NEW MEXICO MEDICARE CARRIER - 04212
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**469.71*446.22*513.15
#**G0186**404.80*384.56*442.24
**G0339**2593.52*2463.84*2833.42
**G0340**1950.66*1853.13*2131.10
**G0398**116.03*110.23*126.76
**G0398*TC*79.47*75.50*86.83
**G0398*26*36.56*34.73*39.94
**G0399**87.78*83.39*95.90
**G0399*TC*46.87*44.53*51.21
**G0399*26*40.91*38.86*44.69
**G0400**88.72*84.28*96.92
**G0400*TC*50.69*48.16*55.38
**G0400*26*38.03*36.13*41.55
**G0460**712.40*676.78*778.30
#**G0460**115.88*110.09*126.60
**G0498**131.04*124.49*143.16
**G0552**128.87*122.43*140.79
**G6017**72.77*69.13*79.50
**0042T**207.21*196.85*226.38
**0054T**227.32*215.95*248.34
**0055T**227.32*215.95*248.34
**0071T**537.16*510.30*586.85
**0072T**537.16*510.30*586.85
**0075T*26*943.63*896.45*1030.92
**0076T**1020.84*969.80*1115.27
**0095T**614.59*583.86*671.44
**0098T**688.96*654.51*752.69
**0101T**286.10*271.80*312.57
#**0101T**211.50*200.93*231.07
**0102T**286.10*271.80*312.57
#**0102T**211.50*200.93*231.07
**0106T**29.10*27.65*31.80
**0107T**29.10*27.65*31.80
**0108T**29.10*27.65*31.80
**0109T**29.10*27.65*31.80
**0110T**29.10*27.65*31.80
**0164T**671.45*637.88*733.56
**0165T**687.76*653.37*751.38
**0184T**784.73*745.49*857.31
**0198T**76.59*72.76*83.67
#**0198T**29.89*28.40*32.66
**0200T**1552.97*1475.32*1696.62
#**0200T**388.13*368.72*424.03
**0201T**2329.46*2212.99*2544.94
#**0201T**582.20*553.09*636.05
**0207T**128.90*122.46*140.83
**0208T**35.33*33.56*38.59
**0209T**42.67*40.54*46.62
**0210T**26.81*25.47*29.29
**0211T**41.50*39.43*45.34
**0212T**33.97*32.27*37.11
#**0212T**29.86*28.37*32.63
**0213T**176.04*167.24*192.33
#**0213T**99.68*94.70*108.91
**0214T**90.62*86.09*99.00
#**0214T**56.84*54.00*62.10
**0215T**90.24*85.73*98.59
#**0215T**57.05*54.20*62.33
**0216T**162.14*154.03*177.13
#**0216T**86.07*81.77*94.04
**0217T**83.72*79.53*91.46
#**0217T**48.47*46.05*52.96
**0218T**82.67*78.54*90.32
#**0218T**48.60*46.17*53.10
**0219T**1277.39*1213.52*1395.55
**0220T**1255.88*1193.09*1372.05
**0221T**1537.40*1460.53*1679.61
**0222T**382.21*363.10*417.57
**0232T**814.84*774.10*890.22
#**0232T**85.86*81.57*93.81
**0234T**7230.21*6868.70*7899.01
#**0234T**566.90*538.56*619.34
**0235T**7230.21*6868.70*7899.01
#**0235T**566.90*538.56*619.34
**0236T**7392.52*7022.89*8076.32
#**0236T**657.54*624.66*718.36
**0237T**7392.52*7022.89*8076.32
#**0237T**657.54*624.66*718.36
**0238T**7392.52*7022.89*8076.32
#**0238T**657.54*624.66*718.36
**0266T**863.75*820.56*943.64
**0267T**153.67*145.99*167.89
**0268T**319.79*303.80*349.37
**0269T**815.90*775.11*891.38
**0270T**153.67*145.99*167.89
**0271T**319.79*303.80*349.37
**0272T**50.21*47.70*54.86
**0273T**64.84*61.60*70.84
**0274T**1077.26*1023.40*1176.91
**0278T**13.75*13.06*15.02
**0308T**1295.56*1230.78*1415.40
**0329T**76.59*72.76*83.67
#**0329T**29.89*28.40*32.66
**0330T**39.25*37.29*42.88
**0331T**162.75*154.61*177.80
**0332T**274.41*260.69*299.79
**0347T**137.42*130.55*150.13
**0348T**29.84*28.35*32.60
**0349T**31.25*29.69*34.14
**0350T**32.13*30.52*35.10
**0351T**149.58*142.10*163.42
**0352T**40.52*38.49*44.26
**0353T**149.58*142.10*163.42
**0354T**40.52*38.49*44.26
**0358T**23.29*22.13*25.45
**0362T**85.49*81.22*93.40
#**0362T**62.58*59.45*68.37
**0378T**23.71*22.52*25.90
**0394T**224.67*213.44*245.46
**0395T**553.24*525.58*604.42
**0397T**43.87*41.68*47.93
**0408T**491.04*466.49*536.46
**0409T**338.02*321.12*369.29
**0410T**351.15*333.59*383.63
**0411T**351.15*333.59*383.63
**0412T**219.24*208.28*239.52
**0413T**458.74*435.80*501.17
**0414T**352.29*334.68*384.88
**0415T**294.71*279.97*321.97
**0416T**324.08*307.88*354.06
**0417T**75.42*71.65*82.40
**0418T**50.21*47.70*54.86
**0419T**417.34*396.47*455.94
#**0419T**340.09*323.09*371.55
**0420T**596.21*566.40*651.36
#**0420T**500.47*475.45*546.77
**0421T**1420.61*1349.58*1552.02
#**0421T**661.38*628.31*722.56
**0437T**205.31*195.04*224.30
**0439T**64.80*61.56*70.79
**0440T**226.50*215.18*247.46
#**0440T**114.01*108.31*124.56
**0441T**226.50*215.18*247.46
#**0441T**114.01*108.31*124.56
**0442T**226.50*215.18*247.46
#**0442T**114.01*108.31*124.56
**0449T**702.65*667.52*767.65
**0464T**59.37*56.40*64.86
**0472T**60.64*57.61*66.25
**0473T**50.21*47.70*54.86
**0479T**47.45*45.08*51.84
**0480T**63.52*60.34*69.39
#**0480T**23.73*22.54*25.92
**0483T**1154.14*1096.43*1260.89
**0484T**1499.43*1424.46*1638.13
**0485T**21.60*20.52*23.60
**0485T*TC*7.87*7.48*8.60
**0485T*26*14.11*13.40*15.41
**0486T**43.19*41.03*47.18
**0486T*TC*15.36*14.59*16.78
**0486T*26*27.83*26.44*30.41
**0488T**58.41*55.49*63.81
#**0488T**46.96*44.61*51.30
**0505T**10144.72*9637.48*11083.10
#**0505T**568.03*539.63*620.57
**0507T**20.59*19.56*22.49
**0507T*TC*17.71*16.82*19.34
**0507T*26*2.88*2.74*3.15
**0510T**555.79*528.00*607.20
#**0510T**402.48*382.36*439.71
**0512T**286.10*271.80*312.57
#**0512T**211.50*200.93*231.07
**0513T**85.83*81.54*93.77
#**0513T**63.45*60.28*69.32
**0515T**491.04*466.49*536.46
**0516T**452.58*429.95*494.44
**0517T**319.79*303.80*349.37
**0518T**219.24*208.28*239.52
**0519T**320.87*304.83*350.55
**0520T**452.58*429.95*494.44
**0521T**50.21*47.70*54.86
**0521T*TC*31.22*29.66*34.11
**0521T*26*18.99*18.04*20.75
**0522T**60.64*57.61*66.25
**0522T*TC*31.51*29.93*34.42
**0522T*26*29.13*27.67*31.82
**0523T**140.44*133.42*153.43
**0524T**1406.59*1336.26*1536.70
#**0524T**171.56*162.98*187.43
**0525T**454.51*431.78*496.55
**0526T**351.15*333.59*383.63
**0527T**307.27*291.91*335.70
**0528T**60.64*57.61*66.25
**0528T*TC*31.51*29.93*34.42
**0528T*26*29.13*27.67*31.82
**0529T**50.21*47.70*54.86
**0529T*TC*31.22*29.66*34.11
**0529T*26*18.99*18.04*20.75
**0530T**601.93*571.83*657.60
**0531T**458.74*435.80*501.17
**0532T**320.87*304.83*350.55
**0543T**1499.43*1424.46*1638.13
**0544T**1713.07*1627.42*1871.53
**0545T**1713.07*1627.42*1871.53
**0546T**65.55*62.27*71.61
**0552T**6.43*6.11*7.03
**0565T**575.53*546.75*628.76
#**0565T**489.18*464.72*534.43
**0566T**92.16*87.55*100.68
#**0566T**56.63*53.80*61.87
**0569T**1713.07*1627.42*1871.53
**0570T**403.46*383.29*440.78
**0571T**530.96*504.41*580.07
**0572T**432.92*411.27*472.96
**0573T**330.41*313.89*360.97
**0574T**381.41*362.34*416.69
**0575T**60.64*57.61*66.25
**0576T**50.21*47.70*54.86
**0577T**176.05*167.25*192.34
**0578T**27.68*26.30*30.25
**0579T**17.71*16.82*19.34
**0580T**202.91*192.76*221.67
**0581T**1940.14*1843.13*2119.60
#**0581T**204.34*194.12*223.24
**0582T**1432.03*1360.43*1564.49
#**0582T**363.23*345.07*396.83
**0583T**1341.50*1274.43*1465.59
#**0583T**124.91*118.66*136.46
**0587T**386.32*367.00*422.05
#**0587T**281.76*267.67*307.82
**0588T**312.91*297.26*341.85
#**0588T**219.81*208.82*240.14
**0589T**44.83*42.59*48.98
#**0589T**36.61*34.78*40.00
**0590T**52.91*50.26*57.80
#**0590T**37.64*35.76*41.12
**0596T**2235.23*2123.47*2441.99
#**0596T**125.25*118.99*136.84
**0597T**125.25*118.99*136.84
**0598T**132.30*125.69*144.54
**0599T**89.80*85.31*98.11
**0600T**3117.79*2961.90*3406.19
#**0600T**696.18*661.37*760.58
**0601T**1403.27*1333.11*1533.08
**0604T**18.09*17.19*19.77
**0605T**39.15*37.19*42.77
**0606T**54.67*51.94*59.73
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**175.52*166.74*191.75
**0611T**37.18*35.32*40.62
**0614T**352.06*334.46*384.63
**0615T**43.37*41.20*47.38
**0619T**589.01*559.56*643.49
#**0619T**452.73*430.09*494.60
**0620T**1414.22*1343.51*1545.04
**0627T**230.91*219.36*252.26
#**0627T**94.04*89.34*102.74
**0628T**69.27*65.81*75.68
#**0628T**28.21*26.80*30.82
**0629T**230.91*219.36*252.26
#**0629T**94.04*89.34*102.74
**0630T**69.27*65.81*75.68
#**0630T**28.21*26.80*30.82
**0631T**73.13*69.47*79.89
**0632T**550.97*523.42*601.93
**0633T**179.75*170.76*196.37
*C*0633T*TC*96.71*91.87*105.65
**0633T*26*55.92*53.12*61.09
**0634T**179.75*170.76*196.37
**0634T*TC*123.82*117.63*135.27
**0634T*26*55.92*53.12*61.09
**0635T**179.75*170.76*196.37
**0635T*TC*123.82*117.63*135.27
**0635T*26*55.92*53.12*61.09
**0636T**179.75*170.76*196.37
**0636T*TC*123.82*117.63*135.27
**0636T*26*55.92*53.12*61.09
**0637T**179.75*170.76*196.37
**0637T*TC*123.82*117.63*135.27
**0637T*26*55.92*53.12*61.09
**0638T**179.75*170.76*196.37
**0638T*TC*123.82*117.63*135.27
**0638T*26*55.92*53.12*61.09
**0639T**73.13*69.47*79.89
**0640T**20.59*19.56*22.49
**0640T*TC*17.71*16.82*19.34
**0640T*26*2.88*2.74*3.15
**0644T**1017.25*966.39*1111.35
#**0644T**233.65*221.97*255.27
**0646T**1713.07*1627.42*1871.53
**0650T**53.50*50.83*58.45
**0652T**259.35*246.38*283.34
#**0652T**115.73*109.94*126.43
**0653T**333.84*317.15*364.72
#**0653T**130.01*123.51*142.04
**0654T**134.47*127.75*146.91
**0655T**1420.61*1349.58*1552.02
#**0655T**661.38*628.31*722.56
**0658T**83.20*79.04*90.90
**0659T**2317.48*2201.61*2531.85
#**0659T**420.73*399.69*459.64
**0660T**702.65*667.52*767.65
**0671T**943.88*896.69*1031.19
**0673T**2960.13*2812.12*3233.94
#**0673T**350.84*333.30*383.30
**0699T**104.29*99.08*113.94
#**0699T**85.79*81.50*93.73
**0707T**330.62*314.09*361.20
#**0707T**253.67*240.99*277.14
**0714T**1219.12*1158.16*1331.88
#**0714T**339.18*322.22*370.55
**0738T**66.65*63.32*72.82
**0739T**1420.61*1349.58*1552.02
#**0739T**661.38*628.31*722.56
**0740T**18.09*17.19*19.77
**0741T**39.15*37.19*42.77
**0742T**82.32*78.20*89.93
**0742T*TC*64.34*61.12*70.29
**0742T*26*17.99*17.09*19.65
**0743T**48.73*46.29*53.23
**0744T**861.85*818.76*941.57
**0745T**229.10*217.65*250.30
**0746T**214.23*203.52*234.05
**0747T**864.33*821.11*944.28
**0748T**174.41*165.69*190.54
**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**3.99*3.79*4.36
**0765T**7.64*7.26*8.35
**0771T**25.18*23.92*27.51
**0772T**25.18*23.92*27.51
**0773T**21.18*20.12*23.14
**0774T**21.18*20.12*23.14
**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**369.23*350.77*403.39
**0779T*TC*344.90*327.66*376.81
**0779T*26*24.33*23.11*26.58
**0780T**21.18*20.12*23.14
**0783T**12.71*12.07*13.88
**0784T**1827.64*1736.26*1996.70
#**0784T**310.65*295.12*339.39
**0785T**219.64*208.66*239.96
#**0785T**136.52*129.69*149.14
**0786T**651.16*618.60*711.39
#**0786T**289.32*274.85*316.08
**0787T**219.64*208.66*239.96
#**0787T**136.52*129.69*149.14
**0788T**17.75*16.86*19.39
#**0788T**17.45*16.58*19.07
**0789T**22.18*21.07*24.23
#**0789T**21.81*20.72*23.83
**0790T**1826.52*1735.19*1995.47
**0791T**8.45*8.03*9.23
**0793T**550.97*523.42*601.93
**0794T**130.35*123.83*142.40
**0795T**678.86*644.92*741.66
**0796T**452.58*429.95*494.44
**0797T**452.58*429.95*494.44
**0798T**720.89*684.85*787.58
**0799T**480.60*456.57*525.06
**0800T**479.59*455.61*523.95
**0801T**933.17*886.51*1019.49
**0802T**466.59*443.26*509.75
**0803T**466.59*443.26*509.75
**0804T**70.69*67.16*77.23
**0804T*TC*36.50*34.68*39.88
**0804T*26*34.18*32.47*37.34
**0805T**2539.17*2412.21*2774.04
#**0805T**312.58*296.95*341.49
**0806T**3385.56*3216.28*3698.72
#**0806T**416.77*395.93*455.32
**0807T**39.12*37.16*42.73
**0807T*TC*24.76*23.52*27.05
**0807T*26*14.37*13.65*15.70
**0808T**39.12*37.16*42.73
**0808T*TC*24.76*23.52*27.05
**0808T*26*14.37*13.65*15.70
**0810T**1051.58*999.00*1148.85
**0811T**18.09*17.19*19.77
**0813T**2141.60*2034.52*2339.70
#**0813T**169.65*161.17*185.35
**0814T**387.75*368.36*423.61
#**0814T**291.56*276.98*318.53
**0820T**145.87*138.58*159.37
#**0820T**129.42*122.95*141.39
**0821T**145.87*138.58*159.37
#**0821T**129.42*122.95*141.39
**0822T**123.99*117.79*135.46
#**0822T**110.01*104.51*120.19
**0823T**678.86*644.92*741.66
**0824T**720.89*684.85*787.58
**0825T**933.17*886.51*1019.49
**0826T**60.64*57.61*66.25
**0826T*TC*31.51*29.93*34.42
**0826T*26*29.13*27.67*31.82
**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**20.59*19.56*22.49
**0859T*TC*17.71*16.82*19.34
**0859T*26*2.88*2.74*3.15
**0864T**286.10*271.80*312.57
#**0864T**211.50*200.93*231.07
**0867T**1523.90*1447.71*1664.87
#**0867T**423.97*402.77*463.19
**0868T**369.23*350.77*403.39
**0868T*TC*344.90*327.66*376.81
**0868T*26*24.33*23.11*26.58
**0869T**330.62*314.09*361.20
#**0869T**253.67*240.99*277.14
**0876T**131.57*124.99*143.74
**0876T*TC*107.75*102.36*117.71
**0876T*26*25.76*24.47*28.14
**0884T**903.50*858.33*987.08
#**0884T**178.78*169.84*195.32
**0885T**604.01*573.81*659.88
#**0885T**287.39*273.02*313.97
**0886T**497.97*473.07*544.03
#**0886T**100.14*95.13*109.40
**0897T**53.04*50.39*57.95
**0897T*TC*47.16*44.80*51.52
**0897T*26*7.64*7.26*8.35
**0898T**63.12*59.96*68.95
**0898T*TC*54.21*51.50*59.23
**0898T*26*8.90*8.46*9.73
**0899T**117.34*111.47*128.19
**0899T*TC*75.94*72.14*82.96
**0899T*26*39.64*37.66*43.31
**0900T**115.58*109.80*126.27
**0900T*TC*75.94*72.14*82.96
**0900T*26*39.64*37.66*43.31
**10011**376.91*358.06*411.77
#**10011**102.88*97.74*112.40
**10012**213.47*202.80*233.22
#**10012**69.85*66.36*76.31
**15847**337.45*320.58*368.67
**21742**1115.87*1060.08*1219.09
**21743**1332.39*1265.77*1455.64
**32855**344.68*327.45*376.57
**32856**438.41*416.49*478.96
**33928**3220.22*3059.21*3518.09
**33929**1205.86*1145.57*1317.41
**33933**529.04*502.59*577.98
**33944**529.04*502.59*577.98
**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**511.84*486.25*559.19
#**43648**232.48*220.86*253.99
**43881**652.36*619.74*712.70
#**43881**600.24*570.23*655.76
**43882**688.41*653.99*752.09
#**43882**632.30*600.69*690.79
**47143**414.19*393.48*452.50
**47144**491.86*467.27*537.36
**47145**465.96*442.66*509.06
**48551**259.86*246.87*283.90
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**722.04*685.94*788.83
**53452**361.02*342.97*394.42
**53453**613.73*583.04*670.50
**53454**52.44*49.82*57.29
#**53454**33.35*31.68*36.43
**63043**560.93*532.88*612.81
**63044**503.36*478.19*549.92
**64596**1827.64*1736.26*1996.70
#**64596**310.65*295.12*339.39
**64597**548.49*521.07*599.23
#**64597**93.39*88.72*102.03
**64598**219.64*208.66*239.96
#**64598**136.52*129.69*149.14
**65757**115.54*109.76*126.22
**66983**614.26*583.55*671.08
**66987**719.38*683.41*785.92
**66988**593.45*563.78*648.35
*C*70170**233.18*221.52*254.75
*C*70170*TC*219.48*208.51*239.79
**70555**241.72*229.63*264.07
**70555*TC*129.37*122.90*141.34
*C*70557**639.83*607.84*699.02
*C*70557*TC*497.92*473.02*543.97
*C*70558**318.69*302.76*348.17
*C*70558*TC*161.62*153.54*176.57
*C*70559**312.17*296.56*341.04
*C*70559*TC*161.62*153.54*176.57
*C*74190**518.69*492.76*566.67
*C*74190*TC*497.92*473.02*543.97
**74235**136.13*129.32*148.72
**74235*TC*82.82*78.68*90.48
**74300**77.04*73.19*84.17
**74300*TC*64.61*61.38*70.59
**74301**23.92*22.72*26.13
**74301*TC*14.40*13.68*15.73
**74328**175.06*166.31*191.26
**74328*TC*153.52*145.84*167.72
**74329**131.09*124.54*143.22
**74329*TC*109.25*103.79*119.36
**74330**262.59*249.46*286.88
**74330*TC*237.26*225.40*259.21
**74340**86.58*82.25*94.59
**74340*TC*62.40*59.28*68.17
**74355**86.58*82.25*94.59
**74355*TC*52.26*49.65*57.10
**74360**86.58*82.25*94.59
**74360*TC*61.13*58.07*66.78
**74363**175.06*166.31*191.26
**74363*TC*137.27*130.41*149.97
*C*74445**147.15*139.79*160.76
*C*74445*TC*96.71*91.87*105.65
*C*74450**234.06*222.36*255.71
*C*74450*TC*219.48*208.51*239.79
*C*74470**521.81*495.72*570.08
*C*74470*TC*497.92*473.02*543.97
**74742**233.47*221.80*255.07
**74742*TC*206.14*195.83*225.20
*C*74775**247.43*235.06*270.32
*C*74775*TC*219.48*208.51*239.79
*C*75801**602.47*572.35*658.20
*C*75801*TC*561.36*533.29*613.28
*C*75803**1462.83*1389.69*1598.14
*C*75803*TC*1410.46*1339.94*1540.93
*C*75805**2894.67*2749.94*3162.43
*C*75805*TC*2858.14*2715.23*3122.51
*C*75807**2907.74*2762.35*3176.70
*C*75807*TC*2858.14*2715.23*3122.51
*C*75810**2904.68*2759.45*3173.37
*C*75810*TC*2858.14*2715.23*3122.51
**75894**827.00*785.65*903.50
**75894*TC*757.86*719.97*827.97
*C*75898**2945.72*2798.43*3218.19
*C*75898*TC*2858.14*2715.23*3122.51
**75970**404.06*383.86*441.44
**75970*TC*368.56*350.13*402.65
**76125**37.01*35.16*40.43
**76125*TC*24.29*23.08*26.54
**76390**188.34*178.92*205.76
**76390*TC*138.42*131.50*151.23
**76390*26*49.92*47.42*54.53
**76932**79.17*75.21*86.49
**76932*TC*45.65*43.37*49.88
**76940**153.03*145.38*167.19
**76940*TC*56.58*53.75*61.81
**76941**109.10*103.65*119.20
**76941*TC*49.35*46.88*53.91
**76945**78.19*74.28*85.42
**76945*TC*48.50*46.08*52.99
*C*76975**257.40*244.53*281.21
*C*76975*TC*219.48*208.51*239.79
**76998**175.06*166.31*191.26
**76998*TC*130.16*123.65*142.20
**77013**384.59*365.36*420.16
**77013*TC*211.39*200.82*230.94
**77022**433.70*412.02*473.82
**77022*TC*245.16*232.90*267.84
**77520**818.99*778.04*894.75
**77522**818.99*778.04*894.75
**77523**940.38*893.36*1027.36
**77525**1061.74*1008.65*1159.95
*C*78282**379.30*360.34*414.39
*C*78282*TC*364.87*346.63*398.62
**78414**514.99*489.24*562.63
**78414*TC*495.36*470.59*541.18
*C*78429**1398.80*1328.86*1528.19
*C*78429*TC*1324.41*1258.19*1446.92
*C*78430**1394.63*1324.90*1523.64
*C*78430*TC*1324.41*1258.19*1446.92
*C*78431**2125.55*2019.27*2322.16
*C*78431*TC*2043.40*1941.23*2232.41
*C*78432**1770.84*1682.30*1934.65
*C*78432*TC*1680.38*1596.36*1835.81
*C*78433**1867.74*1774.35*2040.50
*C*78433*TC*1771.13*1682.57*1934.96
**78434**637.95*606.05*696.96
**78434*TC*610.65*580.12*667.14
*C*78459**1254.44*1191.72*1370.48
*C*78459*TC*1185.48*1126.21*1295.14
*C*78491**1392.04*1322.44*1520.81
*C*78491*TC*1324.41*1258.19*1446.92
*C*78492**1402.74*1332.60*1532.49
*C*78492*TC*1324.41*1258.19*1446.92
*C*78608**1389.21*1319.75*1517.71
*C*78608*TC*1324.41*1258.19*1446.92
*C*78811**1252.55*1189.92*1368.41
*C*78811*TC*1185.48*1126.21*1295.14
*C*78812**1408.67*1338.24*1538.98
*C*78812*TC*1324.41*1258.19*1446.92
*C*78813**1410.34*1339.82*1540.79
*C*78813*TC*1324.41*1258.19*1446.92
*C*78814**1420.21*1349.20*1551.58
*C*78814*TC*1324.41*1258.19*1446.92
*C*78815**1431.67*1360.09*1564.10
*C*78815*TC*1324.41*1258.19*1446.92
*C*78816**1432.27*1360.66*1564.76
*C*78816*TC*1324.41*1258.19*1446.92
**79300**237.04*225.19*258.97
**79300*TC*176.89*168.05*193.26
**79445**237.04*225.19*258.97
**79445*TC*132.78*126.14*145.06
**86485**17.28*16.42*18.88
**90867**273.22*259.56*298.49
#**90867**129.16*122.70*141.11
**90868**185.60*176.32*202.77
#**90868**106.77*101.43*116.64
**90869**221.44*210.37*241.93
#**90869**149.77*142.28*163.62
**92978**227.44*216.07*248.48
**92978*TC*137.82*130.93*150.57
**92979**139.18*132.22*152.05
**92979*TC*67.68*64.30*73.95
*C*93315**614.69*583.96*671.55
*C*93315*TC*497.92*473.02*543.97
**93317**199.58*189.60*218.04
**93317*TC*117.01*111.16*127.83
*C*93318**593.71*564.02*648.62
*C*93318*TC*497.92*473.02*543.97
**93571**226.54*215.21*247.49
**93571*TC*158.33*150.41*172.97
**93572**137.01*130.16*149.68
**93572*TC*87.56*83.18*95.66
**93600**3557.81*3379.92*3886.91
**93600*TC*3448.81*3276.37*3767.83
**93602**3557.81*3379.92*3886.91
**93602*TC*3450.07*3277.57*3769.21
**93603**3557.81*3379.92*3886.91
**93603*TC*3450.07*3277.57*3769.21
**93609**2134.69*2027.96*2332.15
**93609*TC*1878.78*1784.84*2052.57
**93610**3557.81*3379.92*3886.91
**93610*TC*3406.08*3235.78*3721.15
**93612**3557.81*3379.92*3886.91
**93612*TC*3407.89*3237.50*3723.13
**93615**46.29*43.98*50.58
**93615*TC*13.30*12.64*14.54
**93619**7115.62*6759.84*7773.82
**93619*TC*6755.23*6417.47*7380.09
**93620**7115.62*6759.84*7773.82
**93620*TC*6534.78*6208.04*7139.25
**93621**7115.62*6759.84*7773.82
**93621*TC*7038.57*6686.64*7689.64
**93622**7115.62*6759.84*7773.82
**93622*TC*6955.59*6607.81*7598.98
**93623**2134.69*2027.96*2332.15
**93623*TC*2083.24*1979.08*2275.94
**93624**3557.81*3379.92*3886.91
**93624*TC*3331.83*3165.24*3640.03
**93631**7115.62*6759.84*7773.82
**93631*TC*6743.38*6406.21*7367.14
**93640**1133.95*1077.25*1238.84
**93640*TC*968.07*919.67*1057.62
**93641**1133.95*1077.25*1238.84
**93641*TC*845.24*802.98*923.43
**93662**354.69*336.96*387.50
**93662*TC*290.72*276.18*317.61
**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**909.00*863.55*993.08
**95965*TC*533.90*507.21*583.29
**95966**532.61*505.98*581.88
**95966*TC*348.29*330.88*380.51
**95967**448.07*425.67*489.52
**95967*TC*288.96*274.51*315.69
**96020**373.48*354.81*408.03
**97151**48.62*46.19*53.12
#**97151**42.19*40.08*46.09
**97152**40.11*38.10*43.82
#**97152**35.87*34.08*39.19
**97153**33.38*31.71*36.47
#**97153**29.56*28.08*32.29
**97154**4.40*4.18*4.81
#**97154**4.03*3.83*4.40
**97155**31.95*30.35*34.90
#**97155**28.28*26.87*30.90
**97156**33.71*32.02*36.82
#**97156**29.90*28.41*32.67
**97157**9.84*9.35*10.75
#**97157**8.96*8.51*9.79
**97158**5.11*4.85*5.58
#**97158**4.67*4.44*5.11
**98978**39.15*37.19*42.77
# - 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.