COLORADO MEDICARE CARRIER - 04112
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
STATEWIDE
******
**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**471.99*448.39*515.65
#**G0186**403.99*383.79*441.36
**G0339**2842.14*2700.03*3105.03
**G0340**2137.47*2030.60*2335.19
**G0398**141.36*134.29*154.43
**G0398*TC*102.20*97.09*111.65
**G0398*26*39.16*37.20*42.78
**G0399**97.43*92.56*106.44
**G0399*TC*54.18*51.47*59.19
**G0399*26*43.60*41.42*47.63
**G0400**100.70*95.67*110.02
**G0400*TC*60.14*57.13*65.70
**G0400*26*40.56*38.53*44.31
**G0460**832.28*790.67*909.27
#**G0460**120.38*114.36*131.51
**G0465**832.28*790.67*909.27
#**G0465**120.38*114.36*131.51
**G0498**154.09*146.39*168.35
**G6017**80.31*76.29*87.73
**0042T**236.00*224.20*257.83
**0054T**227.14*215.78*248.15
**0055T**227.14*215.78*248.15
**0071T**578.81*549.87*632.35
**0072T**578.81*549.87*632.35
**0075T**955.09*907.34*1043.44
**0075T*TC*955.09*907.34*1043.44
**0075T*26*956.86*909.02*1045.37
**0095T**621.41*590.34*678.89
**0098T**694.88*660.14*759.16
**0100T**1934.84*1838.10*2113.82
**0101T**322.41*306.29*352.23
#**0101T**229.52*218.04*250.75
**0102T**322.41*306.29*352.23
#**0102T**229.52*218.04*250.75
**0106T**35.18*33.42*38.43
**0107T**35.18*33.42*38.43
**0108T**35.18*33.42*38.43
**0109T**35.18*33.42*38.43
**0110T**35.18*33.42*38.43
**0164T**679.89*645.90*742.79
**0165T**696.41*661.59*760.83
**0184T**833.19*791.53*910.26
**0198T**88.32*83.90*96.49
#**0198T**32.23*30.62*35.21
**0200T**1850.63*1758.10*2021.82
#**0200T**404.40*384.18*441.81
**0201T**2775.95*2637.15*3032.72
#**0201T**606.59*576.26*662.70
**0207T**121.71*115.62*132.96
**0208T**39.88*37.89*43.57
**0209T**48.30*45.89*52.77
**0210T**30.42*28.90*33.24
**0211T**47.24*44.88*51.61
**0212T**37.16*35.30*40.60
#**0212T**31.90*30.31*34.86
**0213T**198.87*188.93*217.27
#**0213T**105.98*100.68*115.78
**0214T**99.71*94.72*108.93
#**0214T**59.05*56.10*64.52
**0215T**100.06*95.06*109.32
#**0215T**60.10*57.10*65.67
**0216T**183.42*174.25*200.39
#**0216T**91.23*86.67*99.67
**0217T**93.44*88.77*102.09
#**0217T**50.68*48.15*55.37
**0218T**93.44*88.77*102.09
#**0218T**51.73*49.14*56.51
**0219T**1319.45*1253.48*1441.50
**0220T**1297.80*1232.91*1417.85
**0221T**1589.17*1509.71*1736.17
**0222T**384.83*365.59*420.43
**0232T**832.28*790.67*909.27
#**0232T**120.38*114.36*131.51
**0234T**8961.07*8513.02*9789.97
#**0234T**573.54*544.86*626.59
**0235T**8961.07*8513.02*9789.97
#**0235T**573.54*544.86*626.59
**0236T**9113.50*8657.83*9956.50
#**0236T**664.63*631.40*726.11
**0237T**9113.50*8657.83*9956.50
#**0237T**664.63*631.40*726.11
**0238T**9113.50*8657.83*9956.50
#**0238T**664.63*631.40*726.11
**0266T**893.21*848.55*975.83
**0267T**156.14*148.33*170.58
**0268T**333.51*316.83*364.35
**0269T**847.36*804.99*925.74
**0270T**156.14*148.33*170.58
**0271T**333.51*316.83*364.35
**0272T**58.09*55.19*63.47
**0273T**73.94*70.24*80.78
**0274T**1111.61*1056.03*1214.43
**0278T**14.62*13.89*15.97
**0308T**1421.13*1350.07*1552.58
**0329T**88.32*83.90*96.49
#**0329T**32.23*30.62*35.21
**0330T**38.21*36.30*41.75
**0331T**191.06*181.51*208.74
**0332T**326.32*310.00*356.50
**0347T**141.19*134.13*154.25
**0348T**34.25*32.54*37.42
**0349T**36.38*34.56*39.74
**0350T**37.09*35.24*40.53
**0351T**176.91*168.06*193.27
**0352T**43.44*41.27*47.46
**0353T**176.91*168.06*193.27
**0354T**43.44*41.27*47.46
**0358T**28.32*26.90*30.94
**0362T**92.99*88.34*101.59
#**0362T**66.00*62.70*72.11
**0378T**24.99*23.74*27.30
**0394T**260.64*247.61*284.75
**0395T**629.17*597.71*687.37
**0397T**47.33*44.96*51.70
**0398T*26*1746.88*1659.54*1908.47
**0408T**507.26*481.90*554.19
**0409T**352.43*334.81*385.03
**0410T**366.90*348.56*400.84
**0411T**366.90*348.56*400.84
**0412T**232.44*220.82*253.94
**0413T**476.05*452.25*520.09
**0414T**367.32*348.95*401.29
**0415T**305.55*290.27*333.81
**0416T**341.14*324.08*372.69
**0417T**86.06*81.76*94.02
**0418T**58.09*55.19*63.47
**0419T**461.69*438.61*504.40
#**0419T**367.75*349.36*401.76
**0420T**652.97*620.32*713.37
#**0420T**536.95*510.10*586.62
**0421T**1660.44*1577.42*1814.03
#**0421T**696.86*662.02*761.32
**0437T**212.47*201.85*232.13
**0439T**74.10*70.40*80.96
**0440T**256.94*244.09*280.70
#**0440T**120.24*114.23*131.36
**0441T**256.94*244.09*280.70
#**0441T**120.24*114.23*131.36
**0442T**256.94*244.09*280.70
#**0442T**120.24*114.23*131.36
**0449T**777.95*739.05*849.91
**0464T**70.13*66.62*76.61
**0472T**69.25*65.79*75.66
**0473T**58.09*55.19*63.47
**0479T**63.80*60.61*69.70
**0480T**161.59*153.51*176.54
#**0480T**31.90*30.31*34.86
**0483T**1168.45*1110.03*1276.53
**0484T**1514.61*1438.88*1654.71
**0485T**24.23*23.02*26.47
**0485T*TC*9.21*8.75*10.06
**0485T*26*15.29*14.53*16.71
**0486T**48.46*46.04*52.95
**0486T*TC*18.15*17.24*19.83
**0486T*26*30.31*28.79*33.11
**0488T**63.87*60.68*69.78
#**0488T**50.20*47.69*54.84
**0505T**11147.17*10589.81*12178.28
#**0505T**561.88*533.79*613.86
**0507T**24.31*23.09*26.55
**0507T*TC*21.31*20.24*23.28
**0507T*26*3.00*2.85*3.28
**0510T**617.88*586.99*675.04
#**0510T**428.61*407.18*468.26
**0512T**322.41*306.29*352.23
#**0512T**229.52*218.04*250.75
**0513T**96.72*91.88*105.66
#**0513T**68.86*65.42*75.23
**0515T**507.26*481.90*554.19
**0516T**468.53*445.10*511.87
**0517T**333.51*316.83*364.35
**0518T**232.44*220.82*253.94
**0519T**334.60*317.87*365.55
**0520T**468.53*445.10*511.87
**0521T**58.09*55.19*63.47
**0521T*TC*37.78*35.89*41.27
**0521T*26*20.31*19.29*22.18
**0522T**69.25*65.79*75.66
**0522T*TC*38.48*36.56*42.04
**0522T*26*30.77*29.23*33.61
**0523T**155.72*147.93*170.12
**0524T**1716.34*1630.52*1875.10
#**0524T**173.71*165.02*189.77
**0525T**468.88*445.44*512.26
**0526T**366.90*348.56*400.84
**0527T**318.59*302.66*348.06
**0528T**69.25*65.79*75.66
**0528T*TC*38.48*36.56*42.04
**0528T*26*30.77*29.23*33.61
**0529T**58.09*55.19*63.47
**0529T*TC*37.78*35.89*41.27
**0529T*26*20.31*19.29*22.18
**0530T**626.09*594.79*684.01
**0531T**476.05*452.25*520.09
**0532T**334.60*317.87*365.55
**0540T**179.43*170.46*196.03
**0543T**1514.61*1438.88*1654.71
**0544T**1748.00*1660.60*1909.69
**0545T**1748.00*1660.60*1909.69
**0546T**74.09*70.39*80.95
**0552T**6.85*6.51*7.49
**0553T**2556.64*2428.81*2793.13
#**0553T**383.08*363.93*418.52
**0565T**626.52*595.19*684.47
#**0565T**521.71*495.62*569.96
**0566T**102.03*96.93*111.47
#**0566T**58.91*55.96*64.35
**0569T**1748.00*1660.60*1909.69
**0570T**408.45*388.03*446.23
**0571T**549.23*521.77*600.04
**0572T**446.57*424.24*487.88
**0573T**342.18*325.07*373.83
**0574T**395.67*375.89*432.27
**0575T**69.25*65.79*75.66
**0576T**58.09*55.19*63.47
**0577T**194.14*184.43*212.09
**0578T**29.30*27.84*32.02
**0579T**22.36*21.24*24.43
**0580T**213.46*202.79*233.21
**0581T**2371.19*2252.63*2590.52
#**0581T**207.10*196.75*226.26
**0582T**1727.35*1640.98*1887.13
#**0582T**388.02*368.62*423.91
**0583T**1522.66*1446.53*1663.51
#**0583T**135.82*129.03*148.38
**0587T**452.01*429.41*493.82
#**0587T**296.38*281.56*323.79
**0588T**373.58*354.90*408.14
#**0588T**231.62*220.04*253.05
**0589T**48.78*46.34*53.29
#**0589T**38.61*36.68*42.18
**0590T**57.79*54.90*63.14
#**0590T**39.91*37.91*43.60
**0596T**672.69*639.06*734.92
#**0596T**130.73*124.19*142.82
**0597T**672.69*639.06*734.92
#**0597T**130.73*124.19*142.82
**0598T**158.59*150.66*173.26
**0599T**105.41*100.14*115.16
**0600T**3724.99*3538.74*4069.55
#**0600T**719.65*683.67*786.22
**0601T**1439.07*1367.12*1572.19
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**203.13*192.97*221.92
**0611T**42.61*40.48*46.55
**0614T**366.59*348.26*400.50
**0615T**48.19*45.78*52.65
**0616T**674.15*640.44*736.51
**0617T**753.70*716.02*823.42
**0618T**912.75*867.11*997.18
**0619T**667.69*634.31*729.46
#**0619T**480.92*456.87*525.40
**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**267.95*254.55*292.73
#**0627T**99.70*94.72*108.93
**0628T**80.39*76.37*87.83
#**0628T**29.91*28.41*32.67
**0629T**267.95*254.55*292.73
#**0629T**99.70*94.72*108.93
**0630T**80.39*76.37*87.83
#**0630T**29.91*28.41*32.67
**0631T**85.83*81.54*93.77
**0632T**563.09*534.94*615.18
**0633T**209.24*198.78*228.60
*C*0633T*TC*112.09*106.49*122.46
**0633T*26*59.02*56.07*64.48
**0634T**209.24*198.78*228.60
**0634T*TC*150.22*142.71*164.12
**0634T*26*59.02*56.07*64.48
**0635T**209.24*198.78*228.60
**0635T*TC*150.22*142.71*164.12
**0635T*26*59.02*56.07*64.48
**0636T**209.24*198.78*228.60
**0636T*TC*150.22*142.71*164.12
**0636T*26*59.02*56.07*64.48
**0637T**209.24*198.78*228.60
**0637T*TC*150.22*142.71*164.12
**0637T*26*59.02*56.07*64.48
**0638T**209.24*198.78*228.60
**0638T*TC*150.22*142.71*164.12
**0638T*26*59.02*56.07*64.48
**0639T**85.83*81.54*93.77
**0640T**24.31*23.09*26.55
**0640T*TC*21.42*20.35*23.40
**0640T*26*3.00*2.85*3.28
**0644T**1205.88*1145.59*1317.43
#**0644T**233.90*222.21*255.54
**0646T**1748.00*1660.60*1909.69
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**61.74*58.65*67.45
**0652T**297.41*282.54*324.92
#**0652T**122.15*116.04*133.45
**0653T**389.55*370.07*425.58
#**0653T**137.88*130.99*150.64
**0654T**141.36*134.29*154.43
**0655T**1660.44*1577.42*1814.03
#**0655T**696.86*662.02*761.32
**0658T**99.82*94.83*109.05
**0659T**2800.85*2660.81*3059.93
#**0659T**422.24*401.13*461.30
**0671T**1045.61*993.33*1142.33
**0673T**3588.53*3409.10*3920.47
#**0673T**360.62*342.59*393.98
**0699T**115.14*109.38*125.79
#**0699T**92.01*87.41*100.52
**0707T**383.82*364.63*419.32
#**0707T**286.73*272.39*313.25
**0714T**1465.40*1392.13*1600.95
#**0714T**362.67*344.54*396.22
**0730T**269.50*256.03*294.43
#**0730T**240.88*228.84*263.17
**0738T**71.41*67.84*78.02
**0739T**1660.44*1577.42*1814.03
#**0739T**696.86*662.02*761.32
**0740T**20.88*19.84*22.82
**0741T**49.70*47.22*54.30
**0742T**97.89*93.00*106.95
**0742T*TC*78.75*74.81*86.03
**0742T*26*19.14*18.18*20.91
**0743T**55.41*52.64*60.54
**0744T**866.15*822.84*946.27
**0745T**270.07*256.57*295.06
**0746T**227.07*215.72*248.08
**0747T**1044.41*992.19*1141.02
**0748T**184.49*175.27*201.56
**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**4.40*4.18*4.81
**0765T**8.08*7.68*8.83
**0771T**26.24*24.93*28.67
**0772T**26.24*24.93*28.67
**0773T**24.19*22.98*26.43
**0774T**24.19*22.98*26.43
**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**458.87*435.93*501.32
**0779T*TC*432.81*411.17*472.85
**0779T*26*26.06*24.76*28.47
**0780T**24.19*22.98*26.43
**0783T**15.00*14.25*16.39
**0784T**2218.10*2107.20*2423.28
#**0784T**326.01*309.71*356.17
**0785T**249.76*237.27*272.86
#**0785T**146.36*139.04*159.90
**0786T**757.42*719.55*827.48
#**0786T**303.85*288.66*331.96
**0787T**249.76*237.27*272.86
#**0787T**146.36*139.04*159.90
**0788T**18.88*17.94*20.63
#**0788T**18.18*17.27*19.86
**0789T**25.87*24.58*28.27
#**0789T**22.72*21.58*24.82
**0790T**1927.40*1831.03*2105.68
**0791T**9.22*8.76*10.07
**0793T**563.09*534.94*615.18
**0794T**130.35*123.83*142.40
**0795T**702.79*667.65*767.80
**0796T**468.53*445.10*511.87
**0797T**468.53*445.10*511.87
**0798T**740.60*703.57*809.11
**0799T**493.73*469.04*539.40
**0800T**493.73*469.04*539.40
**0801T**962.26*914.15*1051.27
**0802T**481.13*457.07*525.63
**0803T**481.13*457.07*525.63
**0804T**80.99*76.94*88.48
**0804T*TC*44.44*42.22*48.55
**0804T*26*36.55*34.72*39.93
**0805T**3095.46*2940.69*3381.79
#**0805T**320.42*304.40*350.06
**0806T**4127.29*3920.93*4509.07
#**0806T**427.22*405.86*466.74
**0807T**44.12*41.91*48.20
**0807T*TC*29.37*27.90*32.09
**0807T*26*14.75*14.01*16.11
**0808T**44.12*41.91*48.20
**0808T*TC*29.37*27.90*32.09
**0808T*26*14.75*14.01*16.11
**0810T**1151.01*1093.46*1257.48
**0811T**20.88*19.84*22.82
**0813T**2724.19*2587.98*2976.18
#**0813T**178.73*169.79*195.26
**0814T**479.77*455.78*524.15
#**0814T**358.41*340.49*391.56
**0818T**373.58*354.90*408.14
#**0818T**231.62*220.04*253.05
**0820T**148.56*141.13*162.30
#**0820T**129.98*123.48*142.00
**0821T**148.56*141.13*162.30
#**0821T**129.98*123.48*142.00
**0822T**126.28*119.97*137.97
#**0822T**110.49*104.97*120.72
**0823T**702.79*667.65*767.80
**0824T**740.60*703.57*809.11
**0825T**962.26*914.15*1051.27
**0826T**69.25*65.79*75.66
**0826T*TC*38.48*36.56*42.04
**0826T*26*30.77*29.23*33.61
**0827T**0.01*0.01*0.01
**0828T**0.01*0.01*0.01
**0829T**0.01*0.01*0.01
**0830T**0.01*0.01*0.01
**0831T**0.01*0.01*0.01
**0832T**0.01*0.01*0.01
**0833T**0.01*0.01*0.01
**0834T**0.01*0.01*0.01
**0835T**0.01*0.01*0.01
**0836T**0.01*0.01*0.01
**0837T**0.01*0.01*0.01
**0838T**0.01*0.01*0.01
**0839T**0.01*0.01*0.01
**0840T**0.01*0.01*0.01
**0841T**0.01*0.01*0.01
**0842T**0.01*0.01*0.01
**0843T**0.01*0.01*0.01
**0844T**0.01*0.01*0.01
**0845T**0.01*0.01*0.01
**0846T**0.01*0.01*0.01
**0847T**0.01*0.01*0.01
**0848T**0.01*0.01*0.01
**0849T**0.01*0.01*0.01
**0850T**0.01*0.01*0.01
**0851T**0.01*0.01*0.01
**0852T**0.01*0.01*0.01
**0853T**0.01*0.01*0.01
**0854T**0.01*0.01*0.01
**0855T**0.01*0.01*0.01
**0856T**0.01*0.01*0.01
**0859T**24.31*23.09*26.55
**0859T*TC*21.31*20.24*23.28
**0859T*26*3.00*2.85*3.28
**0864T**322.41*306.29*352.23
#**0864T**229.52*218.04*250.75
**10011**443.27*421.11*484.28
#**10011**107.13*101.77*117.04
**10012**243.06*230.91*265.55
#**10012**70.61*67.08*77.14
**15847**354.72*336.98*387.53
**21742**1147.41*1090.04*1253.55
**21743**1313.72*1248.03*1435.23
**32855**347.84*330.45*380.02
**32856**443.82*421.63*484.87
**33928**3242.01*3079.91*3541.90
**33929**1214.60*1153.87*1326.95
**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
**50323**134.28*127.57*146.71
**50325**138.27*131.36*151.06
**53451**762.84*724.70*833.41
**53452**381.42*362.35*416.70
**53453**648.43*616.01*708.41
**53454**58.09*55.19*63.47
#**53454**35.30*33.54*38.57
**63043**570.55*542.02*623.32
**63044**511.75*486.16*559.08
**64596**2218.10*2107.20*2423.28
#**64596**326.01*309.71*356.17
**64597**665.43*632.16*726.98
#**64597**97.80*92.91*106.85
**64598**249.76*237.27*272.86
#**64598**146.36*139.04*159.90
**65757**121.30*115.24*132.53
**66983**674.15*640.44*736.51
**66987**773.09*734.44*844.61
**66988**645.60*613.32*705.32
*C*70170**264.32*251.10*288.77
*C*70170*TC*249.84*237.35*272.95
**70555**233.47*221.80*255.07
**70555*TC*115.50*109.73*126.19
*C*70557**714.92*679.17*781.05
*C*70557*TC*562.51*534.38*614.54
*C*70558**355.46*337.69*388.34
*C*70558*TC*187.45*178.08*204.79
*C*70559**344.04*326.84*375.87
*C*70559*TC*187.45*178.08*204.79
*C*74190**584.34*555.12*638.39
*C*74190*TC*562.51*534.38*614.54
**74235**148.36*140.94*162.08
**74235*TC*92.06*87.46*100.58
**74300**87.20*82.84*95.27
**74300*TC*74.08*70.38*80.94
**74301**26.73*25.39*29.20
**74301*TC*16.95*16.10*18.52
**74328**175.06*166.31*191.26
**74328*TC*152.08*144.48*166.15
**74329**144.99*137.74*158.40
**74329*TC*121.66*115.58*132.92
**74330**262.59*249.46*286.88
**74330*TC*235.61*223.83*257.40
**74340**86.58*82.25*94.59
**74340*TC*61.33*58.26*67.00
**74355**86.58*82.25*94.59
**74355*TC*50.51*47.98*55.18
**74360**86.58*82.25*94.59
**74360*TC*59.72*56.73*65.24
**74363**175.06*166.31*191.26
**74363*TC*133.99*127.29*146.38
*C*74445**165.46*157.19*180.77
*C*74445*TC*112.09*106.49*122.46
*C*74450**265.40*252.13*289.95
*C*74450*TC*249.84*237.35*272.95
*C*74470**587.06*557.71*641.37
*C*74470*TC*562.51*534.38*614.54
**74742**233.47*221.80*255.07
**74742*TC*204.46*194.24*223.38
*C*74775**279.18*265.22*305.00
*C*74775*TC*249.84*237.35*272.95
*C*75801**682.64*648.51*745.79
*C*75801*TC*640.67*608.64*699.94
*C*75803**1688.97*1604.52*1845.20
*C*75803*TC*1633.34*1551.67*1784.42
*C*75805**3289.42*3124.95*3593.69
*C*75805*TC*3250.97*3088.42*3551.68
*C*75807**3302.95*3137.80*3608.47
*C*75807*TC*3250.97*3088.42*3551.68
*C*75810**3298.29*3133.38*3603.39
*C*75810*TC*3250.97*3088.42*3551.68
**75894**928.90*882.46*1014.83
**75894*TC*858.93*815.98*938.38
*C*75898**3340.08*3173.08*3649.04
*C*75898*TC*3250.97*3088.42*3551.68
**75970**453.23*430.57*495.16
**75970*TC*416.02*395.22*454.50
**76125**40.51*38.48*44.25
**76125*TC*27.39*26.02*29.92
**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*50.86*48.32*55.57
**76940**156.88*149.04*171.40
**76940*TC*58.15*55.24*63.53
**76941**117.12*111.26*127.95
**76941*TC*53.11*50.45*58.02
**76945**85.37*81.10*93.27
**76945*TC*53.50*50.83*58.45
*C*76975**290.47*275.95*317.34
*C*76975*TC*249.84*237.35*272.95
**76998**175.06*166.31*191.26
**76998*TC*129.26*122.80*141.22
**77013**437.01*415.16*477.43
**77013*TC*256.64*243.81*280.38
**77022**486.37*462.05*531.36
**77022*TC*288.97*274.52*315.70
**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**435.67*413.89*475.97
*C*78282*TC*420.55*399.52*459.45
**78414**514.99*489.24*562.63
**78414*TC*494.01*469.31*539.71
*C*78429**1673.71*1590.02*1828.52
*C*78429*TC*1595.48*1515.71*1743.07
*C*78430**1670.07*1586.57*1824.56
*C*78430*TC*1595.48*1515.71*1743.07
*C*78431**2496.17*2371.36*2727.06
*C*78431*TC*2409.03*2288.58*2631.87
*C*78432**2073.81*1970.12*2265.64
*C*78432*TC*1980.70*1881.67*2163.92
*C*78433**2189.83*2080.34*2392.39
*C*78433*TC*2087.96*1983.56*2281.09
**78434**736.62*699.79*804.76
**78434*TC*707.92*672.52*773.40
*C*78459**1520.76*1444.72*1661.43
*C*78459*TC*1448.26*1375.85*1582.23
*C*78491**1666.73*1583.39*1820.90
*C*78491*TC*1595.48*1515.71*1743.07
*C*78492**1679.26*1595.30*1834.60
*C*78492*TC*1595.48*1515.71*1743.07
*C*78608**1663.94*1580.74*1817.85
*C*78608*TC*1595.48*1515.71*1743.07
*C*78811**1518.69*1442.76*1659.17
*C*78811*TC*1448.26*1375.85*1582.23
*C*78812**1684.45*1600.23*1840.26
*C*78812*TC*1595.48*1515.71*1743.07
*C*78813**1686.45*1602.13*1842.45
*C*78813*TC*1595.48*1515.71*1743.07
*C*78814**1696.24*1611.43*1853.14
*C*78814*TC*1595.48*1515.71*1743.07
*C*78815**1707.72*1622.33*1865.68
*C*78815*TC*1595.48*1515.71*1743.07
*C*78816**1708.76*1623.32*1866.82
*C*78816*TC*1595.48*1515.71*1743.07
**79300**237.04*225.19*258.97
**79300*TC*174.04*165.34*190.14
**79445**237.04*225.19*258.97
**79445*TC*129.17*122.71*141.12
**86485**19.92*18.92*21.76
**90867**309.40*293.93*338.02
#**90867**137.47*130.60*150.19
**90868**206.25*195.94*225.33
#**90868**106.44*101.12*116.29
**90869**284.41*270.19*310.72
#**90869**163.48*155.31*178.61
**92978**249.41*236.94*272.48
**92978*TC*157.92*150.02*172.52
**92979**150.80*143.26*164.75
**92979*TC*78.15*74.24*85.38
*C*93315**687.14*652.78*750.70
*C*93315*TC*562.51*534.38*614.54
**93317**216.95*206.10*237.02
**93317*TC*130.53*124.00*142.60
*C*93318**662.49*629.37*723.78
*C*93318*TC*562.51*534.38*614.54
**93571**248.38*235.96*271.35
**93571*TC*178.72*169.78*195.25
**93572**148.46*141.04*162.20
**93572*TC*97.76*92.87*106.80
**93600**3557.81*3379.92*3886.91
**93600*TC*3445.52*3273.24*3764.23
**93602**3557.81*3379.92*3886.91
**93602*TC*3447.47*3275.10*3766.37
**93603**3557.81*3379.92*3886.91
**93603*TC*3447.47*3275.10*3766.37
**93609**2134.69*2027.96*2332.15
**93609*TC*1871.28*1777.72*2044.38
**93610**3557.81*3379.92*3886.91
**93610*TC*3402.00*3231.90*3716.69
**93612**3557.81*3379.92*3886.91
**93612*TC*3404.23*3234.02*3719.12
**93615**35.61*33.83*38.90
**93615*TC*0.64*0.61*0.70
**93619**7115.62*6759.84*7773.82
**93619*TC*6743.62*6406.44*7367.41
**93620**7115.62*6759.84*7773.82
**93620*TC*6518.87*6192.93*7121.87
**93621**7115.62*6759.84*7773.82
**93621*TC*7036.27*6684.46*7687.13
**93622**7115.62*6759.84*7773.82
**93622*TC*6951.90*6604.31*7594.96
**93623**2134.69*2027.96*2332.15
**93623*TC*2068.18*1964.77*2259.49
**93624**3557.81*3379.92*3886.91
**93624*TC*3326.94*3160.59*3634.68
**93631**7115.62*6759.84*7773.82
**93631*TC*6735.83*6399.04*7358.90
**93640**1133.95*1077.25*1238.84
**93640*TC*963.61*915.43*1052.74
**93641**1133.95*1077.25*1238.84
**93641*TC*836.30*794.49*913.66
**93662**430.71*409.17*470.55
**93662*TC*361.31*343.24*394.73
**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
**96547**780.23*741.22*852.40
#**96547**136.33*129.51*148.94
**96548**390.11*370.60*426.19
#**96548**68.16*64.75*74.46
**97151**50.14*47.63*54.77
#**97151**44.18*41.97*48.27
**97152**42.62*40.49*46.56
#**97152**37.55*35.67*41.02
**97153**33.94*32.24*37.08
#**97153**29.56*28.08*32.29
**97154**4.60*4.37*5.03
#**97154**4.16*3.95*4.54
**97155**33.94*32.24*37.08
#**97155**29.56*28.08*32.29
**97156**35.79*34.00*39.10
#**97156**31.23*29.67*34.12
**97157**10.46*9.94*11.43
#**97157**9.41*8.94*10.28
**97158**5.37*5.10*5.87
#**97158**4.84*4.60*5.29
**98978**49.70*47.22*54.30
# - 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.