Capped Rental - 2006 Region A DMERC Fee Schedule Inclusion or exclusion of a fee schedule amount for an item or service does not imply any health insurance coverage. HCPCS MOD1 MOD2 Ceiling Floor CT DE MA ME NH NJ NY PA RI VT --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- E0165 RR 18.58 15.79 18.58 16.00 15.79 15.79 15.79 18.22 18.58 15.79 18.58 15.79 E0166 RR 31.14 26.47 26.47 31.14 31.14 31.14 31.14 26.47 31.14 26.47 31.14 31.14 E0170 RR 160.72 136.61 160.72 160.72 160.72 160.72 160.72 160.72 160.72 160.72 160.72 160.72 E0171 RR 28.92 24.58 28.92 28.92 28.92 28.92 28.92 28.92 28.92 28.92 28.92 28.92 E0180 RR 21.73 18.47 21.73 21.19 21.73 21.73 21.73 20.37 21.05 20.79 18.47 21.73 E0181 RR 24.08 20.47 24.08 23.49 24.08 24.08 24.08 22.60 23.33 23.06 20.47 24.08 E0182 RR 26.18 22.25 22.25 26.18 22.25 22.25 22.25 26.18 22.42 26.18 22.25 22.25 E0186 RR 20.30 17.26 20.30 20.30 17.26 17.26 17.26 20.30 20.30 20.30 18.60 17.26 E0187 RR 23.21 19.73 23.21 23.21 19.73 19.73 19.73 22.57 23.21 23.21 19.73 19.73 E0193 RR 903.46 767.94 895.06 842.90 903.46 903.46 903.46 869.41 895.83 903.46 767.94 903.46 E0194 RR 3254.34 2766.19 3254.34 3254.34 3254.34 3254.34 3254.34 3149.86 2766.19 3216.94 3040.96 3254.34 E0196 RR 32.49 27.62 32.49 31.93 27.62 27.62 27.62 27.62 32.49 32.49 27.62 27.62 E0202 RR 62.61 53.22 54.22 62.61 60.28 62.32 57.22 62.61 62.61 62.61 53.22 59.79 E0235 RR 17.26 14.67 17.26 17.26 15.76 16.21 14.88 17.26 17.26 17.26 14.67 15.55 E0236 RR 44.25 37.61 39.23 39.85 44.25 44.25 44.25 38.28 38.52 39.11 37.61 44.25 E0250 RR 97.76 83.10 97.76 97.76 97.76 97.76 97.76 92.92 83.10 97.76 84.29 97.76 E0251 RR 74.08 62.97 74.08 74.08 74.08 74.08 74.08 67.67 67.61 74.08 74.08 74.08 E0255 RR 117.48 99.86 117.48 117.48 117.48 117.48 117.48 101.58 117.48 114.37 99.86 117.48 E0256 RR 83.35 70.85 83.35 78.46 83.35 83.35 83.35 70.85 83.35 78.09 83.35 83.35 E0260 RR 0.00 0.00 140.45 140.46 140.46 140.45 140.46 140.46 140.46 140.46 140.47 140.45 E0261 RR 136.94 116.40 136.94 136.94 136.94 136.94 136.94 116.40 136.94 128.65 116.40 136.94 E0265 RR 199.88 169.90 193.79 199.88 199.88 199.88 194.63 192.12 199.88 199.88 169.90 199.88 E0266 RR 177.59 150.95 153.96 150.95 177.59 177.59 177.59 177.59 177.59 177.59 150.95 177.59 E0277 RR 0.00 0.00 703.47 645.46 703.47 703.47 703.47 645.46 703.47 645.46 703.47 703.47 E0290 RR 74.74 63.53 74.74 74.74 74.74 74.74 74.74 63.53 73.63 74.74 74.74 74.74 E0291 RR 54.30 46.16 54.30 54.30 54.30 54.30 54.30 46.16 54.30 54.30 54.30 54.30 E0292 RR 84.04 71.43 84.04 77.88 84.04 84.04 84.04 71.43 84.04 81.07 74.71 84.04 E0293 RR 71.51 60.78 71.51 71.51 71.51 71.51 71.51 68.69 71.51 71.51 60.78 71.51 E0294 RR 130.65 111.05 130.65 130.65 130.65 130.65 130.65 111.47 130.65 130.65 111.05 130.65 E0295 RR 127.35 108.25 109.20 127.35 127.35 127.35 127.35 111.47 127.35 127.35 108.25 127.35 E0296 RR 164.20 139.57 162.35 164.20 164.20 164.20 164.20 140.95 164.20 164.20 139.57 164.20 E0297 RR 140.67 119.57 122.51 119.57 140.67 140.67 138.79 140.67 140.67 140.67 119.57 140.67 E0301 RR 270.72 230.11 270.72 264.08 270.72 270.72 270.72 252.58 262.10 258.66 230.11 270.72 E0302 RR 715.44 608.12 715.44 715.44 715.44 715.44 715.44 715.44 715.44 715.44 715.44 715.44 E0303 RR 303.98 258.38 303.98 297.32 303.98 303.98 303.98 285.83 295.35 291.90 258.38 303.98 E0304 RR 770.67 655.07 770.67 770.67 770.67 770.67 770.67 770.67 770.67 770.67 770.67 770.67 E0305 RR 17.79 15.12 17.79 17.79 17.79 17.79 17.79 15.12 15.12 16.00 16.17 17.79 E0316 RR 211.28 179.59 211.28 211.28 211.28 211.28 211.28 211.28 211.28 211.28 211.28 211.28 E0371 RR 444.48 377.81 444.48 433.84 444.48 444.48 444.48 417.09 431.00 425.96 377.81 444.48 E0372 RR 539.34 458.44 539.34 526.47 539.34 539.34 539.34 506.09 522.98 516.87 458.44 539.34 E0373 RR 614.47 522.30 614.47 603.06 614.47 614.47 614.47 579.75 599.09 592.09 522.30 614.47 E0459 RR 50.89 43.26 50.89 50.89 50.89 50.89 50.89 50.89 50.89 50.89 50.89 50.89 E0462 RR 291.40 247.69 269.22 291.40 247.69 247.69 247.69 291.40 247.69 291.40 247.69 247.69 E0470 RR 256.60 218.11 239.78 218.11 231.77 238.54 229.82 218.11 256.60 218.11 237.89 230.98 E0480 RR 43.94 37.35 43.94 43.94 43.94 43.94 43.94 43.94 37.35 43.94 37.35 43.94 E0482 RR 430.02 365.52 430.02 419.73 430.02 430.02 430.02 403.53 416.98 412.10 365.52 430.02 E0483 RR 1063.13 903.66 1063.13 1063.13 1063.13 1063.13 1063.13 1063.13 1063.13 1063.13 1063.13 1063.13 E0550 RR 50.13 42.61 42.61 50.13 42.61 42.61 42.61 50.13 50.13 50.13 42.61 42.61 E0565 RR 61.01 51.86 61.01 51.86 61.01 61.01 61.01 51.86 61.01 61.01 61.01 61.01 E0570 RR 0.00 0.00 16.10 16.10 16.11 16.11 16.11 16.10 16.10 16.10 16.10 16.11 E0571 RR 29.97 25.47 29.97 29.40 29.97 29.97 29.97 28.28 29.21 28.86 25.47 29.97 E0572 RR 38.09 32.38 38.09 37.38 38.09 38.09 38.09 35.93 37.13 36.71 32.38 38.09 E0574 RR 40.26 34.22 40.26 39.52 40.26 40.26 40.26 37.97 39.27 38.80 34.22 40.26 E0585 RR 35.07 29.81 35.07 35.07 29.81 29.81 29.81 35.07 35.07 35.07 35.07 29.81 E0600 RR 45.79 38.92 45.79 45.79 45.79 45.79 45.79 44.03 45.79 45.79 45.79 45.79 E0601 RR 111.71 94.95 102.24 104.09 96.99 99.82 96.18 100.10 111.71 102.23 111.71 96.64 E0606 RR 22.94 19.50 22.94 19.50 22.94 22.94 22.89 19.50 20.96 19.50 19.50 22.94 E0617 RR 304.05 258.44 304.05 304.05 304.05 304.05 304.05 304.05 304.05 304.05 304.05 304.05 E0617 RR KF 328.70 279.40 328.70 328.70 328.70 328.70 328.70 328.70 328.70 328.70 328.70 328.70 E0618 RR 280.35 238.30 280.35 255.08 280.35 280.35 280.35 245.23 280.35 250.47 280.35 280.35 E0619 RR 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 E0630 RR 101.89 86.61 87.68 101.89 101.89 101.89 92.09 96.83 101.89 101.89 97.45 96.27 E0635 RR 122.36 104.01 104.01 104.01 122.36 122.36 122.36 104.01 114.71 104.01 104.01 122.36 E0636 RR 1054.56 896.38 1054.56 1054.56 1054.56 1054.56 1054.56 1054.56 1054.56 1054.56 1054.56 1054.56 E0675 RR 384.55 326.87 384.55 384.55 384.55 384.55 384.55 384.55 384.55 384.55 384.55 384.55 E0744 RR 91.57 77.83 85.25 91.57 91.57 91.57 91.57 91.57 91.57 91.57 77.83 91.57 E0745 RR 89.51 76.08 78.95 89.51 89.51 89.51 76.08 89.51 88.78 89.51 76.08 76.08 E0749 RR KF 276.89 235.36 276.89 276.89 276.89 276.89 261.49 276.89 247.19 276.89 235.36 273.34 E0779 RR 16.73 14.22 16.73 16.43 16.73 16.73 16.73 16.73 16.32 16.13 14.70 16.73 E0781 RR 264.87 225.14 264.87 225.14 225.14 225.14 225.14 225.14 225.14 225.14 231.27 225.14 E0784 RR 417.57 354.93 417.57 417.57 417.57 417.57 417.57 417.57 417.57 417.57 417.57 417.57 E0791 RR 316.20 268.77 316.20 268.77 316.20 316.20 316.20 268.77 268.77 268.77 271.87 316.20 E0910 RR 20.00 17.00 20.00 20.00 20.00 20.00 20.00 19.56 20.00 20.00 20.00 20.00 E0911 RR 49.85 42.37 49.85 49.85 49.85 49.85 49.85 49.85 49.85 49.85 49.85 49.85 E0912 RR 114.47 97.30 114.47 114.47 114.47 114.47 114.47 114.47 114.47 114.47 114.47 114.47 E0920 RR 46.14 39.22 46.14 46.14 46.14 46.14 46.14 39.69 46.14 46.14 46.14 46.14 E0930 RR 45.69 38.84 45.69 41.31 45.69 45.69 45.69 39.69 40.46 45.69 45.69 45.69 E0940 RR 34.77 29.55 34.38 34.77 34.77 34.77 34.77 31.68 34.77 29.55 34.77 34.77 E0941 RR 43.41 36.90 43.41 40.30 36.90 36.90 36.90 38.73 43.41 43.41 43.41 36.90 E0946 RR 59.16 50.29 59.16 59.16 59.16 59.16 59.16 59.16 53.53 59.16 59.16 59.16 E0958 RR 43.63 37.09 43.63 43.63 37.09 37.41 37.09 42.41 43.35 43.40 37.09 37.09 E0968 RR 17.93 15.24 17.93 17.93 16.94 17.46 16.02 17.93 17.91 17.93 15.24 16.75 E0983 RR 249.93 212.44 249.93 244.47 249.93 249.93 249.93 235.02 242.86 240.02 212.44 249.93 E1031 RR 50.51 42.93 50.51 50.51 49.09 50.51 46.35 50.51 42.93 50.51 50.51 48.44 E1035 RR 613.20 521.22 613.20 613.20 613.20 613.20 613.20 613.20 613.20 613.20 613.20 613.20 E1037 RR 108.49 92.22 108.49 108.49 108.49 108.49 108.49 108.49 108.49 108.49 108.49 108.49 E1038 RR 18.03 15.33 18.03 18.03 18.03 18.03 18.03 18.03 18.03 18.03 18.03 18.03 E1039 RR 34.20 29.07 34.20 34.20 34.20 34.20 34.20 34.20 34.20 34.20 34.20 34.20 E1050 RR 101.84 86.56 101.84 101.84 86.56 86.56 86.56 101.84 101.54 94.75 86.56 86.56 E1060 RR 126.07 107.16 114.36 126.07 126.07 126.07 125.01 113.30 110.27 126.07 118.92 126.07 E1070 RR 109.53 93.10 109.53 93.10 109.53 109.53 97.27 109.53 103.96 109.53 103.87 101.66 E1083 RR 78.74 66.93 78.74 78.74 72.72 74.79 68.65 72.17 78.74 78.74 66.93 71.75 E1084 RR 98.10 83.39 98.10 98.10 96.57 98.10 91.18 98.10 92.14 98.10 83.39 95.32 E1087 RR 126.51 107.53 107.53 126.51 126.51 126.51 107.53 116.00 126.51 109.10 126.51 107.53 E1088 RR 150.77 128.15 128.15 150.77 150.77 150.77 128.15 150.77 150.77 147.66 150.77 128.15 E1092 RR 128.51 109.23 128.51 128.51 109.23 109.23 109.23 128.51 128.51 128.51 109.23 109.23 E1093 RR 110.52 93.94 110.52 110.52 93.94 93.94 93.94 110.52 110.52 110.52 93.94 93.94 E1100 RR 103.81 88.24 103.81 103.81 103.81 103.81 97.27 103.81 97.48 103.81 99.85 101.66 E1110 RR 101.66 86.41 86.41 86.41 101.66 101.66 97.27 101.66 96.56 100.33 101.66 101.66 E1150 RR 81.58 69.34 69.92 81.58 81.58 75.12 81.58 78.16 81.58 81.58 69.34 81.58 E1160 RR 62.50 53.13 62.50 62.50 62.50 55.56 53.13 61.46 62.50 62.50 62.50 55.02 E1170 RR 89.31 75.91 89.31 89.31 89.31 89.31 89.31 86.31 82.62 75.91 75.91 89.31 E1171 RR 80.15 68.13 80.15 71.43 80.15 80.15 80.15 68.67 76.67 70.14 71.80 80.15 E1172 RR 97.95 83.26 97.95 91.85 97.95 97.95 97.27 88.30 97.95 88.95 83.26 97.95 E1180 RR 101.34 86.14 101.34 86.14 101.34 101.34 101.34 94.39 101.34 86.14 86.14 101.34 E1190 RR 117.07 99.51 117.07 117.07 107.92 105.76 101.91 109.06 117.07 101.97 99.51 106.53 E1195 RR 125.63 106.79 125.63 106.79 125.63 125.63 125.63 106.79 125.63 106.79 106.79 125.63 E1200 RR 87.01 73.96 73.96 76.51 87.01 87.01 74.36 81.21 87.01 87.01 73.96 77.73 E1221 RR 47.51 40.38 40.38 47.51 47.51 47.50 45.77 41.92 47.51 40.38 40.38 47.51 E1222 RR 67.79 57.62 67.79 67.79 67.79 67.68 65.19 67.79 67.79 67.79 57.62 67.79 E1223 RR 74.02 62.92 74.02 74.02 74.02 74.02 72.38 74.02 72.52 72.60 62.92 74.02 E1224 RR 81.15 68.98 81.15 81.15 81.15 81.15 81.15 81.15 68.98 81.15 68.98 81.15 E1225 RR 45.20 38.42 45.20 45.20 38.42 38.42 38.42 45.20 45.20 45.20 38.42 38.42 E1228 RR 28.02 23.82 28.02 23.82 28.02 28.02 28.02 23.82 23.82 23.82 23.82 28.02 E1240 RR 103.02 87.57 103.02 103.02 103.02 103.02 98.57 103.02 94.40 92.49 87.57 103.02 E1270 RR 78.94 67.10 78.94 67.10 78.94 78.94 78.94 76.84 70.38 78.94 67.10 78.94 E1280 RR 131.26 111.57 131.26 111.57 131.26 131.26 131.26 122.82 131.26 131.26 113.02 131.26 E1295 RR 121.47 103.25 121.47 116.14 121.47 121.47 121.47 118.19 121.47 118.38 110.78 121.47 E1800 RR 122.50 104.13 104.13 104.13 104.13 104.29 104.13 104.13 104.13 104.13 104.13 104.13 E1801 RR 129.00 109.65 129.00 125.93 129.00 129.00 129.00 121.09 125.09 123.65 109.65 129.00 E1802 RR 326.80 277.78 326.80 326.80 326.80 326.80 326.80 326.80 326.80 326.80 326.80 326.80 E1805 RR 126.34 107.39 126.34 116.91 126.34 126.34 124.58 112.39 116.14 114.79 107.39 126.32 E1806 RR 105.91 90.02 105.91 103.37 105.91 105.91 105.91 99.37 102.69 101.49 90.02 105.91 E1810 RR 124.58 105.89 105.89 116.91 105.89 105.89 124.58 112.39 116.14 114.79 105.89 124.58 E1811 RR 134.12 114.00 134.12 130.94 134.12 134.12 134.12 125.87 130.08 128.55 114.00 134.12 E1812 RR 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 E1815 RR 126.34 107.39 126.34 116.91 126.34 126.34 124.58 112.39 116.14 114.79 107.39 126.32 E1816 RR 136.24 115.80 136.24 132.97 136.24 136.24 136.24 127.85 132.10 130.57 115.80 136.24 E1818 RR 139.09 118.23 139.09 135.77 139.09 139.09 139.09 130.52 134.86 133.29 118.23 139.09 E1825 RR 126.34 107.39 126.34 116.91 126.34 126.34 124.58 112.39 116.14 114.79 107.39 126.32 E1830 RR 126.34 107.39 126.34 116.91 126.34 126.34 124.58 112.39 116.14 114.79 107.39 126.32 E1840 RR 382.71 325.30 382.71 382.71 382.71 382.71 382.71 371.82 382.71 379.70 325.30 382.71 E1841 RR 453.00 385.05 453.00 453.00 453.00 453.00 453.00 453.00 453.00 453.00 453.00 453.00 E2000 RR 51.83 44.06 51.83 50.57 51.83 51.83 51.83 48.62 50.25 49.65 44.06 51.83 E2120 RR 283.52 240.99 283.52 283.52 283.52 283.52 283.52 283.52 283.52 283.52 283.52 283.52 E2402 RR 1716.46 1458.99 1716.46 1716.46 1716.46 1716.46 1716.46 1716.46 1716.46 1716.46 1716.46 1716.46 K0001 RR 0.00 0.00 48.33 53.27 53.27 53.27 51.28 52.48 51.56 53.27 53.27 46.43 K0002 RR 81.83 69.56 77.61 81.83 75.59 77.81 71.39 81.83 81.40 81.83 69.56 74.60 K0003 RR 89.59 76.15 89.59 76.15 89.59 89.59 88.76 89.59 80.22 89.59 76.15 89.59 K0004 RR 133.64 113.59 114.03 113.59 133.64 133.64 127.82 114.12 133.64 128.42 133.64 133.64 K0006 RR 125.41 106.60 125.41 106.60 125.41 125.41 125.41 122.39 125.41 125.41 106.60 125.41 K0007 RR 178.50 151.73 178.50 176.63 178.50 178.50 178.50 169.81 175.47 173.43 151.73 178.50 K0010 RR 425.99 362.09 425.99 365.46 425.99 425.99 425.99 362.09 362.09 362.41 362.09 425.99 K0011 RR 0.00 0.00 512.28 512.25 512.28 512.28 512.28 497.02 512.27 507.59 450.20 512.28 K0011 RR KF 0.00 0.00 553.80 553.78 553.80 553.80 553.80 537.32 553.81 548.73 486.69 553.80 K0012 RR 324.92 276.18 324.92 317.16 324.92 324.92 324.92 304.88 315.04 311.39 276.18 324.92 K0195 RR 21.07 17.91 17.91 21.07 17.91 17.91 17.91 17.91 17.91 21.07 17.91 20.19 K0606 RR 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 K0606 RR KF 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00