57.15*65.72
**74363**175.06*166.31*191.26
**74363*TC*134.66*127.93*147.12
*C*74445**162.76*154.62*177.81
*C*74445*TC*110.26*104.75*120.46
*C*74450**261.07*248.02*285.22
*C*74450*TC*245.77*233.48*268.50
*C*74470**577.48*548.61*630.90
*C*74470*TC*553.32*525.65*604.50
**74742**233.47*221.80*255.07
**74742*TC*204.94*194.69*223.89
*C*74775**274.63*260.90*300.04
*C*74775*TC*245.77*233.48*268.50
*C*75801**671.50*637.93*733.62
*C*75801*TC*630.21*598.70*688.51
*C*75803**1661.40*1578.33*1815.08
*C*75803*TC*1606.68*1526.35*1755.30
*C*75805**3235.73*3073.94*3535.03
*C*75805*TC*3197.91*3038.01*3493.71
*C*75807**3249.04*3086.59*3549.58
*C*75807*TC*3197.91*3038.01*3493.71
*C*75810**3244.45*3082.23*3544.56
*C*75810*TC*3197.91*3038.01*3493.71
**75894**928.90*882.46*1014.83
**75894*TC*860.08*817.08*939.64
*C*75898**3285.57*3121.29*3589.48
*C*75898*TC*3197.91*3038.01*3493.71
**75970**453.23*430.57*495.16
**75970*TC*461.62*438.54*504.32
**76125**40.51*38.48*44.25
**76125*TC*27.61*26.23*30.16
**76390**211.45*200.88*231.01
**76390*TC*160.18*152.17*175.00
**76390*26*51.27*48.71*56.02
**76932**86.33*82.01*94.31
**76932*TC*51.43*48.86*56.19
**76940**156.88*149.04*171.40
**76940*TC*59.77*56.78*65.30
**76941**117.12*111.26*127.95
**76941*TC*54.15*51.44*59.16
**76945**85.37*81.10*93.27
**76945*TC*54.02*51.32*59.02
*C*76975**285.73*271.44*312.16
*C*76975*TC*245.77*233.48*268.50
**76998**175.06*166.31*191.26
**76998*TC*130.00*123.50*142.03
**77013**437.01*415.16*477.43
**77013*TC*259.58*246.60*283.59
**77022**486.37*462.05*531.36
**77022*TC*292.19*277.58*319.22
**77371**618.38*587.46*675.58
**77520**897.28*852.42*980.28
**77522**897.28*852.42*980.28
**77523**1030.33*978.81*1125.63
**77525**1163.36*1105.19*1270.97
*C*78282**428.56*407.13*468.20
*C*78282*TC*413.68*393.00*451.95
**78414**514.99*489.24*562.63
**78414*TC*494.35*469.63*540.07
*C*78429**1646.39*1564.07*1798.68
*C*78429*TC*1569.44*1490.97*1714.62
*C*78430**1642.81*1560.67*1794.77
*C*78430*TC*1569.44*1490.97*1714.62
*C*78431**2455.43*2332.66*2682.56
*C*78431*TC*2369.71*2251.22*2588.90
*C*78432**2039.97*1937.97*2228.67
*C*78432*TC*1948.37*1850.95*2128.59
*C*78433**2154.08*2046.38*2353.34
*C*78433*TC*2053.88*1951.19*2243.87
**78434**736.62*699.79*804.76
**78434*TC*708.39*672.97*773.92
*C*78459**1495.94*1421.14*1634.31
*C*78459*TC*1424.62*1353.39*1556.40
*C*78491**1639.52*1557.54*1791.17
*C*78491*TC*1569.44*1490.97*1714.62
*C*78492**1651.85*1569.26*1804.65
*C*78492*TC*1569.44*1490.97*1714.62
*C*78608**1636.78*1554.94*1788.18
*C*78608*TC*1569.44*1490.97*1714.62
*C*78811**1493.90*1419.21*1632.09
*C*78811*TC*1424.62*1353.39*1556.40
*C*78812**1656.96*1574.11*1810.23
*C*78812*TC*1569.44*1490.97*1714.62
*C*78813**1658.92*1575.97*1812.37
*C*78813*TC*1569.44*1490.97*1714.62
*C*78814**1668.55*1585.12*1822.89
*C*78814*TC*1569.44*1490.97*1714.62
*C*78815**1679.85*1595.86*1835.24
*C*78815*TC*1569.44*1490.97*1714.62
*C*78816**1680.87*1596.83*1836.35
*C*78816*TC*1569.44*1490.97*1714.62
**79300**237.04*225.19*258.97
**79300*TC*175.07*166.32*191.27
**79445**237.04*225.19*258.97
**79445*TC*130.93*124.38*143.04
**86485**19.92*18.92*21.76
**90867**304.35*289.13*332.50
#**90867**135.22*128.46*147.73
**90868**202.88*192.74*221.65
#**90868**104.70*99.47*114.39
**90869**279.77*265.78*305.65
#**90869**160.81*152.77*175.69
**90952**487.33*462.96*532.40
**90953**345.84*328.55*377.83
**92978**249.41*236.94*272.48
**92978*TC*159.41*151.44*174.16
**92979**150.80*143.26*164.75
**92979*TC*79.34*75.37*86.68
*C*93315**675.92*642.12*738.44
*C*93315*TC*553.32*525.65*604.50
**93317**216.95*206.10*237.02
**93317*TC*131.94*125.34*144.14
*C*93318**651.67*619.09*711.95
*C*93318*TC*553.32*525.65*604.50
**93571**248.38*235.96*271.35
**93571*TC*179.86*170.87*196.50
**93572**148.46*141.04*162.20
**93572*TC*98.59*93.66*107.71
**93600**3557.81*3379.92*3886.91
**93600*TC*3447.35*3274.98*3766.23
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.27*3276.81*3768.33
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.27*3276.81*3768.33
**93609**2134.69*2027.96*2332.15
**93609*TC*1875.58*1781.80*2049.07
**93610**3557.81*3379.92*3886.91
**93610*TC*3404.55*3234.32*3719.47
**93612**3557.81*3379.92*3886.91
**93612*TC*3406.74*3236.40*3721.86
**93615**35.61*33.83*38.90
**93615*TC*0.64*0.61*0.70
**93619**7115.62*6759.84*7773.82
**93619*TC*6749.69*6412.21*7374.04
**93620**7115.62*6759.84*7773.82
**93620*TC*6528.61*6202.18*7132.51
**93621**7115.62*6759.84*7773.82
**93621*TC*7037.57*6685.69*7688.54
**93622**7115.62*6759.84*7773.82
**93622*TC*6954.57*6606.84*7597.87
**93623**2134.69*2027.96*2332.15
**93623*TC*2069.27*1965.81*2260.68
**93624**3557.81*3379.92*3886.91
**93624*TC*3330.70*3164.17*3638.80
**93631**7115.62*6759.84*7773.82
**93631*TC*6742.03*6404.93*7365.67
**93640**1133.95*1077.25*1238.84
**93640*TC*966.39*918.07*1055.78
**93641**1133.95*1077.25*1238.84
**93641*TC*841.16*799.10*918.97
**93662**430.71*409.17*470.55
**93662*TC*362.44*344.32*395.97
**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**929.08*882.63*1015.02
**95965*TC*527.27*500.91*576.05
**95966**538.17*511.26*587.95
**95966*TC*345.30*328.04*377.25
**95967**452.54*429.91*494.40
**95967*TC*285.34*271.07*311.73
**96020**375.13*356.37*409.83
**96020*TC*221.92*210.82*242.44
**96547**767.49*729.12*838.49
#**96547**134.10*127.40*146.51
**96548**383.75*364.56*419.24
#**96548**67.05*63.70*73.26
**97151**49.32*46.85*53.88
#**97151**43.46*41.29*47.48
**97152**41.92*39.82*45.79
#**97152**36.94*35.09*40.35
**97153**33.38*31.71*36.47
#**97153**29.07*27.62*31.76
**97154**4.53*4.30*4.95
#**97154**4.09*3.89*4.47
**97155**33.38*31.71*36.47
#**97155**29.07*27.62*31.76
**97156**35.21*33.45*38.47
#**97156**30.72*29.18*33.56
**97157**10.29*9.78*11.25
#**97157**9.26*8.80*10.12
**97158**5.28*5.02*5.77
#**97158**4.76*4.52*5.20
**98978**48.89*46.45*53.42
# - 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.