COLORADO MEDICARE CARRIER - 04112
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**517.84*491.95*565.74
#**G0186**442.56*420.43*483.49
**G0339**2842.14*2700.03*3105.03
**G0340**2137.47*2030.60*2335.19
**G0398**129.53*123.05*141.51
**G0398*TC*91.82*87.23*100.31
**G0398*26*37.71*35.82*41.19
**G0399**96.38*91.56*105.29
**G0399*TC*54.01*51.31*59.01
**G0399*26*42.37*40.25*46.29
**G0400**97.85*92.96*106.90
**G0400*TC*58.44*55.52*63.85
**G0400*26*39.42*37.45*43.07
**G0460**808.76*768.32*883.57
#**G0460**116.98*111.13*127.80
**G0498**149.73*142.24*163.58
**G0552**128.87*122.43*140.79
**G6017**79.48*75.51*86.84
**0042T**229.67*218.19*250.92
**0054T**222.15*211.04*242.70
**0055T**222.15*211.04*242.70
**0071T**553.40*525.73*604.59
**0072T**553.40*525.73*604.59
**0075T*26*929.08*882.63*1015.02
**0076T**1049.38*996.91*1146.45
**0095T**607.08*576.73*663.24
**0098T**678.98*645.03*741.78
**0101T**310.04*294.54*338.72
#**0101T**223.52*212.34*244.19
**0102T**310.04*294.54*338.72
#**0102T**223.52*212.34*244.19
**0106T**33.16*31.50*36.23
**0107T**33.16*31.50*36.23
**0108T**33.16*31.50*36.23
**0109T**33.16*31.50*36.23
**0110T**33.16*31.50*36.23
**0164T**664.50*631.28*725.97
**0165T**680.31*646.29*743.23
**0184T**813.87*773.18*889.16
**0198T**85.48*81.21*93.39
#**0198T**31.32*29.75*34.21
**0200T**1747.10*1659.75*1908.71
#**0200T**396.25*376.44*432.91
**0201T**2620.65*2489.62*2863.06
#**0201T**594.37*564.65*649.35
**0207T**128.90*122.46*140.83
**0208T**40.80*38.76*44.57
**0209T**49.32*46.85*53.88
**0210T**30.92*29.37*33.78
**0211T**47.95*45.55*52.38
**0212T**36.11*34.30*39.45
#**0212T**31.34*29.77*34.24
**0213T**192.30*182.69*210.09
#**0213T**103.74*98.55*113.33
**0214T**97.16*92.30*106.15
#**0214T**57.99*55.09*63.35
**0215T**96.89*92.05*105.86
#**0215T**58.40*55.48*63.80
**0216T**177.82*168.93*194.27
#**0216T**89.60*85.12*97.89
**0217T**90.46*85.94*98.83
#**0217T**49.59*47.11*54.18
**0218T**89.58*85.10*97.87
#**0218T**50.07*47.57*54.71
**0219T**1291.86*1227.27*1411.36
**0220T**1272.84*1209.20*1390.58
**0221T**1553.15*1475.49*1696.81
**0222T**376.06*357.26*410.85
**0232T**933.74*887.05*1020.11
#**0232T**88.35*83.93*96.52
**0234T**8284.47*7870.25*9050.79
#**0234T**557.09*529.24*608.63
**0235T**8284.47*7870.25*9050.79
#**0235T**557.09*529.24*608.63
**0236T**8458.00*8035.10*9240.37
#**0236T**647.50*615.13*707.40
**0237T**8458.00*8035.10*9240.37
#**0237T**647.50*615.13*707.40
**0238T**8458.00*8035.10*9240.37
#**0238T**647.50*615.13*707.40
**0266T**870.64*827.11*951.18
**0267T**152.40*144.78*166.50
**0268T**324.64*308.41*354.67
**0269T**825.06*783.81*901.38
**0270T**152.40*144.78*166.50
**0271T**324.64*308.41*354.67
**0272T**55.77*52.98*60.93
**0273T**70.82*67.28*77.37
**0274T**1091.62*1037.04*1192.60
**0278T**14.55*13.82*15.89
**0308T**1378.91*1309.96*1506.45
**0329T**85.48*81.21*93.39
#**0329T**31.32*29.75*34.21
**0330T**39.25*37.29*42.88
**0331T**183.61*174.43*200.59
**0332T**310.09*294.59*338.78
**0347T**138.49*131.57*151.31
**0348T**33.28*31.62*36.36
**0349T**35.02*33.27*38.26
**0350T**36.04*34.24*39.38
**0351T**168.85*160.41*184.47
**0352T**42.55*40.42*46.48
**0353T**168.85*160.41*184.47
**0354T**42.55*40.42*46.48
**0358T**26.83*25.49*29.31
**0362T**91.04*86.49*99.46
#**0362T**64.48*61.26*70.45
**0378T**24.63*23.40*26.91
**0394T**254.02*241.32*277.52
**0395T**618.12*587.21*675.29
**0397T**45.73*43.44*49.96
**0408T**494.77*470.03*540.53
**0409T**343.07*325.92*374.81
**0410T**357.96*340.06*391.07
**0411T**357.96*340.06*391.07
**0412T**226.62*215.29*247.58
**0413T**464.64*441.41*507.62
**0414T**357.76*339.87*390.85
**0415T**298.35*283.43*325.94
**0416T**332.93*316.28*363.72
**0417T**82.60*78.47*90.24
**0418T**55.77*52.98*60.93
**0419T**451.36*428.79*493.11
#**0419T**361.78*343.69*395.24
**0420T**637.46*605.59*696.43
#**0420T**526.42*500.10*575.12
**0421T**1562.55*1484.42*1707.08
#**0421T**682.08*647.98*745.18
**0437T**208.31*197.89*227.57
**0439T**71.03*67.48*77.60
**0440T**249.34*236.87*272.40
#**0440T**118.88*112.94*129.88
**0441T**249.34*236.87*272.40
#**0441T**118.88*112.94*129.88
**0442T**249.34*236.87*272.40
#**0442T**118.88*112.94*129.88
**0449T**753.96*716.26*823.70
**0464T**66.78*63.44*72.96
**0472T**66.62*63.29*72.78
**0473T**55.77*52.98*60.93
**0479T**50.27*47.76*54.92
**0480T**71.29*67.73*77.89
#**0480T**25.14*23.88*27.46
**0483T**1138.85*1081.91*1244.20
**0484T**1478.33*1404.41*1615.07
**0485T**23.55*22.37*25.73
**0485T*TC*8.95*8.50*9.78
**0485T*26*14.86*14.12*16.24
**0486T**47.09*44.74*51.45
**0486T*TC*17.64*16.76*19.27
**0486T*26*29.46*27.99*32.19
**0488T**61.80*58.71*67.52
#**0488T**48.52*46.09*53.00
**0505T**11147.17*10589.81*12178.28
#**0505T**561.88*533.79*613.86
**0507T**23.28*22.12*25.44
**0507T*TC*20.36*19.34*22.24
**0507T*26*2.92*2.77*3.19
**0510T**597.57*567.69*652.84
#**0510T**419.77*398.78*458.60
**0512T**310.04*294.54*338.72
#**0512T**223.52*212.34*244.19
**0513T**93.01*88.36*101.61
#**0513T**67.06*63.71*73.27
**0515T**494.77*470.03*540.53
**0516T**456.45*433.63*498.67
**0517T**324.64*308.41*354.67
**0518T**226.62*215.29*247.58
**0519T**326.04*309.74*356.20
**0520T**456.45*433.63*498.67
**0521T**55.77*52.98*60.93
**0521T*TC*36.03*34.23*39.36
**0521T*26*19.74*18.75*21.56
**0522T**66.62*63.29*72.78
**0522T*TC*36.37*34.55*39.73
**0522T*26*30.24*28.73*33.04
**0523T**151.32*143.75*165.31
**0524T**1601.82*1521.73*1749.99
#**0524T**169.56*161.08*185.24
**0525T**458.35*435.43*500.74
**0526T**357.96*340.06*391.07
**0527T**311.97*296.37*340.83
**0528T**66.62*63.29*72.78
**0528T*TC*36.37*34.55*39.73
**0528T*26*30.24*28.73*33.04
**0529T**55.77*52.98*60.93
**0529T*TC*36.03*34.23*39.36
**0529T*26*19.74*18.75*21.56
**0530T**610.92*580.37*667.43
**0531T**464.64*441.41*507.62
**0532T**326.04*309.74*356.20
**0543T**1478.33*1404.41*1615.07
**0544T**1702.39*1617.27*1859.86
**0545T**1702.39*1617.27*1859.86
**0546T**71.99*68.39*78.65
**0552T**6.99*6.64*7.64
**0565T**612.90*582.26*669.60
#**0565T**512.76*487.12*560.19
**0566T**98.73*93.79*107.86
#**0566T**57.52*54.64*62.84
**0569T**1702.39*1617.27*1859.86
**0570T**397.99*378.09*434.80
**0571T**535.82*509.03*585.38
**0572T**435.65*413.87*475.95
**0573T**335.24*318.48*366.25
**0574T**385.12*365.86*420.74
**0575T**66.62*63.29*72.78
**0576T**55.77*52.98*60.93
**0577T**187.70*178.32*205.07
**0578T**28.47*27.05*31.11
**0579T**20.36*19.34*22.24
**0580T**208.52*198.09*227.80
**0581T**2215.68*2104.90*2420.64
#**0581T**202.68*192.55*221.43
**0582T**1619.40*1538.43*1769.19
#**0582T**379.92*360.92*415.06
**0583T**1544.24*1467.03*1687.08
#**0583T**133.37*126.70*145.71
**0587T**410.76*390.22*448.75
#**0587T**289.51*275.03*316.28
**0588T**334.82*318.08*365.79
#**0588T**226.85*215.51*247.84
**0589T**47.13*44.77*51.49
#**0589T**37.60*35.72*41.08
**0590T**56.23*53.42*61.43
#**0590T**38.52*36.59*42.08
**0596T**2235.23*2123.47*2441.99
#**0596T**127.04*120.69*138.79
**0597T**127.04*120.69*138.79
**0598T**151.44*143.87*165.45
**0599T**102.38*97.26*111.85
**0600T**3515.19*3339.43*3840.34
#**0600T**706.88*671.54*772.27
**0601T**1405.64*1335.36*1535.66
**0604T**20.63*19.60*22.54
**0605T**45.23*42.97*49.42
**0606T**60.33*57.31*65.91
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**194.74*185.00*212.75
**0611T**42.77*40.63*46.72
**0614T**357.39*339.52*390.45
**0615T**46.49*44.17*50.80
**0619T**630.06*598.56*688.34
#**0619T**472.02*448.42*515.68
**0620T**1414.22*1343.51*1545.04
**0627T**256.02*243.22*279.70
#**0627T**97.30*92.44*106.31
**0628T**76.81*72.97*83.92
#**0628T**29.19*27.73*31.89
**0629T**256.02*243.22*279.70
#**0629T**97.30*92.44*106.31
**0630T**76.81*72.97*83.92
#**0630T**29.19*27.73*31.89
**0631T**82.72*78.58*90.37
**0632T**548.95*521.50*599.73
**0633T**200.94*190.89*219.52
*C*0633T*TC*111.99*106.39*122.35
**0633T*26*57.69*54.81*63.03
**0634T**200.94*190.89*219.52
**0634T*TC*143.25*136.09*156.50
**0634T*26*57.69*54.81*63.03
**0635T**200.94*190.89*219.52
**0635T*TC*143.25*136.09*156.50
**0635T*26*57.69*54.81*63.03
**0636T**200.94*190.89*219.52
**0636T*TC*143.25*136.09*156.50
**0636T*26*57.69*54.81*63.03
**0637T**200.94*190.89*219.52
**0637T*TC*143.25*136.09*156.50
**0637T*26*57.69*54.81*63.03
**0638T**200.94*190.89*219.52
**0638T*TC*143.25*136.09*156.50
**0638T*26*57.69*54.81*63.03
**0639T**82.72*78.58*90.37
**0640T**23.28*22.12*25.44
**0640T*TC*20.36*19.34*22.24
**0640T*26*2.92*2.77*3.19
**0644T**1138.00*1081.10*1243.27
#**0644T**229.26*217.80*250.47
**0646T**1702.39*1617.27*1859.86
**0650T**58.97*56.02*64.42
**0652T**285.86*271.57*312.31
#**0652T**119.31*113.34*130.34
**0653T**370.43*351.91*404.70
#**0653T**134.05*127.35*146.45
**0654T**138.04*131.14*150.81
**0655T**1562.55*1484.42*1707.08
#**0655T**682.08*647.98*745.18
**0658T**96.32*91.50*105.23
**0659T**2611.58*2481.00*2853.15
#**0659T**411.93*391.33*450.03
**0660T**753.96*716.26*823.70
**0671T**1012.11*961.50*1105.73
**0673T**3379.80*3210.81*3692.43
#**0673T**353.83*336.14*386.56
**0699T**111.81*106.22*122.15
#**0699T**90.35*85.83*98.70
**0707T**363.65*345.47*397.29
#**0707T**274.41*260.69*299.79
**0714T**1376.02*1307.22*1503.30
#**0714T**355.56*337.78*388.45
**0738T**69.88*66.39*76.35
**0739T**1562.55*1484.42*1707.08
#**0739T**682.08*647.98*745.18
**0740T**20.63*19.60*22.54
**0741T**45.23*42.97*49.42
**0742T**93.03*88.38*101.64
**0742T*TC*74.40*70.68*81.28
**0742T*26*18.62*17.69*20.34
**0743T**54.52*51.79*59.56
**0744T**845.36*803.09*923.55
**0745T**264.48*251.26*288.95
**0746T**224.47*213.25*245.24
**0747T**997.71*947.82*1089.99
**0748T**179.47*170.50*196.08
**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**4.28*4.07*4.68
**0765T**7.85*7.46*8.58
**0771T**25.49*24.22*27.85
**0772T**25.49*24.22*27.85
**0773T**23.51*22.33*25.68
**0774T**23.51*22.33*25.68
**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**425.13*403.87*464.45
**0779T*TC*399.80*379.81*436.78
**0779T*26*25.32*24.05*27.66
**0780T**23.51*22.33*25.68
**0783T**14.57*13.84*15.92
**0784T**2080.39*1976.37*2272.83
#**0784T**321.15*305.09*350.85
**0785T**239.37*227.40*261.51
#**0785T**142.97*135.82*156.19
**0786T**716.06*680.26*782.30
#**0786T**296.43*281.61*323.85
**0787T**239.37*227.40*261.51
#**0787T**142.97*135.82*156.19
**0788T**18.35*17.43*20.04
#**0788T**18.00*17.10*19.67
**0789T**22.93*21.78*25.05
#**0789T**22.51*21.38*24.59
**0790T**1878.73*1784.79*2052.51
**0791T**8.96*8.51*9.79
**0793T**548.95*521.50*599.73
**0794T**130.35*123.83*142.40
**0795T**684.68*650.45*748.02
**0796T**456.45*433.63*498.67
**0797T**456.45*433.63*498.67
**0798T**721.92*685.82*788.69
**0799T**481.28*457.22*525.80
**0800T**479.77*455.78*524.15
**0801T**937.74*890.85*1024.48
**0802T**468.87*445.43*512.24
**0803T**468.87*445.43*512.24
**0804T**77.68*73.80*84.87
**0804T*TC*42.16*40.05*46.06
**0804T*26*35.52*33.74*38.80
**0805T**2895.56*2750.78*3163.40
#**0805T**313.40*297.73*342.39
**0806T**3860.74*3667.70*4217.86
#**0806T**417.87*396.98*456.53
**0807T**43.21*41.05*47.21
**0807T*TC*28.54*27.11*31.18
**0807T*26*14.67*13.94*16.03
**0808T**43.21*41.05*47.21
**0808T*TC*28.54*27.11*31.18
**0808T*26*14.67*13.94*16.03
**0810T**1117.52*1061.64*1220.89
**0811T**20.63*19.60*22.54
**0813T**2459.38*2336.41*2686.87
#**0813T**172.53*163.90*188.49
**0814T**425.80*404.51*465.19
#**0814T**314.25*298.54*343.32
**0820T**150.62*143.09*164.55
#**0820T**131.54*124.96*143.70
**0821T**150.62*143.09*164.55
#**0821T**131.54*124.96*143.70
**0822T**128.02*121.62*139.86
#**0822T**111.81*106.22*122.15
**0823T**684.68*650.45*748.02
**0824T**721.92*685.82*788.69
**0825T**937.74*890.85*1024.48
**0826T**66.62*63.29*72.78
**0826T*TC*36.37*34.55*39.73
**0826T*26*30.24*28.73*33.04
**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**23.28*22.12*25.44
**0859T*TC*20.36*19.34*22.24
**0859T*26*2.92*2.77*3.19
**0864T**310.04*294.54*338.72
#**0864T**223.52*212.34*244.19
**0867T**1720.03*1634.03*1879.13
#**0867T**444.45*422.23*485.56
**0868T**425.13*403.87*464.45
**0868T*TC*399.80*379.81*436.78
**0868T*26*25.32*24.05*27.66
**0869T**363.65*345.47*397.29
#**0869T**274.41*260.69*299.79
**0876T**148.41*140.99*162.14
**0876T*TC*124.44*118.22*135.95
**0876T*26*25.92*24.62*28.31
**0884T**1023.16*972.00*1117.80
#**0884T**182.71*173.57*199.61
**0885T**661.66*628.58*722.87
#**0885T**294.48*279.76*321.72
**0886T**555.36*527.59*606.73
#**0886T**104.07*98.87*113.70
**0897T**60.16*57.15*65.72
**0897T*TC*54.35*51.63*59.37
**0897T*26*7.85*7.46*8.58
**0898T**71.70*68.12*78.34
**0898T*TC*62.53*59.40*68.31
**0898T*26*9.17*8.71*10.02
**0899T**130.89*124.35*143.00
**0899T*TC*87.91*83.51*96.04
**0899T*26*40.93*38.88*44.71
**0900T**128.85*122.41*140.77
**0900T*TC*87.91*83.51*96.04
**0900T*26*40.93*38.88*44.71
**10011**422.23*401.12*461.29
#**10011**104.44*99.22*114.10
**10012**235.85*224.06*257.67
#**10012**69.29*65.83*75.70
**15847**348.85*331.41*381.12
**21742**1120.74*1064.70*1224.41
**21743**1314.91*1249.16*1436.53
**32855**347.84*330.45*380.02
**32856**431.28*409.72*471.18
**33928**3150.36*2992.84*3441.77
**33929**1180.27*1121.26*1289.45
**33933**532.60*505.97*581.87
**33944**532.60*505.97*581.87
**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**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
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**746.53*709.20*815.58
**53452**373.26*354.60*407.79
**53453**634.60*602.87*693.30
**53454**56.52*53.69*61.74
#**53454**34.38*32.66*37.56
**63043**554.42*526.70*605.71
**63044**511.75*486.16*559.08
**64596**2080.39*1976.37*2272.83
#**64596**321.15*305.09*350.85
**64597**624.31*593.09*682.05
#**64597**96.54*91.71*105.47
**64598**239.37*227.40*261.51
#**64598**142.97*135.82*156.19
**65757**123.47*117.30*134.90
**66983**655.10*622.35*715.70
**66987**751.24*713.68*820.73
**66988**627.35*595.98*685.38
*C*70170**268.42*255.00*293.25
*C*70170*TC*254.36*241.64*277.89
**70555**241.72*229.63*264.07
**70555*TC*126.13*119.82*137.79
*C*70557**725.36*689.09*792.45
*C*70557*TC*577.26*548.40*630.66
*C*70558**351.13*333.57*383.61
*C*70558*TC*187.26*177.90*204.59
*C*70559**341.32*324.25*372.89
*C*70559*TC*187.26*177.90*204.59
*C*74190**598.48*568.56*653.84
*C*74190*TC*577.26*548.40*630.66
**74235**148.36*140.94*162.08
**74235*TC*93.24*88.58*101.87
**74300**87.20*82.84*95.27
**74300*TC*74.46*70.74*81.35
**74301**26.73*25.39*29.20
**74301*TC*16.89*16.05*18.46
**74328**175.06*166.31*191.26
**74328*TC*152.73*145.09*166.85
**74329**144.99*137.74*158.40
**74329*TC*122.32*116.20*133.63
**74330**262.59*249.46*286.88
**74330*TC*236.30*224.49*258.16
**74340**86.58*82.25*94.59
**74340*TC*61.70*58.62*67.41
**74355**86.58*82.25*94.59
**74355*TC*51.19*48.63*55.92
**74360**86.58*82.25*94.59
**74360*TC*60.41*57.39*66.00
**74363**175.06*166.31*191.26
**74363*TC*136.59*129.76*149.22
*C*74445**164.19*155.98*179.38
*C*74445*TC*111.99*106.39*122.35
*C*74450**269.48*256.01*294.41
*C*74450*TC*254.36*241.64*277.89
*C*74470**601.80*571.71*657.47
*C*74470*TC*577.26*548.40*630.66
**74742**233.47*221.80*255.07
**74742*TC*205.28*195.02*224.27
*C*74775**283.21*269.05*309.41
*C*74775*TC*254.36*241.64*277.89
*C*75801**692.30*657.69*756.34
*C*75801*TC*650.83*618.29*711.03
*C*75803**1689.66*1605.18*1845.96
*C*75803*TC*1635.53*1553.75*1786.81
*C*75805**3352.09*3184.49*3662.16
*C*75805*TC*3314.39*3148.67*3620.97
*C*75807**3364.97*3196.72*3676.23
*C*75807*TC*3314.39*3148.67*3620.97
*C*75810**3361.05*3193.00*3671.95
*C*75810*TC*3314.39*3148.67*3620.97
**75894**928.90*882.46*1014.83
**75894*TC*859.96*816.96*939.50
*C*75898**3401.66*3231.58*3716.32
*C*75898*TC*3314.39*3148.67*3620.97
**75970**453.23*430.57*495.16
**75970*TC*417.00*396.15*455.57
**76125**40.51*38.48*44.25
**76125*TC*27.42*26.05*29.96
**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*52.13*49.52*56.95
**76940**156.88*149.04*171.40
**76940*TC*59.66*56.68*65.18
**76941**117.12*111.26*127.95
**76941*TC*54.91*52.16*59.98
**76945**85.37*81.10*93.27
**76945*TC*54.40*51.68*59.43
*C*76975**293.84*279.15*321.02
*C*76975*TC*254.36*241.64*277.89
**76998**175.06*166.31*191.26
**76998*TC*130.21*123.70*142.26
**77013**437.01*415.16*477.43
**77013*TC*260.04*247.04*284.10
**77022**486.37*462.05*531.36
**77022*TC*292.66*278.03*319.73
**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**437.66*415.78*478.15
*C*78282*TC*422.96*401.81*462.08
**78414**514.99*489.24*562.63
**78414*TC*494.60*469.87*540.35
*C*78429**1612.51*1531.88*1761.66
*C*78429*TC*1535.73*1458.94*1677.78
*C*78430**1608.28*1527.87*1757.05
*C*78430*TC*1535.73*1458.94*1677.78
*C*78431**2454.63*2331.90*2681.69
*C*78431*TC*2369.54*2251.06*2588.72
*C*78432**2042.10*1940.00*2231.00
*C*78432*TC*1948.55*1851.12*2128.79
*C*78433**2153.54*2045.86*2352.74
*C*78433*TC*2053.80*1951.11*2243.78
**78434**736.62*699.79*804.76
**78434*TC*708.39*672.97*773.92
*C*78459**1445.83*1373.54*1579.57
*C*78459*TC*1374.62*1305.89*1501.77
*C*78491**1605.64*1525.36*1754.16
*C*78491*TC*1535.73*1458.94*1677.78
*C*78492**1616.88*1536.04*1766.45
*C*78492*TC*1535.73*1458.94*1677.78
*C*78608**1602.67*1522.54*1750.92
*C*78608*TC*1535.73*1458.94*1677.78
*C*78811**1443.81*1371.62*1577.36
*C*78811*TC*1374.62*1305.89*1501.77
*C*78812**1622.60*1541.47*1772.69
*C*78812*TC*1535.73*1458.94*1677.78
*C*78813**1624.20*1542.99*1774.44
*C*78813*TC*1535.73*1458.94*1677.78
*C*78814**1634.32*1552.60*1785.49
*C*78814*TC*1535.73*1458.94*1677.78
*C*78815**1646.09*1563.79*1798.36
*C*78815*TC*1535.73*1458.94*1677.78
*C*78816**1646.83*1564.49*1799.16
*C*78816*TC*1535.73*1458.94*1677.78
**79300**237.04*225.19*258.97
**79300*TC*175.48*166.71*191.72
**79445**237.04*225.19*258.97
**79445*TC*130.66*124.13*142.75
**86485**19.92*18.92*21.76
**90867**300.65*285.62*328.46
#**90867**133.58*126.90*145.94
**90868**200.42*190.40*218.96
#**90868**109.00*103.55*119.08
**90869**241.97*229.87*264.35
#**90869**158.86*150.92*173.56
**92978**249.41*236.94*272.48
**92978*TC*160.17*152.16*174.98
**92979**150.80*143.26*164.75
**92979*TC*79.60*75.62*86.96
*C*93315**698.10*663.20*762.68
*C*93315*TC*577.26*548.40*630.66
**93317**216.95*206.10*237.02
**93317*TC*132.29*125.68*144.53
*C*93318**675.22*641.46*737.68
*C*93318*TC*577.26*548.40*630.66
**93571**248.38*235.96*271.35
**93571*TC*180.35*171.33*197.03
**93572**148.46*141.04*162.20
**93572*TC*99.12*94.16*108.28
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.69*3276.26*3767.70
**93602**3557.81*3379.92*3886.91
**93602*TC*3449.98*3277.48*3769.10
**93603**3557.81*3379.92*3886.91
**93603*TC*3449.98*3277.48*3769.10
**93609**2134.69*2027.96*2332.15
**93609*TC*1878.24*1784.33*2051.98
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.14*3235.83*3721.20
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.55*3237.17*3722.75
**93615**35.61*33.83*38.90
**93615*TC*0.80*0.76*0.87
**93619**7115.62*6759.84*7773.82
**93619*TC*6754.53*6416.80*7379.32
**93620**7115.62*6759.84*7773.82
**93620*TC*6534.23*6207.52*7138.65
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.44*6686.52*7689.50
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.58*6607.80*7598.97
**93623**2134.69*2027.96*2332.15
**93623*TC*2082.93*1978.78*2275.60
**93624**3557.81*3379.92*3886.91
**93624*TC*3333.05*3166.40*3641.36
**93631**7115.62*6759.84*7773.82
**93631*TC*6747.52*6410.14*7371.66
**93640**1133.95*1077.25*1238.84
**93640*TC*968.08*919.68*1057.63
**93641**1133.95*1077.25*1238.84
**93641*TC*845.03*802.78*923.20
**93662**394.08*374.38*430.54
**93662*TC*326.30*309.99*356.49
**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*531.81*505.22*581.00
**95966**538.17*511.26*587.95
**95966*TC*345.07*327.82*376.99
**95967**452.54*429.91*494.40
**95967*TC*286.00*271.70*312.46
**96020**375.13*356.37*409.83
**97151**50.22*47.71*54.87
#**97151**42.93*40.78*46.90
**97152**41.41*39.34*45.24
#**97152**36.49*34.67*39.87
**97153**34.46*32.74*37.65
#**97153**30.03*28.53*32.81
**97154**4.47*4.25*4.89
#**97154**4.04*3.84*4.42
**97155**32.98*31.33*36.03
#**97155**28.72*27.28*31.37
**97156**34.78*33.04*38.00
#**97156**30.35*28.83*33.15
**97157**10.17*9.66*11.11
#**97157**9.14*8.68*9.98
**97158**5.22*4.96*5.70
#**97158**4.71*4.47*5.14
**98978**45.23*42.97*49.42
# - 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 2024 BY THE AMERICAN MEDICAL ASSOCIATION.