hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|AR,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Washington Regiol Medical Center,1/7/2025,2.0.0,Washington Regiol Medical Center,"3215 N. North Hills Blvd Fayetteville, AR 72703",710664687,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Service,Category,Code,Description,Revenue code,Charges,6 DEGREES PLAN,6 DEGREES REIMBURSEMENT METHOD,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,ALLWELL MEDICARE MANAGED PLAN,ALLWELL MEDICARE MANAGED REIMBURSEMENT METHOD,AR STATE MEDICAID PLAN,AR STATE MEDICAID REIMBURSEMENT METHOD,AR STATE WORKERS COMP PLAN,AR STATE WORKERS COMP REIMBURSEMENT METHOD,BCBS MARKETPLACE PLAN,BCBS MARKETPLACE REIMBURSEMENT METHOD,BCBS OF AR PLAN,BCBS OF AR REIMBURSEMENT METHOD,BLUE CROSS MEDIPAK ADV HMO PLAN,BLUE CROSS MEDIPAK ADV HMO REIMBURSEMENT METHOD,CHEROKEE NATION PLAN,CHEROKEE NATION REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,CONSOLIDATED BILLING MEDICARE PLAN,CONSOLIDATED BILLING MEDICARE REIMBURSEMENT METHOD,COVENTRY PLAN,COVENTRY REIMBURSEMENT METHOD,COVENTRY MED ADV PLAN,COVENTRY MED ADV REIMBURSEMENT METHOD,EMPLOYERS HEALTH PLAN,EMPLOYERS HEALTH REIMBURSEMENT METHOD,FIRST HEALTH PLAN,FIRST HEALTH REIMBURSEMENT METHOD,HEALTHCHOICE PLAN,HEALTHCHOICE REIMBURSEMENT METHOD,HEALTHLINK PPO HMO PLAN,HEALTHLINK PPO HMO REIMBURSEMENT METHOD,HEALTHSOUTH PLAN,HEALTHSOUTH REIMBURSEMENT METHOD,HPO PLAN,HPO REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,HUMANA MEDICARE PLAN,HUMANA MEDICARE REIMBURSEMENT METHOD,MEDICAID MISSOURI PLAN,MEDICAID MISSOURI REIMBURSEMENT METHOD,MEDICAID OKLAHOMA PLAN,MEDICAID OKLAHOMA REIMBURSEMENT METHOD,MEDICAID TEXAS PLAN,MEDICAID TEXAS REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MEDICARE ADVANTAGE PLAN,MEDICARE ADVANTAGE REIMBURSEMENT METHOD,MEDICARE ADVANTAGE LESSER CHARGES PLAN,MEDICARE ADVANTAGE LESSER CHARGES REIMBURSEMENT METHOD,MUNICIPAL HEALTH PLAN,MUNICIPAL HEALTH REIMBURSEMENT METHOD,NOVASYS AMBETTER MARKETPLACE PLAN,NOVASYS AMBETTER MARKETPLACE REIMBURSEMENT METHOD,PASSE AR TOTAL CARE PLAN,PASSE AR TOTAL CARE REIMBURSEMENT METHOD,PASSE EMPOWER PLAN,PASSE EMPOWER REIMBURSEMENT METHOD,PASSE SUMMIT PLAN,PASSE SUMMIT REIMBURSEMENT METHOD,PCC PLAN,PCC REIMBURSEMENT METHOD,PHCS MULTIPLAN PLAN,PHCS MULTIPLAN REIMBURSEMENT METHOD,PPOPLUS PLAN,PPOPLUS REIMBURSEMENT METHOD,QUALCHOICE PLAN,QUALCHOICE REIMBURSEMENT METHOD,SELF PAY PLAN,SELF PAY REIMBURSEMENT METHOD,SELF PAY CLASSIC PLAN,SELF PAY CLASSIC REIMBURSEMENT METHOD,SHARP PLAN,SHARP REIMBURSEMENT METHOD,SOUTHERN HEALTH PARTNERS PLAN,SOUTHERN HEALTH PARTNERS REIMBURSEMENT METHOD,SPREEMO PLAN,SPREEMO REIMBURSEMENT METHOD,THREE RIVERS PROVIDER NETWORK PLAN,THREE RIVERS PROVIDER NETWORK REIMBURSEMENT METHOD,TRICARE PLAN,TRICARE REIMBURSEMENT METHOD,TRICARE WEST VAPC3 PLAN,TRICARE WEST VAPC3 REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,USA HEALTH PLAN,USA HEALTH REIMBURSEMENT METHOD,VA PROFESSIONAL PLAN,VA PROFESSIONAL REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,OCCUPATIONAL THERAPY,97110,OT THERAPEUTIC EXERCISE PER 15 MI,431,204,46.69,175% of CMS fee schedule,144,pays based on per visit rate,26.68,100% of CMS fee schedule,27.48,103% of CMS fee schedule,21.76,100% of AR fee schedule,68.42,33.54% of total billed charges,23,pays based on per visit rate,23,pays based on per visit rate,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,149.74,pays based on per visit rate,29.01,100% of CMS fee schedule,152,pays based on per visit rate,26.68,100% of CMS fee schedule,142.8,70% of total billed charges,152,pays based on per visit rate,42.95,100% of CMS fee schedule,153,75% of total billed charges,153,75% of total billed charges,173.4,85% of total billed charges,153,75% of total billed charges,26.68,100% of CMS fee schedule,55.08,27% of total billed charges,N/A,not seperately reimbursable,46.92,23% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,122.4,60% of total billed charges,30.26,100% of CMS fee schedule,49.4,227% of AR fee schedule,50.88,233.81% of AR fee schedule,49.4,227% of AR fee schedule,142.8,70% of total billed charges,157.08,77% of total billed charges,132.6,65% of total billed charges,204,100% of total billed charges,204,100% of total billed charges,153,75% of total billed charges,N/A,not seperately reimbursable,102,50% of total billed charges,68.42,33.54% of total billed charges,193.8,95% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,130,pays based on per day visit,26.68,100% of CMS fee schedule,173.4,85% of total billed charges,26.68,100% of CMS fee schedule,21.76,204,153.00
Outpatient Medical Services,OCCUPATIONAL THERAPY,97112,OT NEURO MUSCULAR RE-ED,431,210,51.96,175% of CMS fee schedule,144,pays based on per visit rate,29.69,100% of CMS fee schedule,30.58,103% of CMS fee schedule,N/A,not seperately reimbursable,70.43,33.54% of total billed charges,27,pays based on per visit rate,27,pays based on per visit rate,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,149.74,pays based on per visit rate,33.3,100% of CMS fee schedule,152,pays based on per visit rate,29.69,100% of CMS fee schedule,147,70% of total billed charges,152,pays based on per visit rate,49.2,100% of CMS fee schedule,157.5,75% of total billed charges,157.5,75% of total billed charges,178.5,85% of total billed charges,157.5,75% of total billed charges,29.69,100% of CMS fee schedule,56.7,27% of total billed charges,N/A,not seperately reimbursable,48.3,23% of total billed charges,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,126,60% of total billed charges,31.32,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147,70% of total billed charges,161.7,77% of total billed charges,136.5,65% of total billed charges,210,100% of total billed charges,210,100% of total billed charges,157.5,75% of total billed charges,N/A,not seperately reimbursable,105,50% of total billed charges,70.43,33.54% of total billed charges,199.5,95% of total billed charges,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,130,pays based on per day visit,29.69,100% of CMS fee schedule,178.5,85% of total billed charges,29.69,100% of CMS fee schedule,27,210,157.50
Outpatient Medical Services,OCCUPATIONAL THERAPY,97140,OT MANUAL THERAPY PER 15 MIN,431,193,44.1,175% of CMS fee schedule,144,pays based on per visit rate,25.2,100% of CMS fee schedule,25.96,103% of CMS fee schedule,N/A,not seperately reimbursable,64.73,33.54% of total billed charges,21,pays based on per visit rate,21,pays based on per visit rate,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,149.74,pays based on per visit rate,26.74,100% of CMS fee schedule,152,pays based on per visit rate,25.2,100% of CMS fee schedule,135.1,70% of total billed charges,152,pays based on per visit rate,39.62,100% of CMS fee schedule,144.75,75% of total billed charges,144.75,75% of total billed charges,164.05,85% of total billed charges,144.75,75% of total billed charges,25.2,100% of CMS fee schedule,52.11,27% of total billed charges,N/A,not seperately reimbursable,44.39,23% of total billed charges,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,115.8,60% of total billed charges,28.11,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,135.1,70% of total billed charges,148.61,77% of total billed charges,125.45,65% of total billed charges,193,100% of total billed charges,193,100% of total billed charges,144.75,75% of total billed charges,N/A,not seperately reimbursable,96.5,50% of total billed charges,64.73,33.54% of total billed charges,183.35,95% of total billed charges,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,130,pays based on per day visit,25.2,100% of CMS fee schedule,164.05,85% of total billed charges,25.2,100% of CMS fee schedule,21,193,144.75
Outpatient Medical Services,OCCUPATIONAL THERAPY,97166,OT EVAL MOD COMPLEX 45 MIN,431,473,162.82,175% of CMS fee schedule,144,pays based on per visit rate,93.04,100% of CMS fee schedule,95.83,103% of CMS fee schedule,148.32,100% of AR fee schedule,158.64,33.54% of total billed charges,69,pays based on per visit rate,69,pays based on per visit rate,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,149.74,pays based on per visit rate,85.16,100% of CMS fee schedule,152,pays based on per visit rate,93.04,100% of CMS fee schedule,331.1,70% of total billed charges,152,pays based on per visit rate,148.26,100% of CMS fee schedule,354.75,75% of total billed charges,354.75,75% of total billed charges,402.05,85% of total billed charges,354.75,75% of total billed charges,93.04,100% of CMS fee schedule,127.71,27% of total billed charges,N/A,not seperately reimbursable,108.79,23% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,283.8,60% of total billed charges,73.39,100% of CMS fee schedule,336.69,227% of AR fee schedule,346.79,233.81% of AR fee schedule,336.69,227% of AR fee schedule,331.1,70% of total billed charges,364.21,77% of total billed charges,307.45,65% of total billed charges,473,100% of total billed charges,473,100% of total billed charges,354.75,75% of total billed charges,N/A,not seperately reimbursable,236.5,50% of total billed charges,158.64,33.54% of total billed charges,449.35,95% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,130,pays based on per day visit,93.04,100% of CMS fee schedule,402.05,85% of total billed charges,93.04,100% of CMS fee schedule,69,473,354.75
Outpatient Medical Services,OCCUPATIONAL THERAPY,97167,OT EVAL HIGH COMPLEX 60 MIN,431,537,162.82,175% of CMS fee schedule,144,pays based on per visit rate,93.04,100% of CMS fee schedule,95.83,103% of CMS fee schedule,197.76,100% of AR fee schedule,180.11,33.54% of total billed charges,69,pays based on per visit rate,69,pays based on per visit rate,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,149.74,pays based on per visit rate,85.16,100% of CMS fee schedule,152,pays based on per visit rate,93.04,100% of CMS fee schedule,375.9,70% of total billed charges,152,pays based on per visit rate,148.26,100% of CMS fee schedule,402.75,75% of total billed charges,402.75,75% of total billed charges,456.45,85% of total billed charges,402.75,75% of total billed charges,93.04,100% of CMS fee schedule,144.99,27% of total billed charges,N/A,not seperately reimbursable,123.51,23% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,322.2,60% of total billed charges,73.39,100% of CMS fee schedule,448.92,227% of AR fee schedule,462.38,233.81% of AR fee schedule,448.92,227% of AR fee schedule,375.9,70% of total billed charges,413.49,77% of total billed charges,349.05,65% of total billed charges,537,100% of total billed charges,537,100% of total billed charges,402.75,75% of total billed charges,N/A,not seperately reimbursable,268.5,50% of total billed charges,180.11,33.54% of total billed charges,510.15,95% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,130,pays based on per day visit,93.04,100% of CMS fee schedule,456.45,85% of total billed charges,93.04,100% of CMS fee schedule,69,537,402.75
Outpatient Medical Services,OCCUPATIONAL THERAPY,97530,OT THERAPEUTIC ACTIVIT PER 15 MIN,431,163,55.37,175% of CMS fee schedule,144,pays based on per visit rate,31.64,100% of CMS fee schedule,32.59,103% of CMS fee schedule,21.76,100% of AR fee schedule,54.67,33.54% of total billed charges,30,pays based on per visit rate,30,pays based on per visit rate,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,149.74,pays based on per visit rate,36.71,100% of CMS fee schedule,152,pays based on per visit rate,31.64,100% of CMS fee schedule,114.1,70% of total billed charges,152,pays based on per visit rate,53.01,100% of CMS fee schedule,122.25,75% of total billed charges,122.25,75% of total billed charges,138.55,85% of total billed charges,122.25,75% of total billed charges,31.64,100% of CMS fee schedule,44.01,27% of total billed charges,N/A,not seperately reimbursable,37.49,23% of total billed charges,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,97.8,60% of total billed charges,32.51,100% of CMS fee schedule,49.4,227% of AR fee schedule,50.88,233.81% of AR fee schedule,49.4,227% of AR fee schedule,114.1,70% of total billed charges,125.51,77% of total billed charges,105.95,65% of total billed charges,163,100% of total billed charges,163,100% of total billed charges,122.25,75% of total billed charges,N/A,not seperately reimbursable,81.5,50% of total billed charges,54.67,33.54% of total billed charges,154.85,95% of total billed charges,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,130,pays based on per day visit,31.64,100% of CMS fee schedule,138.55,85% of total billed charges,31.64,100% of CMS fee schedule,21.76,163,122.25
Outpatient Medical Services,OCCUPATIONAL THERAPY,97542,OT WHEELCHAIR MANAGEMENT PER 15 M,431,86,49.86,175% of CMS fee schedule,144,pays based on per visit rate,28.49,100% of CMS fee schedule,29.34,103% of CMS fee schedule,N/A,not seperately reimbursable,28.84,33.54% of total billed charges,25,pays based on per visit rate,25,pays based on per visit rate,28.49,100% of CMS fee schedule,28.49,100% of CMS fee schedule,86,pays based on per visit rate,31.33,100% of CMS fee schedule,152,pays based on per visit rate,28.49,100% of CMS fee schedule,60.2,70% of total billed charges,152,pays based on per visit rate,46.33,100% of CMS fee schedule,64.5,75% of total billed charges,64.5,75% of total billed charges,73.1,85% of total billed charges,64.5,75% of total billed charges,28.49,100% of CMS fee schedule,23.22,27% of total billed charges,N/A,not seperately reimbursable,19.78,23% of total billed charges,28.49,100% of CMS fee schedule,28.49,100% of CMS fee schedule,28.49,100% of CMS fee schedule,51.6,60% of total billed charges,28.82,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,60.2,70% of total billed charges,66.22,77% of total billed charges,55.9,65% of total billed charges,86,100% of total billed charges,86,100% of total billed charges,64.5,75% of total billed charges,N/A,not seperately reimbursable,43,50% of total billed charges,28.84,33.54% of total billed charges,81.7,95% of total billed charges,28.49,100% of CMS fee schedule,28.49,100% of CMS fee schedule,130,pays based on per day visit,28.49,100% of CMS fee schedule,73.1,85% of total billed charges,28.49,100% of CMS fee schedule,19.78,152,64.50
Outpatient Medical Services,OCCUPATIONAL THERAPY,97165,OT EVAL LOW COMPLEX 30 MIN,431,489,162.82,175% of CMS fee schedule,144,pays based on per visit rate,93.04,100% of CMS fee schedule,95.83,103% of CMS fee schedule,98.88,100% of AR fee schedule,164.01,33.54% of total billed charges,70,pays based on per visit rate,70,pays based on per visit rate,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,149.74,pays based on per visit rate,85.47,100% of CMS fee schedule,152,pays based on per visit rate,93.04,100% of CMS fee schedule,342.3,70% of total billed charges,152,pays based on per visit rate,148.26,100% of CMS fee schedule,366.75,75% of total billed charges,366.75,75% of total billed charges,415.65,85% of total billed charges,366.75,75% of total billed charges,93.04,100% of CMS fee schedule,132.03,27% of total billed charges,N/A,not seperately reimbursable,112.47,23% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,293.4,60% of total billed charges,73.39,100% of CMS fee schedule,224.46,227% of AR fee schedule,231.19,233.81% of AR fee schedule,224.46,227% of AR fee schedule,342.3,70% of total billed charges,376.53,77% of total billed charges,317.85,65% of total billed charges,489,100% of total billed charges,489,100% of total billed charges,366.75,75% of total billed charges,N/A,not seperately reimbursable,244.5,50% of total billed charges,164.01,33.54% of total billed charges,464.55,95% of total billed charges,93.04,100% of CMS fee schedule,93.04,100% of CMS fee schedule,130,pays based on per day visit,93.04,100% of CMS fee schedule,415.65,85% of total billed charges,93.04,100% of CMS fee schedule,70,489,366.75
Outpatient Medical Services,SPEECH THERAPY,92506,ST EVALUATION,440,129,N/A,not seperately reimbursable,105.78,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,43.27,33.54% of total billed charges,28.38,22% of total billed charges,76.11,59% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,129,pays based on per visit rate,N/A,not seperately reimbursable,152,pays based on per visit rate,N/A,not seperately reimbursable,90.3,70% of total billed charges,152,pays based on per visit rate,N/A,not seperately reimbursable,96.75,75% of total billed charges,96.75,75% of total billed charges,109.65,85% of total billed charges,96.75,75% of total billed charges,N/A,not seperately reimbursable,34.83,27% of total billed charges,N/A,not seperately reimbursable,29.67,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77.4,60% of total billed charges,43.34,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.3,70% of total billed charges,99.33,77% of total billed charges,83.85,65% of total billed charges,129,100% of total billed charges,129,100% of total billed charges,96.75,75% of total billed charges,76.11,59% of total billed charges,64.5,50% of total billed charges,43.27,33.54% of total billed charges,122.55,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,130,pays based on per day visit,N/A,not seperately reimbursable,109.65,85% of total billed charges,N/A,not seperately reimbursable,28.38,152,96.75
Outpatient Medical Services,SPEECH THERAPY,92507,SLP THERAPY,440,194,122.66,175% of CMS fee schedule,144,pays based on per visit rate,70.09,100% of CMS fee schedule,72.19,103% of CMS fee schedule,21.76,100% of AR fee schedule,65.07,33.54% of total billed charges,62,pays based on per visit rate,62,pays based on per visit rate,70.09,100% of CMS fee schedule,70.09,100% of CMS fee schedule,149.74,pays based on per visit rate,75.75,100% of CMS fee schedule,152,pays based on per visit rate,70.09,100% of CMS fee schedule,135.8,70% of total billed charges,152,pays based on per visit rate,112.47,100% of CMS fee schedule,145.5,75% of total billed charges,145.5,75% of total billed charges,164.9,85% of total billed charges,145.5,75% of total billed charges,70.09,100% of CMS fee schedule,52.38,27% of total billed charges,N/A,not seperately reimbursable,44.62,23% of total billed charges,70.09,100% of CMS fee schedule,70.09,100% of CMS fee schedule,70.09,100% of CMS fee schedule,116.4,60% of total billed charges,75.21,100% of CMS fee schedule,49.4,227% of AR fee schedule,50.88,233.81% of AR fee schedule,49.4,227% of AR fee schedule,135.8,70% of total billed charges,149.38,77% of total billed charges,126.1,65% of total billed charges,194,100% of total billed charges,194,100% of total billed charges,145.5,75% of total billed charges,N/A,not seperately reimbursable,97,50% of total billed charges,65.07,33.54% of total billed charges,184.3,95% of total billed charges,70.09,100% of CMS fee schedule,70.09,100% of CMS fee schedule,130,pays based on per day visit,70.09,100% of CMS fee schedule,164.9,85% of total billed charges,70.09,100% of CMS fee schedule,21.76,194,145.50
Outpatient Medical Services,SPEECH THERAPY,92523,ST EVALUATION SOUND PRODUCTION LA,440,490,364.88,175% of CMS fee schedule,144,pays based on per visit rate,208.5,100% of CMS fee schedule,214.76,103% of CMS fee schedule,N/A,not seperately reimbursable,164.35,33.54% of total billed charges,151,pays based on per visit rate,151,pays based on per visit rate,208.5,100% of CMS fee schedule,208.5,100% of CMS fee schedule,149.74,pays based on per visit rate,184.42,100% of CMS fee schedule,152,pays based on per visit rate,208.5,100% of CMS fee schedule,343,70% of total billed charges,152,pays based on per visit rate,335.64,100% of CMS fee schedule,367.5,75% of total billed charges,367.5,75% of total billed charges,416.5,85% of total billed charges,367.5,75% of total billed charges,208.5,100% of CMS fee schedule,132.3,27% of total billed charges,N/A,not seperately reimbursable,112.7,23% of total billed charges,208.5,100% of CMS fee schedule,208.5,100% of CMS fee schedule,208.5,100% of CMS fee schedule,294,60% of total billed charges,177.66,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,343,70% of total billed charges,377.3,77% of total billed charges,318.5,65% of total billed charges,490,100% of total billed charges,490,100% of total billed charges,367.5,75% of total billed charges,N/A,not seperately reimbursable,245,50% of total billed charges,164.35,33.54% of total billed charges,465.5,95% of total billed charges,208.5,100% of CMS fee schedule,208.5,100% of CMS fee schedule,130,pays based on per day visit,208.5,100% of CMS fee schedule,416.5,85% of total billed charges,208.5,100% of CMS fee schedule,112.7,490,367.50
Outpatient Medical Services,SPEECH THERAPY,92526,ST TREATMENT SWALLOWING/ORAL/FEED,440,235,134.66,175% of CMS fee schedule,192.7,82% total billed charges,76.95,100% of CMS fee schedule,79.26,103% of CMS fee schedule,N/A,not seperately reimbursable,78.82,33.54% of total billed charges,68,pays based on per visit rate,68,pays based on per visit rate,76.95,100% of CMS fee schedule,76.95,100% of CMS fee schedule,149.74,pays based on per visit rate,83.09,100% of CMS fee schedule,152,pays based on per visit rate,76.95,100% of CMS fee schedule,164.5,70% of total billed charges,152,pays based on per visit rate,124.19,100% of CMS fee schedule,176.25,75% of total billed charges,176.25,75% of total billed charges,199.75,85% of total billed charges,176.25,75% of total billed charges,76.95,100% of CMS fee schedule,63.45,27% of total billed charges,N/A,not seperately reimbursable,54.05,23% of total billed charges,76.95,100% of CMS fee schedule,76.95,100% of CMS fee schedule,76.95,100% of CMS fee schedule,141,60% of total billed charges,81.32,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,164.5,70% of total billed charges,180.95,77% of total billed charges,152.75,65% of total billed charges,235,100% of total billed charges,235,100% of total billed charges,176.25,75% of total billed charges,N/A,not seperately reimbursable,117.5,50% of total billed charges,78.82,33.54% of total billed charges,223.25,95% of total billed charges,76.95,100% of CMS fee schedule,76.95,100% of CMS fee schedule,130,pays based on per day visit,76.95,100% of CMS fee schedule,199.75,85% of total billed charges,76.95,100% of CMS fee schedule,54.05,235,176.25
Outpatient Medical Services,SPEECH THERAPY,92610,ST EVAL FOR SWALLOWING/ORAL/PHARY,440,203,113.21,175% of CMS fee schedule,166.46,82% total billed charges,64.69,100% of CMS fee schedule,66.63,103% of CMS fee schedule,N/A,not seperately reimbursable,68.09,33.54% of total billed charges,44.66,22% of total billed charges,119.77,59% of total billed charges,64.69,100% of CMS fee schedule,64.69,100% of CMS fee schedule,149.74,pays based on per visit rate,70.05,100% of CMS fee schedule,152,pays based on per visit rate,64.69,100% of CMS fee schedule,142.1,70% of total billed charges,152,pays based on per visit rate,124.84,100% of CMS fee schedule,152.25,75% of total billed charges,152.25,75% of total billed charges,172.55,85% of total billed charges,152.25,75% of total billed charges,64.69,100% of CMS fee schedule,54.81,27% of total billed charges,N/A,not seperately reimbursable,46.69,23% of total billed charges,64.69,100% of CMS fee schedule,64.69,100% of CMS fee schedule,64.69,100% of CMS fee schedule,121.8,60% of total billed charges,80.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,142.1,70% of total billed charges,156.31,77% of total billed charges,131.95,65% of total billed charges,203,100% of total billed charges,203,100% of total billed charges,152.25,75% of total billed charges,N/A,not seperately reimbursable,101.5,50% of total billed charges,68.09,33.54% of total billed charges,192.85,95% of total billed charges,64.69,100% of CMS fee schedule,64.69,100% of CMS fee schedule,130,pays based on per day visit,64.69,100% of CMS fee schedule,172.55,85% of total billed charges,64.69,100% of CMS fee schedule,44.66,203,152.25
Outpatient Medical Services,SPEECH THERAPY,G0378,OBSERVATION HOURS AUTO OBS,762,9,N/A,not seperately reimbursable,1965,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.02,33.54% of total billed charges,9,pays based on per visit rate,9,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1338.12,60% of total billed charges,N/A,not seperately reimbursable,5.85,pays based on per visit rate,N/A,not seperately reimbursable,6.3,70% of total billed charges,6.75,pays based on per visit rate,N/A,not seperately reimbursable,6.75,75% of total billed charges,6.75,75% of total billed charges,7.65,85% of total billed charges,106,pays based on per visit rate,N/A,not seperately reimbursable,2.43,27% of total billed charges,N/A,not seperately reimbursable,2.07,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1750,60% of total billed charges,3.02,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6.3,70% of total billed charges,6.93,77% of total billed charges,5.85,65% of total billed charges,9,100% of total billed charges,9,100% of total billed charges,6.75,75% of total billed charges,N/A,not seperately reimbursable,4.5,50% of total billed charges,3.02,33.54% of total billed charges,8.55,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1637,58.1% of total billed charges,N/A,not seperately reimbursable,7.65,85% of total billed charges,N/A,not seperately reimbursable,2.07,1965,6.75
Outpatient Medical Services,WOUND CARE,11042,DEBRIDEMENT SUBQ (1ST 20SQ CM),761,289,649.5,175% of CMS APC rate,231.2,pays based on per visit rate,371.14,100% of CMS APC rate,382.27,103% of CMS APC rate,145.5,100% of AR ASC tier groupings rate,96.93,33.54% of total billed charges,312,100% of BCBS ASC tier groupings rate,312,100% of BCBS ASC tier groupings rate,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,173.4,60% of total billed charges,57.92,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,371.14,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,683.86,100% of CMS fee schedule,216.75,75% of total billed charges,216.75,75% of total billed charges,245.65,85% of total billed charges,216.75,75% of total billed charges,371.14,100% of CMS APC rate,78.03,27% of total billed charges,258.55,100% of OK APC rate,66.47,23% of total billed charges,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,97.1,33.6% of total billed charges,330.29,227% of AR ASC tier groupings rate,340.19,233.81% of AR ASC tier groupings rate,330.29,227% of AR ASC tier groupings rate,350,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,187.85,65% of total billed charges,289,100% of total billed charges,289,100% of total billed charges,216.75,75% of total billed charges,196,100% of SHARP ASC tier groupings rate,144.5,50% of total billed charges,96.93,33.54% of total billed charges,274.55,95% of total billed charges,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,N/A,not seperately reimbursable,371.14,100% of CMS APC rate,245.65,85% of total billed charges,371.14,100% of CMS apc rate,57.92,2500,216.75
Outpatient Medical Services,WOUND CARE,11045,DEBRIDEMENT SUBQ ADD'L 20SQ CM,761,397,N/A,not seperately reimbursable,317.6,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,133.15,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,238.2,60% of total billed charges,25.31,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,277.9,70% of total billed charges,975,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,297.75,75% of total billed charges,297.75,75% of total billed charges,337.45,85% of total billed charges,297.75,75% of total billed charges,N/A,not seperately reimbursable,107.19,27% of total billed charges,N/A,not seperately reimbursable,91.31,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2500,100% of CMS ASC tier groupings rate,133.39,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,277.9,70% of total billed charges,305.69,77% of total billed charges,258.05,65% of total billed charges,397,100% of total billed charges,397,100% of total billed charges,297.75,75% of total billed charges,N/A,not seperately reimbursable,198.5,50% of total billed charges,133.15,33.54% of total billed charges,377.15,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,337.45,85% of total billed charges,N/A,not seperately reimbursable,25.31,2500,297.75
Outpatient Medical Services,WOUND CARE,97597,SELECTIVE DEBR  (1ST 20SQ CM),761,153,323.01,175% of CMS APC rate,122.4,pays based on per visit rate,184.58,100% of CMS APC rate,190.12,103% of CMS APC rate,24.06,100% of AR fee schedule,51.32,33.54% of total billed charges,161.3,100% of BCBS fee schedule,161.3,100% of BCBS fee schedule,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,91.8,60% of total billed charges,35.73,100% of CMS fee schedule,99.45,65% of total billed charges,184.58,100% of CMS APC rate,107.1,70% of total billed charges,114.75,75% of toal billed charges,295.66,100% of CMS fee schedule,114.75,75% of total billed charges,114.75,75% of total billed charges,130.05,85% of total billed charges,114.75,75% of total billed charges,184.58,100% of CMS APC rate,41.31,27% of total billed charges,N/A,not seperately reimbursable,35.19,23% of total billed charges,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,1750,60% of total billed charges,68.94,100% of CMS fee schedule,54.62,227% of AR fee schedule,56.25,233.81% of AR fee schedule,54.62,227% of AR fee schedule,107.1,70% of total billed charges,117.81,77% of total billed charges,99.45,65% of total billed charges,153,100% of total billed charges,153,100% of total billed charges,114.75,75% of total billed charges,N/A,not seperately reimbursable,76.5,50% of total billed charges,51.32,33.54% of total billed charges,145.35,95% of total billed charges,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,N/A,not seperately reimbursable,184.58,100% of CMS APC rate,130.05,85% of total billed charges,184.58,100% of CMS apc rate,24.06,1750,114.75
Outpatient Medical Services,WOUND CARE,99203,E&M NEW PT VISIT INTERMEDIATE,761,257,N/A,not seperately reimbursable,205.6,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,86.2,33.54% of total billed charges,70.75,100% of BCBS fee schedule,70.75,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,154.2,60% of total billed charges,71.98,100% of CMS fee schedule,167.05,65% of total billed charges,N/A,not seperately reimbursable,179.9,70% of total billed charges,192.75,75% of toal billed charges,162.36,100% of CMS fee schedule,192.75,75% of total billed charges,192.75,75% of total billed charges,218.45,85% of total billed charges,192.75,75% of total billed charges,N/A,not seperately reimbursable,69.39,27% of total billed charges,N/A,not seperately reimbursable,59.11,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1750,60% of total billed charges,86.35,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,179.9,70% of total billed charges,197.89,77% of total billed charges,167.05,65% of total billed charges,257,100% of total billed charges,257,100% of total billed charges,192.75,75% of total billed charges,N/A,not seperately reimbursable,128.5,50% of total billed charges,86.2,33.54% of total billed charges,244.15,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,218.45,85% of total billed charges,N/A,not seperately reimbursable,59.11,1750,192.75
Outpatient Medical Services,WOUND CARE,99204,E&M NEW PT VISIT EXTENDED,761,330,N/A,not seperately reimbursable,264,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,110.68,33.54% of total billed charges,121.04,100% of BCBS fee schedule,121.04,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,198,60% of total billed charges,123.14,100% of CMS fee schedule,214.5,65% of total billed charges,N/A,not seperately reimbursable,231,70% of total billed charges,247.5,75% of toal billed charges,244.44,100% of CMS fee schedule,247.5,75% of total billed charges,247.5,75% of total billed charges,280.5,85% of total billed charges,247.5,75% of total billed charges,N/A,not seperately reimbursable,89.1,27% of total billed charges,N/A,not seperately reimbursable,75.9,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1750,60% of total billed charges,110.88,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,231,70% of total billed charges,254.1,77% of total billed charges,214.5,65% of total billed charges,330,100% of total billed charges,330,100% of total billed charges,247.5,75% of total billed charges,N/A,not seperately reimbursable,165,50% of total billed charges,110.68,33.54% of total billed charges,313.5,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,280.5,85% of total billed charges,N/A,not seperately reimbursable,75.9,1750,247.50
Outpatient Medical Services,WOUND CARE,99205,E&M NEW PT VISIT COMPLEX,761,435,N/A,not seperately reimbursable,348,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12,100% of AR fee schedule,145.9,33.54% of total billed charges,158.15,100% of BCBS fee schedule,158.15,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,261,60% of total billed charges,160.9,100% of CMS fee schedule,282.75,65% of total billed charges,N/A,not seperately reimbursable,304.5,70% of total billed charges,326.25,75% of toal billed charges,322.69,100% of CMS fee schedule,326.25,75% of total billed charges,326.25,75% of total billed charges,369.75,85% of total billed charges,326.25,75% of total billed charges,N/A,not seperately reimbursable,117.45,27% of total billed charges,N/A,not seperately reimbursable,100.05,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1750,60% of total billed charges,146.16,33.6% of total billed charges,27.24,227% of AR fee schedule,28.06,233.81% of AR fee schedule,27.24,227% of AR fee schedule,304.5,70% of total billed charges,334.95,77% of total billed charges,282.75,65% of total billed charges,435,100% of total billed charges,435,100% of total billed charges,326.25,75% of total billed charges,N/A,not seperately reimbursable,217.5,50% of total billed charges,145.9,33.54% of total billed charges,413.25,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,369.75,85% of total billed charges,N/A,not seperately reimbursable,12,1750,326.25
Outpatient Medical Services,WOUND CARE,99211,E&M ESTABLISHED PT VISIT BRIEF,761,67,N/A,not seperately reimbursable,53.6,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.47,33.54% of total billed charges,21.62,100% of BCBS fee schedule,21.62,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,40.2,60% of total billed charges,8.85,100% of CMS fee schedule,43.55,65% of total billed charges,N/A,not seperately reimbursable,46.9,70% of total billed charges,50.25,75% of toal billed charges,33.15,100% of CMS fee schedule,50.25,75% of total billed charges,50.25,75% of total billed charges,56.95,85% of total billed charges,50.25,75% of total billed charges,N/A,not seperately reimbursable,18.09,27% of total billed charges,N/A,not seperately reimbursable,15.41,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1750,60% of total billed charges,22.51,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,46.9,70% of total billed charges,51.59,77% of total billed charges,43.55,65% of total billed charges,67,100% of total billed charges,67,100% of total billed charges,50.25,75% of total billed charges,N/A,not seperately reimbursable,33.5,50% of total billed charges,22.47,33.54% of total billed charges,63.65,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,56.95,85% of total billed charges,N/A,not seperately reimbursable,8.85,1750,50.25
Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT EXTEN,761,237,209.49,175% of CMS APC rate,189.6,pays based on per visit rate,119.71,100% of CMS APC rate,123.3,103% of CMS APC rate,N/A,not seperately reimbursable,79.49,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,142.2,60% of total billed charges,N/A,not seperately reimbursable,154.05,65% of total billed charges,119.71,100% of CMS APC rate,165.9,70% of total billed charges,177.75,75% of toal billed charges,157.44,100% of CMS fee schedule,177.75,75% of total billed charges,177.75,75% of total billed charges,201.45,85% of total billed charges,177.75,75% of total billed charges,119.71,100% of CMS APC rate,63.99,27% of total billed charges,N/A,not seperately reimbursable,54.51,23% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,1750,60% of total billed charges,79.63,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,165.9,70% of total billed charges,182.49,77% of total billed charges,154.05,65% of total billed charges,237,100% of total billed charges,237,100% of total billed charges,177.75,75% of total billed charges,N/A,not seperately reimbursable,118.5,50% of total billed charges,79.49,33.54% of total billed charges,225.15,95% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,201.45,85% of total billed charges,119.71,100% of CMS apc rate,54.51,1750,177.75
Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT INTER,761,192,209.49,175% of CMS APC rate,153.6,pays based on per visit rate,119.71,100% of CMS APC rate,123.3,103% of CMS APC rate,N/A,not seperately reimbursable,64.4,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,115.2,60% of total billed charges,N/A,not seperately reimbursable,124.8,65% of total billed charges,119.71,100% of CMS APC rate,134.4,70% of total billed charges,144,75% of toal billed charges,157.44,100% of CMS fee schedule,144,75% of total billed charges,144,75% of total billed charges,163.2,85% of total billed charges,144,75% of total billed charges,119.71,100% of CMS APC rate,51.84,27% of total billed charges,N/A,not seperately reimbursable,44.16,23% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,1750,60% of total billed charges,64.51,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,134.4,70% of total billed charges,147.84,77% of total billed charges,124.8,65% of total billed charges,192,100% of total billed charges,192,100% of total billed charges,144,75% of total billed charges,N/A,not seperately reimbursable,96,50% of total billed charges,64.4,33.54% of total billed charges,182.4,95% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,163.2,85% of total billed charges,119.71,100% of CMS apc rate,44.16,1750,144.00
Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT COMPL,761,331,209.49,175% of CMS APC rate,264.8,pays based on per visit rate,119.71,100% of CMS APC rate,123.3,103% of CMS APC rate,N/A,not seperately reimbursable,111.02,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,198.6,60% of total billed charges,N/A,not seperately reimbursable,215.15,65% of total billed charges,119.71,100% of CMS APC rate,231.7,70% of total billed charges,248.25,75% of toal billed charges,157.44,100% of CMS fee schedule,248.25,75% of total billed charges,248.25,75% of total billed charges,281.35,85% of total billed charges,248.25,75% of total billed charges,119.71,100% of CMS APC rate,89.37,27% of total billed charges,N/A,not seperately reimbursable,76.13,23% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,1750,60% of total billed charges,111.22,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,231.7,70% of total billed charges,254.87,77% of total billed charges,215.15,65% of total billed charges,331,100% of total billed charges,331,100% of total billed charges,248.25,75% of total billed charges,N/A,not seperately reimbursable,165.5,50% of total billed charges,111.02,33.54% of total billed charges,314.45,95% of total billed charges,119.71,100% of CMS APC rate,119.71,100% of CMS APC rate,N/A,not seperately reimbursable,119.71,100% of CMS APC rate,281.35,85% of total billed charges,119.71,100% of CMS apc rate,76.13,1750,248.25
Outpatient Medical Services,SLEEP STUDY,95806,HOME SLEEP TEST TYPE III,740,1146,254.34,175% of CMS APC rate,1326,pays based on per visit rate,145.34,100% of CMS APC rate,149.69,103% of CMS APC rate,N/A,not seperately reimbursable,384.37,33.54% of total billed charges,127.71,100% of BCBS fee schedule,127.71,100% of BCBS fee schedule,145.34,100% of CMS APC rate,145.34,100% of CMS APC rate,687.6,60% of total billed charges,62.49,100% of CMS fee schedule,744.9,65% of total billed charges,145.34,100% of CMS APC rate,802.2,70% of total billed charges,859.5,75% of toal billed charges,260.45,100% of CMS fee schedule,859.5,75% of total billed charges,859.5,75% of total billed charges,974.1,85% of total billed charges,859.5,75% of total billed charges,145.34,100% of CMS APC rate,309.42,27% of total billed charges,N/A,not seperately reimbursable,263.58,23% of total billed charges,145.34,100% of CMS APC rate,145.34,100% of CMS APC rate,145.34,100% of CMS APC rate,687.6,60% of total billed charges,385.06,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,802.2,70% of total billed charges,882.42,77% of total billed charges,744.9,65% of total billed charges,1146,100% of total billed charges,1146,100% of total billed charges,859.5,75% of total billed charges,71.53,100% of SHARP fee schedule,573,50% of total billed charges,384.37,33.54% of total billed charges,1088.7,95% of total billed charges,145.34,100% of CMS APC rate,145.34,100% of CMS APC rate,982,pays based on per day visit,145.34,100% of CMS APC rate,974.1,85% of total billed charges,145.34,100% of CMS apc rate,62.49,1326,859.50
Outpatient Medical Services,SLEEP STUDY,95810,SLEEP STUDY PSG,740,2389,1653.94,175% of CMS APC rate,1326,pays based on per visit rate,945.11,100% of CMS APC rate,973.46,103% of CMS APC rate,122,100% of AR fee schedule,801.27,33.54% of total billed charges,839.06,100% of BCBS fee schedule,839.06,100% of BCBS fee schedule,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,1433.4,60% of total billed charges,425.23,100% of CMS fee schedule,1552.85,65% of total billed charges,945.11,100% of CMS APC rate,1672.3,70% of total billed charges,1791.75,75% of toal billed charges,1743.32,100% of CMS fee schedule,1791.75,75% of total billed charges,1791.75,75% of total billed charges,2030.65,85% of total billed charges,1791.75,75% of total billed charges,945.11,100% of CMS APC rate,645.03,27% of total billed charges,N/A,not seperately reimbursable,549.47,23% of total billed charges,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,1433.4,60% of total billed charges,802.7,33.6% of total billed charges,276.94,227% of AR fee schedule,285.25,233.81% of AR fee schedule,276.94,227% of AR fee schedule,1672.3,70% of total billed charges,1839.53,77% of total billed charges,1552.85,65% of total billed charges,2389,100% of total billed charges,2389,100% of total billed charges,1791.75,75% of total billed charges,176.39,100% of SHARP fee schedule,1194.5,50% of total billed charges,801.27,33.54% of total billed charges,2269.55,95% of total billed charges,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,982,pays based on per day visit,945.11,100% of CMS APC rate,2030.65,85% of total billed charges,945.11,100% of CMS apc rate,122,2389,1791.75
Outpatient Medical Services,SLEEP STUDY,95811,SLEEP STUDY WITH TITRATION,740,2486,1653.94,175% of CMS APC rate,1326,pays based on per visit rate,945.11,100% of CMS APC rate,973.46,103% of CMS APC rate,205.37,100% of AR fee schedule,833.8,33.54% of total billed charges,839.06,100% of BCBS fee schedule,839.06,100% of BCBS fee schedule,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,1491.6,60% of total billed charges,445.07,100% of CMS fee schedule,1615.9,65% of total billed charges,945.11,100% of CMS APC rate,1740.2,70% of total billed charges,1864.5,75% of toal billed charges,1743.32,100% of CMS fee schedule,1864.5,75% of total billed charges,1864.5,75% of total billed charges,2113.1,85% of total billed charges,1864.5,75% of total billed charges,945.11,100% of CMS APC rate,671.22,27% of total billed charges,N/A,not seperately reimbursable,571.78,23% of total billed charges,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,1491.6,60% of total billed charges,835.3,33.6% of total billed charges,466.19,227% of AR fee schedule,480.18,233.81% of AR fee schedule,466.19,227% of AR fee schedule,1740.2,70% of total billed charges,1914.22,77% of total billed charges,1615.9,65% of total billed charges,2486,100% of total billed charges,2486,100% of total billed charges,1864.5,75% of total billed charges,183.14,100% of SHARP fee schedule,1243,50% of total billed charges,833.8,33.54% of total billed charges,2361.7,95% of total billed charges,945.11,100% of CMS APC rate,945.11,100% of CMS APC rate,982,pays based on per day visit,945.11,100% of CMS APC rate,2113.1,85% of total billed charges,945.11,100% of CMS apc rate,183.14,2486,1864.50
Outpatient Medical Services,CARDIOLOGY,93306,ECHO TRANSTHORACIC,483,3190,891.35,175% of CMS APC rate,2552,pays based on per visit rate,509.33,100% of CMS APC rate,524.62,103% of CMS APC rate,257.51,100% of AR fee schedule,1069.93,33.54% of total billed charges,444.55,100% of BCBS fee schedule,444.55,100% of BCBS fee schedule,509.33,100% of CMS APC rate,509.33,100% of CMS APC rate,1914,60% of total billed charges,116.93,100% of CMS fee schedule,2073.5,65% of total billed charges,509.33,100% of CMS APC rate,2233,70% of total billed charges,2392.5,75% of toal billed charges,946.13,100% of CMS fee schedule,2392.5,75% of total billed charges,2392.5,75% of total billed charges,2711.5,85% of total billed charges,2392.5,75% of total billed charges,509.33,100% of CMS APC rate,861.3,27% of total billed charges,N/A,not seperately reimbursable,733.7,23% of total billed charges,509.33,100% of CMS APC rate,509.33,100% of CMS APC rate,509.33,100% of CMS APC rate,1914,60% of total billed charges,1071.84,33.6% of total billed charges,584.55,227% of AR fee schedule,602.08,233.81% of AR fee schedule,584.55,227% of AR fee schedule,2233,70% of total billed charges,2456.3,77% of total billed charges,2073.5,65% of total billed charges,3190,100% of total billed charges,3190,100% of total billed charges,2392.5,75% of total billed charges,106.55,100% of SHARP fee schedule,1595,50% of total billed charges,1069.93,33.54% of total billed charges,3030.5,95% of total billed charges,509.33,100% of CMS APC rate,509.33,100% of CMS APC rate,386,pays based on per day visit,509.33,100% of CMS APC rate,2711.5,85% of total billed charges,509.33,100% of CMS apc rate,106.55,3190,2392.50
Outpatient Medical Services,CARDIOLOGY,93005,EKG,730,169,96.56,175% of CMS APC rate,135.2,pays based on per visit rate,55.18,100% of CMS APC rate,56.83,103% of CMS APC rate,17,100% of AR fee schedule,56.68,33.54% of total billed charges,50.78,100% of BCBS fee schedule,50.78,100% of BCBS fee schedule,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,101.4,60% of total billed charges,7.31,100% of CMS fee schedule,109.85,65% of total billed charges,55.18,100% of CMS APC rate,118.3,70% of total billed charges,126.75,75% of toal billed charges,104.9,100% of CMS fee schedule,126.75,75% of total billed charges,126.75,75% of total billed charges,143.65,85% of total billed charges,126.75,75% of total billed charges,55.18,100% of CMS APC rate,45.63,27% of total billed charges,N/A,not seperately reimbursable,38.87,23% of total billed charges,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,101.4,60% of total billed charges,56.78,33.6% of total billed charges,38.59,227% of AR fee schedule,39.75,233.81% of AR fee schedule,38.59,227% of AR fee schedule,118.3,70% of total billed charges,130.13,77% of total billed charges,109.85,65% of total billed charges,169,100% of total billed charges,169,100% of total billed charges,126.75,75% of total billed charges,N/A,not seperately reimbursable,84.5,50% of total billed charges,56.68,33.54% of total billed charges,160.55,95% of total billed charges,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,197,pays based on per day visit,55.18,100% of CMS APC rate,143.65,85% of total billed charges,55.18,100% of CMS apc rate,7.31,197,126.75
Outpatient Medical Services,CARDIOLOGY,93225,HOLTER MONITOR 48 HR,731,694,209.55,175% of CMS APC rate,555.2,pays based on per visit rate,119.74,100% of CMS APC rate,123.33,103% of CMS APC rate,44,100% of AR fee schedule,232.77,33.54% of total billed charges,100.65,100% of BCBS fee schedule,100.65,100% of BCBS fee schedule,119.74,100% of CMS APC rate,119.74,100% of CMS APC rate,416.4,60% of total billed charges,22.19,100% of CMS fee schedule,451.1,65% of total billed charges,119.74,100% of CMS APC rate,485.8,70% of total billed charges,520.5,75% of toal billed charges,219.08,100% of CMS fee schedule,520.5,75% of total billed charges,520.5,75% of total billed charges,589.9,85% of total billed charges,520.5,75% of total billed charges,119.74,100% of CMS APC rate,187.38,27% of total billed charges,N/A,not seperately reimbursable,159.62,23% of total billed charges,119.74,100% of CMS APC rate,119.74,100% of CMS APC rate,119.74,100% of CMS APC rate,416.4,60% of total billed charges,233.18,33.6% of total billed charges,99.88,227% of AR fee schedule,102.88,233.81% of AR fee schedule,99.88,227% of AR fee schedule,485.8,70% of total billed charges,534.38,77% of total billed charges,451.1,65% of total billed charges,694,100% of total billed charges,694,100% of total billed charges,520.5,75% of total billed charges,31.85,100% of SHARP fee schedule,347,50% of total billed charges,232.77,33.54% of total billed charges,659.3,95% of total billed charges,119.74,100% of CMS APC rate,119.74,100% of CMS APC rate,786,pays based on per day visit,119.74,100% of CMS APC rate,589.9,85% of total billed charges,119.74,100% of CMS apc rate,22.19,786,520.50
Outpatient Medical Services,CARDIOLOGY,93226,HOLTER SCANNING,731,638,96.56,175% of CMS APC rate,510.4,pays based on per visit rate,55.18,100% of CMS APC rate,56.83,103% of CMS APC rate,83,100% of AR fee schedule,213.99,33.54% of total billed charges,100.65,100% of BCBS fee schedule,100.65,100% of BCBS fee schedule,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,382.8,60% of total billed charges,31.49,100% of CMS fee schedule,414.7,65% of total billed charges,55.18,100% of CMS APC rate,446.6,70% of total billed charges,478.5,75% of toal billed charges,104.9,100% of CMS fee schedule,478.5,75% of total billed charges,478.5,75% of total billed charges,542.3,85% of total billed charges,478.5,75% of total billed charges,55.18,100% of CMS APC rate,172.26,27% of total billed charges,N/A,not seperately reimbursable,146.74,23% of total billed charges,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,382.8,60% of total billed charges,214.37,33.6% of total billed charges,188.41,227% of AR fee schedule,194.06,233.81% of AR fee schedule,188.41,227% of AR fee schedule,446.6,70% of total billed charges,491.26,77% of total billed charges,414.7,65% of total billed charges,638,100% of total billed charges,638,100% of total billed charges,478.5,75% of total billed charges,45,100% of SHARP fee schedule,319,50% of total billed charges,213.99,33.54% of total billed charges,606.1,95% of total billed charges,55.18,100% of CMS APC rate,55.18,100% of CMS APC rate,786,pays based on per day visit,55.18,100% of CMS APC rate,542.3,85% of total billed charges,55.18,100% of CMS apc rate,31.49,786,478.50
Outpatient Medical Services,CARDIOLOGY,G0237,CR THERAPEUTIC PROC FOR ENDURANCE,419,82,39.79,175% of CMS APC rate,65.6,pays based on per visit rate,22.75,100% of CMS APC rate,23.42,103% of CMS APC rate,N/A,not seperately reimbursable,27.5,33.54% of total billed charges,21.22,100% of BCBS fee schedule,21.22,100% of BCBS fee schedule,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,82,pays based on per visit rate,7.93,100% of CMS fee schedule,53.3,65% of total billed charges,22.75,100% of CMS APC rate,57.4,70% of total billed charges,61.5,75% of toal billed charges,42.56,100% of CMS fee schedule,61.5,75% of total billed charges,61.5,75% of total billed charges,69.7,85% of total billed charges,61.5,75% of total billed charges,22.75,100% of CMS APC rate,22.14,27% of total billed charges,N/A,not seperately reimbursable,18.86,23% of total billed charges,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,49.2,60% of total billed charges,27.55,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.4,70% of total billed charges,63.14,77% of total billed charges,53.3,65% of total billed charges,82,100% of total billed charges,82,100% of total billed charges,61.5,75% of total billed charges,N/A,not seperately reimbursable,41,50% of total billed charges,27.5,33.54% of total billed charges,77.9,95% of total billed charges,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,163,pays based on per day visit,22.75,100% of CMS APC rate,69.7,85% of total billed charges,22.75,100% of CMS apc rate,7.93,163,61.50
Outpatient Medical Services,CARDIOLOGY,G0238,CR THERAPEUTIC PROC FOR RESPIRATORY,419,82,39.79,175% of CMS APC rate,65.6,pays based on per visit rate,22.75,100% of CMS APC rate,23.42,103% of CMS APC rate,N/A,not seperately reimbursable,27.5,33.54% of total billed charges,21.22,100% of BCBS fee schedule,21.22,100% of BCBS fee schedule,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,82,pays based on per visit rate,8.24,100% of CMS fee schedule,53.3,65% of total billed charges,22.75,100% of CMS APC rate,57.4,70% of total billed charges,61.5,75% of toal billed charges,42.56,100% of CMS fee schedule,61.5,75% of total billed charges,61.5,75% of total billed charges,69.7,85% of total billed charges,61.5,75% of total billed charges,22.75,100% of CMS APC rate,22.14,27% of total billed charges,N/A,not seperately reimbursable,18.86,23% of total billed charges,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,49.2,60% of total billed charges,27.55,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.4,70% of total billed charges,63.14,77% of total billed charges,53.3,65% of total billed charges,82,100% of total billed charges,82,100% of total billed charges,61.5,75% of total billed charges,N/A,not seperately reimbursable,41,50% of total billed charges,27.5,33.54% of total billed charges,77.9,95% of total billed charges,22.75,100% of CMS APC rate,22.75,100% of CMS APC rate,163,pays based on per day visit,22.75,100% of CMS APC rate,69.7,85% of total billed charges,22.75,100% of CMS apc rate,8.24,163,61.50
Outpatient Medical Services,CARDIOLOGY,93798,CR PHASE II CARDIAC EXERCISE,943,402,204.68,175% of CMS APC rate,329.64,82% total billed charges,116.96,100% of CMS APC rate,120.46,103% of CMS APC rate,N/A,not seperately reimbursable,134.83,33.54% of total billed charges,101.57,100% of BCBS fee schedule,101.57,100% of BCBS fee schedule,116.96,100% of CMS APC rate,116.96,100% of CMS APC rate,241.2,60% of total billed charges,13.58,100% of CMS fee schedule,261.3,65% of total billed charges,116.96,100% of CMS APC rate,281.4,70% of total billed charges,301.5,75% of toal billed charges,226.62,100% of CMS fee schedule,301.5,75% of total billed charges,301.5,75% of total billed charges,341.7,85% of total billed charges,301.5,75% of total billed charges,116.96,100% of CMS APC rate,108.54,27% of total billed charges,N/A,not seperately reimbursable,92.46,23% of total billed charges,116.96,100% of CMS APC rate,116.96,100% of CMS APC rate,116.96,100% of CMS APC rate,241.2,60% of total billed charges,135.07,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,281.4,70% of total billed charges,309.54,77% of total billed charges,261.3,65% of total billed charges,402,100% of total billed charges,402,100% of total billed charges,301.5,75% of total billed charges,N/A,not seperately reimbursable,201,50% of total billed charges,134.83,33.54% of total billed charges,381.9,95% of total billed charges,116.96,100% of CMS APC rate,116.96,100% of CMS APC rate,302,pays based on per day visit,116.96,100% of CMS APC rate,341.7,85% of total billed charges,116.96,100% of CMS apc rate,13.58,402,301.50
Outpatient Medical Services,REHAB,97110,PT THERAPEUTIC EXERCISE PER 15 MIN,421,212,46.69,175% of CMS fee schedule,144,pays based on per visit rate,26.68,100% of CMS fee schedule,27.48,103% of CMS fee schedule,21.76,100% of AR fee schedule,71.1,33.54% of total billed charges,23,pays based on per visit rate,23,pays based on per visit rate,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,149.74,pays based on per visit rate,29.01,100% of CMS fee schedule,152,pays based on per visit rate,26.68,100% of CMS fee schedule,148.4,70% of total billed charges,152,pays based on per visit rate,42.95,100% of CMS fee schedule,159,75% of total billed charges,159,75% of total billed charges,180.2,85% of total billed charges,159,75% of total billed charges,26.68,100% of CMS fee schedule,57.24,27% of total billed charges,N/A,not seperately reimbursable,48.76,23% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,127.2,60% of total billed charges,30.26,100% of CMS fee schedule,49.4,227% of AR fee schedule,50.88,233.81% of AR fee schedule,49.4,227% of AR fee schedule,148.4,70% of total billed charges,163.24,77% of total billed charges,137.8,65% of total billed charges,212,100% of total billed charges,212,100% of total billed charges,159,75% of total billed charges,N/A,not seperately reimbursable,106,50% of total billed charges,71.1,33.54% of total billed charges,201.4,95% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,130,pays based on per day visit,26.68,100% of CMS fee schedule,180.2,85% of total billed charges,26.68,100% of CMS fee schedule,21.76,212,159.00
Outpatient Medical Services,REHAB,97112,PT NEURO MUSCULAR RE ED PER 15 MI,421,239,51.96,175% of CMS fee schedule,144,pays based on per visit rate,29.69,100% of CMS fee schedule,30.58,103% of CMS fee schedule,N/A,not seperately reimbursable,80.16,33.54% of total billed charges,27,pays based on per visit rate,27,pays based on per visit rate,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,149.74,pays based on per visit rate,33.3,100% of CMS fee schedule,152,pays based on per visit rate,29.69,100% of CMS fee schedule,167.3,70% of total billed charges,152,pays based on per visit rate,49.2,100% of CMS fee schedule,179.25,75% of total billed charges,179.25,75% of total billed charges,203.15,85% of total billed charges,179.25,75% of total billed charges,29.69,100% of CMS fee schedule,64.53,27% of total billed charges,N/A,not seperately reimbursable,54.97,23% of total billed charges,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,143.4,60% of total billed charges,31.32,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,167.3,70% of total billed charges,184.03,77% of total billed charges,155.35,65% of total billed charges,239,100% of total billed charges,239,100% of total billed charges,179.25,75% of total billed charges,N/A,not seperately reimbursable,119.5,50% of total billed charges,80.16,33.54% of total billed charges,227.05,95% of total billed charges,29.69,100% of CMS fee schedule,29.69,100% of CMS fee schedule,130,pays based on per day visit,29.69,100% of CMS fee schedule,203.15,85% of total billed charges,29.69,100% of CMS fee schedule,27,239,179.25
Outpatient Medical Services,REHAB,97116,PT GAIT TRAINING PER 15 MIN,421,67,46.69,175% of CMS fee schedule,144,pays based on per visit rate,26.68,100% of CMS fee schedule,27.48,103% of CMS fee schedule,N/A,not seperately reimbursable,22.47,33.54% of total billed charges,23,pays based on per visit rate,23,pays based on per visit rate,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,67,pays based on per visit rate,28.7,100% of CMS fee schedule,152,pays based on per visit rate,26.68,100% of CMS fee schedule,46.9,70% of total billed charges,152,pays based on per visit rate,42.95,100% of CMS fee schedule,50.25,75% of total billed charges,50.25,75% of total billed charges,56.95,85% of total billed charges,50.25,75% of total billed charges,26.68,100% of CMS fee schedule,18.09,27% of total billed charges,N/A,not seperately reimbursable,15.41,23% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,40.2,60% of total billed charges,26.72,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,46.9,70% of total billed charges,51.59,77% of total billed charges,43.55,65% of total billed charges,67,100% of total billed charges,67,100% of total billed charges,50.25,75% of total billed charges,N/A,not seperately reimbursable,33.5,50% of total billed charges,22.47,33.54% of total billed charges,63.65,95% of total billed charges,26.68,100% of CMS fee schedule,26.68,100% of CMS fee schedule,130,pays based on per day visit,26.68,100% of CMS fee schedule,56.95,85% of total billed charges,26.68,100% of CMS fee schedule,15.41,152,50.25
Outpatient Medical Services,REHAB,97161,PT EVAL LOW COMPLEX 20 MIN,421,473,158.92,175% of CMS fee schedule,144,pays based on per visit rate,90.81,100% of CMS fee schedule,93.53,103% of CMS fee schedule,98.88,100% of AR fee schedule,158.64,33.54% of total billed charges,82.98,pays based on per visit rate,66,pays based on per visit rate,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,149.74,pays based on per visit rate,80.82,100% of CMS fee schedule,152,pays based on per visit rate,90.81,100% of CMS fee schedule,331.1,70% of total billed charges,152,pays based on per visit rate,146.88,100% of CMS fee schedule,354.75,75% of total billed charges,354.75,75% of total billed charges,402.05,85% of total billed charges,354.75,75% of total billed charges,90.81,100% of CMS fee schedule,127.71,27% of total billed charges,N/A,not seperately reimbursable,108.79,23% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,283.8,60% of total billed charges,75.57,100% of CMS fee schedule,224.46,227% of AR fee schedule,231.19,233.81% of AR fee schedule,224.46,227% of AR fee schedule,331.1,70% of total billed charges,364.21,77% of total billed charges,307.45,65% of total billed charges,473,100% of total billed charges,473,100% of total billed charges,354.75,75% of total billed charges,N/A,not seperately reimbursable,236.5,50% of total billed charges,158.64,33.54% of total billed charges,449.35,95% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,130,pays based on per day visit,90.81,100% of CMS fee schedule,402.05,85% of total billed charges,90.81,100% of CMS fee schedule,66,473,354.75
Outpatient Medical Services,REHAB,97163,PT EVAL HIGH COMPLEX 45 MIN,421,489,158.92,175% of CMS fee schedule,144,pays based on per visit rate,90.81,100% of CMS fee schedule,93.53,103% of CMS fee schedule,197.76,100% of AR fee schedule,164.01,33.54% of total billed charges,82.98,pays based on per visit rate,66,pays based on per visit rate,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,149.74,pays based on per visit rate,80.82,100% of CMS fee schedule,152,pays based on per visit rate,90.81,100% of CMS fee schedule,342.3,70% of total billed charges,152,pays based on per visit rate,146.88,100% of CMS fee schedule,366.75,75% of total billed charges,366.75,75% of total billed charges,415.65,85% of total billed charges,366.75,75% of total billed charges,90.81,100% of CMS fee schedule,132.03,27% of total billed charges,N/A,not seperately reimbursable,112.47,23% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,293.4,60% of total billed charges,75.57,100% of CMS fee schedule,448.92,227% of AR fee schedule,462.38,233.81% of AR fee schedule,448.92,227% of AR fee schedule,342.3,70% of total billed charges,376.53,77% of total billed charges,317.85,65% of total billed charges,489,100% of total billed charges,489,100% of total billed charges,366.75,75% of total billed charges,N/A,not seperately reimbursable,244.5,50% of total billed charges,164.01,33.54% of total billed charges,464.55,95% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,130,pays based on per day visit,90.81,100% of CMS fee schedule,415.65,85% of total billed charges,90.81,100% of CMS fee schedule,66,489,366.75
Outpatient Medical Services,REHAB,97530,PT THERAPEUTIC ACTIVITIES PER 15,421,162,55.37,175% of CMS fee schedule,144,pays based on per visit rate,31.64,100% of CMS fee schedule,32.59,103% of CMS fee schedule,21.76,100% of AR fee schedule,54.33,33.54% of total billed charges,30,pays based on per visit rate,30,pays based on per visit rate,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,149.74,pays based on per visit rate,36.71,100% of CMS fee schedule,152,pays based on per visit rate,31.64,100% of CMS fee schedule,113.4,70% of total billed charges,152,pays based on per visit rate,53.01,100% of CMS fee schedule,121.5,75% of total billed charges,121.5,75% of total billed charges,137.7,85% of total billed charges,121.5,75% of total billed charges,31.64,100% of CMS fee schedule,43.74,27% of total billed charges,N/A,not seperately reimbursable,37.26,23% of total billed charges,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,97.2,60% of total billed charges,32.51,100% of CMS fee schedule,49.4,227% of AR fee schedule,50.88,233.81% of AR fee schedule,49.4,227% of AR fee schedule,113.4,70% of total billed charges,124.74,77% of total billed charges,105.3,65% of total billed charges,162,100% of total billed charges,162,100% of total billed charges,121.5,75% of total billed charges,N/A,not seperately reimbursable,81,50% of total billed charges,54.33,33.54% of total billed charges,153.9,95% of total billed charges,31.64,100% of CMS fee schedule,31.64,100% of CMS fee schedule,130,pays based on per day visit,31.64,100% of CMS fee schedule,137.7,85% of total billed charges,31.64,100% of CMS fee schedule,21.76,162,121.50
Outpatient Medical Services,REHAB,97140,PT MANUAL THERAPY PER 15 MIN,421,203,44.1,175% of CMS fee schedule,144,pays based on per visit rate,25.2,100% of CMS fee schedule,25.96,103% of CMS fee schedule,N/A,not seperately reimbursable,68.09,33.54% of total billed charges,21,pays based on per visit rate,21,pays based on per visit rate,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,149.74,pays based on per visit rate,26.74,100% of CMS fee schedule,152,pays based on per visit rate,25.2,100% of CMS fee schedule,142.1,70% of total billed charges,152,pays based on per visit rate,39.62,100% of CMS fee schedule,152.25,75% of total billed charges,152.25,75% of total billed charges,172.55,85% of total billed charges,152.25,75% of total billed charges,25.2,100% of CMS fee schedule,54.81,27% of total billed charges,N/A,not seperately reimbursable,46.69,23% of total billed charges,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,121.8,60% of total billed charges,28.11,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,142.1,70% of total billed charges,156.31,77% of total billed charges,131.95,65% of total billed charges,203,100% of total billed charges,203,100% of total billed charges,152.25,75% of total billed charges,N/A,not seperately reimbursable,101.5,50% of total billed charges,68.09,33.54% of total billed charges,192.85,95% of total billed charges,25.2,100% of CMS fee schedule,25.2,100% of CMS fee schedule,130,pays based on per day visit,25.2,100% of CMS fee schedule,172.55,85% of total billed charges,25.2,100% of CMS fee schedule,21,203,152.25
Outpatient Medical Services,REHAB,97162,PT EVAL MOD COMPLEX 30 MIN,421,470,158.92,175% of CMS fee schedule,144,pays based on per visit rate,90.81,100% of CMS fee schedule,93.53,103% of CMS fee schedule,148.32,100% of AR fee schedule,157.64,33.54% of total billed charges,82.98,pays based on per visit rate,66,pays based on per visit rate,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,149.74,pays based on per visit rate,80.82,100% of CMS fee schedule,152,pays based on per visit rate,90.81,100% of CMS fee schedule,329,70% of total billed charges,152,pays based on per visit rate,146.88,100% of CMS fee schedule,352.5,75% of total billed charges,352.5,75% of total billed charges,399.5,85% of total billed charges,352.5,75% of total billed charges,90.81,100% of CMS fee schedule,126.9,27% of total billed charges,N/A,not seperately reimbursable,108.1,23% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,282,60% of total billed charges,75.57,100% of CMS fee schedule,336.69,227% of AR fee schedule,346.79,233.81% of AR fee schedule,336.69,227% of AR fee schedule,329,70% of total billed charges,361.9,77% of total billed charges,305.5,65% of total billed charges,470,100% of total billed charges,470,100% of total billed charges,352.5,75% of total billed charges,N/A,not seperately reimbursable,235,50% of total billed charges,157.64,33.54% of total billed charges,446.5,95% of total billed charges,90.81,100% of CMS fee schedule,90.81,100% of CMS fee schedule,130,pays based on per day visit,90.81,100% of CMS fee schedule,399.5,85% of total billed charges,90.81,100% of CMS fee schedule,66,470,352.50
Outpatient Medical Services,SURGERY,45378,COLONOSCOPY SCREENING,360,1753,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,587.96,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1314.75,75% of total billed charges,1490.05,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,473.31,27% of total billed charges,618.13,100% of OK APC rate,403.19,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,589.01,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1139.45,65% of total billed charges,1753,100% of total billed charges,1753,100% of total billed charges,1314.75,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,876.5,50% of total billed charges,587.96,33.54% of total billed charges,1665.35,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,1490.05,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2500,1314.75
Outpatient Medical Services,SURGERY,31231,"ENDOSCOPY, UPPER/DX",360,1785,315.6,175% of CMS APC rate,1591,100% of CMS fee schedule,180.34,100% of CMS APC rate,185.75,103% of CMS APC rate,69.3,100% of AR ASC tier groupings rate,598.69,33.54% of total billed charges,153,100% of BCBS ASC tier groupings rate,153,100% of BCBS ASC tier groupings rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,277.15,100% of CIGNA ASC tier groupings rate,60.43,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,1249.5,70% of total billed charges,975,100% of CMS ASC tier groupings rate,339.71,100% of CMS fee schedule,2503,100% of CMS ASC tier groupings rate,1338.75,75% of total billed charges,1517.25,85% of total billed charges,1903,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,481.95,27% of total billed charges,126.68,100% of OK APC rate,410.55,23% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,2000,100% of CMS ASC tier groupings rate,599.76,33.6% of total billed charges,157.31,227% of AR ASC tier groupings rate,162.03,233.81% of AR ASC tier groupings rate,157.31,227% of AR ASC tier groupings rate,1249.5,70% of total billed charges,1374.45,77% of total billed charges,1160.25,65% of total billed charges,1785,100% of total billed charges,1785,100% of total billed charges,1338.75,75% of total billed charges,95,100% of SHARP ASC tier groupings rate,892.5,50% of total billed charges,598.69,33.54% of total billed charges,1695.75,95% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,392,100% of UHC ASC tier groupings rate,180.34,100% of CMS APC rate,1517.25,85% of total billed charges,180.34,100% of CMS apc rate,60.43,2503,1338.75
Outpatient Medical Services,SURGERY,31231,"ENDOSCOPY, UPPER/BX",360,1927,315.6,175% of CMS APC rate,1591,100% of CMS fee schedule,180.34,100% of CMS APC rate,185.75,103% of CMS APC rate,69.3,100% of AR ASC tier groupings rate,646.32,33.54% of total billed charges,153,100% of BCBS ASC tier groupings rate,153,100% of BCBS ASC tier groupings rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,277.15,100% of CIGNA ASC tier groupings rate,60.43,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,1348.9,70% of total billed charges,975,100% of CMS ASC tier groupings rate,339.71,100% of CMS fee schedule,2503,100% of CMS ASC tier groupings rate,1445.25,75% of total billed charges,1637.95,85% of total billed charges,1903,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,520.29,27% of total billed charges,126.68,100% of OK APC rate,443.21,23% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,2000,100% of CMS ASC tier groupings rate,647.47,33.6% of total billed charges,157.31,227% of AR ASC tier groupings rate,162.03,233.81% of AR ASC tier groupings rate,157.31,227% of AR ASC tier groupings rate,1348.9,70% of total billed charges,1483.79,77% of total billed charges,1252.55,65% of total billed charges,1927,100% of total billed charges,1927,100% of total billed charges,1445.25,75% of total billed charges,95,100% of SHARP ASC tier groupings rate,963.5,50% of total billed charges,646.32,33.54% of total billed charges,1830.65,95% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,392,100% of UHC ASC tier groupings rate,180.34,100% of CMS APC rate,1637.95,85% of total billed charges,180.34,100% of CMS apc rate,60.43,2503,1445.25
Outpatient Medical Services,SURGERY,31231,SURGICAL REPROCESSING,360,37,315.6,175% of CMS APC rate,1591,100% of CMS fee schedule,180.34,100% of CMS APC rate,185.75,103% of CMS APC rate,69.3,100% of AR ASC tier groupings rate,12.41,33.54% of total billed charges,153,100% of BCBS ASC tier groupings rate,153,100% of BCBS ASC tier groupings rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,37,100% of CIGNA ASC tier groupings rate,37,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,25.9,70% of total billed charges,975,100% of CMS ASC tier groupings rate,339.71,100% of CMS fee schedule,2503,100% of CMS ASC tier groupings rate,27.75,75% of total billed charges,31.45,85% of total billed charges,1903,100% of CMS ASC tier groupings rate,180.34,100% of CMS APC rate,9.99,27% of total billed charges,126.68,100% of OK APC rate,8.51,23% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,2000,100% of CMS ASC tier groupings rate,12.43,33.6% of total billed charges,157.31,227% of AR ASC tier groupings rate,162.03,233.81% of AR ASC tier groupings rate,157.31,227% of AR ASC tier groupings rate,25.9,70% of total billed charges,28.49,77% of total billed charges,24.05,65% of total billed charges,37,100% of total billed charges,37,100% of total billed charges,27.75,75% of total billed charges,95,100% of SHARP ASC tier groupings rate,18.5,50% of total billed charges,12.41,33.54% of total billed charges,35.15,95% of total billed charges,180.34,100% of CMS APC rate,180.34,100% of CMS APC rate,392,100% of UHC ASC tier groupings rate,180.34,100% of CMS APC rate,31.45,85% of total billed charges,180.34,100% of CMS apc rate,8.51,2503,27.75
Outpatient Medical Services,SURGERY,45378,COLONOSCOPY & POLYP,360,2503,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,839.51,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1877.25,75% of total billed charges,2127.55,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,675.81,27% of total billed charges,618.13,100% of OK APC rate,575.69,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,841.01,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1626.95,65% of total billed charges,2503,100% of total billed charges,2503,100% of total billed charges,1877.25,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,1251.5,50% of total billed charges,839.51,33.54% of total billed charges,2377.85,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,2127.55,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2503,1877.25
Outpatient Medical Services,SURGERY,45378,COLONOSCOPY HIGH RISK,360,1952,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,654.7,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1464,75% of total billed charges,1659.2,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,527.04,27% of total billed charges,618.13,100% of OK APC rate,448.96,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,655.87,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1268.8,65% of total billed charges,1952,100% of total billed charges,1952,100% of total billed charges,1464,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,976,50% of total billed charges,654.7,33.54% of total billed charges,1854.4,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,1659.2,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2500,1464.00
Outpatient Medical Services,SURGERY,45378,"COLONOSCOPY, DX",360,1937,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,649.67,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1452.75,75% of total billed charges,1646.45,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,522.99,27% of total billed charges,618.13,100% of OK APC rate,445.51,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,650.83,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1259.05,65% of total billed charges,1937,100% of total billed charges,1937,100% of total billed charges,1452.75,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,968.5,50% of total billed charges,649.67,33.54% of total billed charges,1840.15,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,1646.45,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2500,1452.75
Outpatient Medical Services,SURGERY,45378,COLONOSCOPY/MU POLY,360,2629,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,881.77,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1971.75,75% of total billed charges,2234.65,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,709.83,27% of total billed charges,618.13,100% of OK APC rate,604.67,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,883.34,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1708.85,65% of total billed charges,2629,100% of total billed charges,2629,100% of total billed charges,1971.75,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,1314.5,50% of total billed charges,881.77,33.54% of total billed charges,2497.55,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,2234.65,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2629,1971.75
Outpatient Medical Services,SURGERY,20206,BX SOFT TISSUE,360,1721,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,494.68,100% of AR ASC tier groupings rate,577.22,33.54% of total billed charges,1340,100% of BCBS ASC tier groupings rate,1340,100% of BCBS ASC tier groupings rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,977.78,100% of CIGNA ASC tier groupings rate,55.71,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,1324.27,100% of CMS ASC tier groupings rate,975,100% of CMS ASC tier groupings rate,2780.55,100% of CMS ASC tier groupings rate,715,100% of CMS ASC tier groupings rate,1290.75,75% of total billed charges,1462.85,85% of total billed charges,1125,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,464.67,27% of total billed charges,1110.7,100% of OK APC rate,395.83,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2000,100% of CMS ASC tier groupings rate,578.26,33.6% of total billed charges,1122.92,227% of AR ASC tier groupings rate,1156.61,233.81% of AR ASC tier groupings rate,1122.92,227% of AR ASC tier groupings rate,509,100% of AR ASC tier groupings rate,926,100% of CMS ASC tier groupings rate,1118.65,65% of total billed charges,1721,100% of total billed charges,1721,100% of total billed charges,1290.75,75% of total billed charges,698,100% of SHARP ASC tier groupings rate,860.5,50% of total billed charges,577.22,33.54% of total billed charges,1634.95,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1280,100% of UHC ASC tier groupings rate,N/A,not seperately reimbursable,1462.85,85% of total billed charges,N/A,not seperately reimbursable,55.71,2780.55,1290.75
Outpatient Medical Services,SURGERY,29907,ARTHROSCOPY,360,5013,20917.32,175% of CMS APC rate,1591,100% of CMS fee schedule,11952.76,100% of CMS APC rate,12311.33,103% of CMS APC rate,6366.45,100% of AR ASC tier groupings rate,1681.36,33.54% of total billed charges,11610,100% of BCBS ASC tier groupings rate,11610,100% of BCBS ASC tier groupings rate,11952.76,100% of CMS APC rate,11952.76,100% of CMS APC rate,3235.86,100% of CIGNA ASC tier groupings rate,816.9,100% of CMS fee schedule,3756,100% of CMS ASC tier groupings rate,11952.76,100% of CMS APC rate,3509.1,70% of total billed charges,3850,100% of CMS ASC tier groupings rate,22571.68,100% of CMS ASC tier groupings rate,2503,100% of CMS ASC tier groupings rate,3759.75,75% of total billed charges,4261.05,85% of total billed charges,1903,100% of CMS ASC tier groupings rate,11952.76,100% of CMS APC rate,1353.51,27% of total billed charges,9629.95,100% of OK APC rate,1152.99,23% of total billed charges,11952.76,100% of CMS APC rate,11952.76,100% of CMS APC rate,11952.76,100% of CMS APC rate,3000,100% of CMS ASC tier groupings rate,1684.37,33.6% of total billed charges,14451.84,227% of AR ASC tier groupings rate,14885.4,233.81% of AR ASC tier groupings rate,14451.84,227% of AR ASC tier groupings rate,3509.1,70% of total billed charges,3860.01,77% of total billed charges,3258.45,65% of total billed charges,5013,100% of total billed charges,5013,100% of total billed charges,3759.75,75% of total billed charges,9516,100% of SHARP ASC tier groupings rate,2506.5,50% of total billed charges,1681.36,33.54% of total billed charges,4762.35,95% of total billed charges,11952.76,100% of CMS APC rate,11952.76,100% of CMS APC rate,2895,100% of UHC ASC tier groupings rate,11952.76,100% of CMS APC rate,4261.05,85% of total billed charges,11952.76,100% of CMS apc rate,816.9,22571.68,3759.75
Outpatient Medical Services,SURGERY,49650,LAP HERNIA,360,10133,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1920.8,100% of AR ASC tier groupings rate,3398.61,33.54% of total billed charges,4716,100% of BCBS ASC tier groupings rate,4716,100% of BCBS ASC tier groupings rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1723.24,100% of CIGNA ASC tier groupings rate,401.45,100% of CMS fee schedule,1664,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,2377.15,100% of CMS ASC tier groupings rate,1750,100% of CMS ASC tier groupings rate,9895.66,100% of CMS ASC tier groupings rate,1348,100% of CMS ASC tier groupings rate,7599.75,75% of total billed charges,8613.05,85% of total billed charges,2164,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,2735.91,27% of total billed charges,5555.43,100% of OK APC rate,2330.59,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6000,100% of CMS ASC tier groupings rate,3404.69,33.6% of total billed charges,4360.22,227% of AR ASC tier groupings rate,4491.02,233.81% of AR ASC tier groupings rate,4360.22,227% of AR ASC tier groupings rate,1474,100% of AR ASC tier groupings rate,2263,100% of CMS ASC tier groupings rate,6586.45,65% of total billed charges,10133,100% of total billed charges,10133,100% of total billed charges,7599.75,75% of total billed charges,2656,100% of SHARP ASC tier groupings rate,5066.5,50% of total billed charges,3398.61,33.54% of total billed charges,9626.35,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2895,100% of UHC ASC tier groupings rate,N/A,not seperately reimbursable,8613.05,85% of total billed charges,N/A,not seperately reimbursable,401.45,10133,7599.75
Outpatient Medical Services,SURGERY,99202,MINOR PROCEDURE,360,1667,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,559.11,33.54% of total billed charges,47.16,100% of BCBS fee schedule,47.16,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1667,100% of CIGNA ASC tier groupings rate,47.96,100% of CMS fee schedule,1083.55,65% of total billed charges,N/A,not seperately reimbursable,1166.9,70% of total billed charges,1250.25,75% of toal billed charges,104.67,100% of CMS fee schedule,2503,100% of CMS ASC tier groupings rate,1250.25,75% of total billed charges,1416.95,85% of total billed charges,1250.25,75% of total billed charges,N/A,not seperately reimbursable,450.09,27% of total billed charges,N/A,not seperately reimbursable,383.41,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1000.2,60% of total billed charges,560.11,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1166.9,70% of total billed charges,1283.59,77% of total billed charges,1083.55,65% of total billed charges,1667,100% of total billed charges,1667,100% of total billed charges,1250.25,75% of total billed charges,N/A,not seperately reimbursable,833.5,50% of total billed charges,559.11,33.54% of total billed charges,1583.65,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1416.95,85% of total billed charges,N/A,not seperately reimbursable,47.16,2503,1250.25
Outpatient Medical Services,SURGERY,62310,EPIDURAL STEROID INJECTION W/ GUIDANCE,360,1432,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,480.29,33.54% of total billed charges,315.04,22% of total billed charges,844.88,59% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,977.78,100% of CIGNA ASC tier groupings rate,N/A,not seperately reimbursable,930.8,65% of total billed charges,N/A,not seperately reimbursable,1324.27,100% of CMS ASC tier groupings rate,975,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,715,100% of CMS ASC tier groupings rate,1074,75% of total billed charges,1217.2,85% of total billed charges,1125,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,386.64,27% of total billed charges,N/A,not seperately reimbursable,329.36,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2000,100% of CMS ASC tier groupings rate,481.15,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,789,100% of AR ASC tier groupings rate,926,100% of CMS ASC tier groupings rate,930.8,65% of total billed charges,1432,100% of total billed charges,1432,100% of total billed charges,1074,75% of total billed charges,844.88,59% of total billed charges,716,50% of total billed charges,480.29,33.54% of total billed charges,1360.4,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,831.99,58.1% of total billed charges,N/A,not seperately reimbursable,1217.2,85% of total billed charges,N/A,not seperately reimbursable,315.04,2000,1074.00
Outpatient Medical Services,SURGERY,45378,COLONOSCOPY & BX,360,2347,1482.14,175% of CMS APC rate,1591,100% of CMS fee schedule,846.94,100% of CMS APC rate,872.34,103% of CMS APC rate,334.06,100% of AR ASC tier groupings rate,787.18,33.54% of total billed charges,746,100% of BCBS ASC tier groupings rate,746,100% of BCBS ASC tier groupings rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,177.44,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,1567.46,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,1760.25,75% of total billed charges,1994.95,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,846.94,100% of CMS APC rate,633.69,27% of total billed charges,618.13,100% of OK APC rate,539.81,23% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,788.59,33.6% of total billed charges,758.32,227% of AR ASC tier groupings rate,781.07,233.81% of AR ASC tier groupings rate,758.32,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,1525.55,65% of total billed charges,2347,100% of total billed charges,2347,100% of total billed charges,1760.25,75% of total billed charges,467,100% of SHARP ASC tier groupings rate,1173.5,50% of total billed charges,787.18,33.54% of total billed charges,2229.65,95% of total billed charges,846.94,100% of CMS APC rate,846.94,100% of CMS APC rate,1280,100% of UHC ASC tier groupings rate,846.94,100% of CMS APC rate,1994.95,85% of total billed charges,846.94,100% of CMS apc rate,177.44,2500,1760.25
Outpatient Medical Services,SURGERY,25608,ORIF,360,3443,11613.41,175% of CMS APC rate,1591,100% of CMS fee schedule,6636.24,100% of CMS APC rate,6835.32,103% of CMS APC rate,3493.53,100% of AR ASC tier groupings rate,1154.78,33.54% of total billed charges,5836,100% of BCBS ASC tier groupings rate,5836,100% of BCBS ASC tier groupings rate,6636.24,100% of CMS APC rate,6636.24,100% of CMS APC rate,1968.98,100% of CIGNA ASC tier groupings rate,768.16,100% of CMS fee schedule,2050,100% of CMS ASC tier groupings rate,6636.24,100% of CMS APC rate,3129.37,100% of CMS ASC tier groupings rate,2250,100% of CMS ASC tier groupings rate,12269.39,100% of CMS ASC tier groupings rate,1529,100% of CMS ASC tier groupings rate,2582.25,75% of total billed charges,2926.55,85% of total billed charges,2467,100% of CMS ASC tier groupings rate,6636.24,100% of CMS APC rate,929.61,27% of total billed charges,4840.54,100% of OK APC rate,791.89,23% of total billed charges,6636.24,100% of CMS APC rate,6636.24,100% of CMS APC rate,6636.24,100% of CMS APC rate,6500,100% of CMS ASC tier groupings rate,1156.85,33.6% of total billed charges,7930.31,227% of AR ASC tier groupings rate,8168.22,233.81% of AR ASC tier groupings rate,7930.31,227% of AR ASC tier groupings rate,1698,100% of AR ASC tier groupings rate,2586,100% of CMS ASC tier groupings rate,2237.95,65% of total billed charges,3443,100% of total billed charges,3443,100% of total billed charges,2582.25,75% of total billed charges,4866,100% of SHARP ASC tier groupings rate,1721.5,50% of total billed charges,1154.78,33.54% of total billed charges,3270.85,95% of total billed charges,6636.24,100% of CMS APC rate,6636.24,100% of CMS APC rate,2895,100% of UHC ASC tier groupings rate,6636.24,100% of CMS APC rate,2926.55,85% of total billed charges,6636.24,100% of CMS apc rate,768.16,12269.39,2582.25
Outpatient Medical Services,SURGERY,64721,CARPEL TUNNEL RELEAS,360,1143,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,671.11,100% of AR ASC tier groupings rate,383.36,33.54% of total billed charges,1678,100% of BCBS ASC tier groupings rate,1678,100% of BCBS ASC tier groupings rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1143,100% of CIGNA ASC tier groupings rate,397.06,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,3311.33,100% of CMS ASC tier groupings rate,963,100% of CMS ASC tier groupings rate,857.25,75% of total billed charges,971.55,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,308.61,27% of total billed charges,1391.28,100% of OK APC rate,262.89,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2500,100% of CMS ASC tier groupings rate,384.05,33.6% of total billed charges,1523.42,227% of AR ASC tier groupings rate,1569.12,233.81% of AR ASC tier groupings rate,1523.42,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,742.95,65% of total billed charges,1143,100% of total billed charges,1143,100% of total billed charges,857.25,75% of total billed charges,965,100% of SHARP ASC tier groupings rate,571.5,50% of total billed charges,383.36,33.54% of total billed charges,1085.85,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1665,100% of UHC ASC tier groupings rate,N/A,not seperately reimbursable,971.55,85% of total billed charges,N/A,not seperately reimbursable,262.89,3311.33,857.25
Outpatient Medical Services,SURGERY,47562,LAP. CHOLECYSTECTOMY,360,8654,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1920.8,100% of AR ASC tier groupings rate,2902.55,33.54% of total billed charges,4716,100% of BCBS ASC tier groupings rate,4716,100% of BCBS ASC tier groupings rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5066.48,60% of total billed charges,617.69,100% of CMS fee schedule,3756,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,6057.8,70% of total billed charges,3850,100% of CMS ASC tier groupings rate,9895.66,100% of CMS ASC tier groupings rate,6490.5,75% of total billed charges,6490.5,75% of total billed charges,7355.9,85% of total billed charges,4114,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,2336.58,27% of total billed charges,3911.4,100% of OK APC rate,1990.42,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7500,100% of CMS ASC tier groupings rate,2907.74,33.6% of total billed charges,4360.22,227% of AR ASC tier groupings rate,4491.02,233.81% of AR ASC tier groupings rate,4360.22,227% of AR ASC tier groupings rate,6057.8,70% of total billed charges,6663.58,77% of total billed charges,5625.1,65% of total billed charges,8654,100% of total billed charges,8654,100% of total billed charges,6490.5,75% of total billed charges,2656,100% of SHARP ASC tier groupings rate,4327,50% of total billed charges,2902.55,33.54% of total billed charges,8221.3,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2895,100% of UHC ASC tier groupings rate,N/A,not seperately reimbursable,7355.9,85% of total billed charges,N/A,not seperately reimbursable,617.69,9895.66,6490.50
Outpatient Medical Services,SURGERY,10060,I & D,360,1405,323.01,175% of CMS APC rate,1591,100% of CMS fee schedule,184.58,100% of CMS APC rate,190.12,103% of CMS APC rate,64.17,100% of AR ASC tier groupings rate,471.24,33.54% of total billed charges,171,100% of BCBS ASC tier groupings rate,171,100% of BCBS ASC tier groupings rate,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,277.15,100% of CIGNA ASC tier groupings rate,93.59,100% of CMS fee schedule,884,100% of CMS ASC tier groupings rate,184.58,100% of CMS APC rate,983.5,70% of total billed charges,975,100% of CMS ASC tier groupings rate,343.35,100% of CMS fee schedule,2503,100% of CMS ASC tier groupings rate,1053.75,75% of total billed charges,1194.25,85% of total billed charges,1903,100% of CMS ASC tier groupings rate,184.58,100% of CMS APC rate,379.35,27% of total billed charges,141.38,100% of OK APC rate,323.15,23% of total billed charges,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,843,60% of total billed charges,472.08,33.6% of total billed charges,145.67,227% of AR ASC tier groupings rate,150.04,233.81% of AR ASC tier groupings rate,145.67,227% of AR ASC tier groupings rate,983.5,70% of total billed charges,1081.85,77% of total billed charges,913.25,65% of total billed charges,1405,100% of total billed charges,1405,100% of total billed charges,1053.75,75% of total billed charges,91,100% of SHARP ASC tier groupings rate,702.5,50% of total billed charges,471.24,33.54% of total billed charges,1334.75,95% of total billed charges,184.58,100% of CMS APC rate,184.58,100% of CMS APC rate,392,100% of UHC ASC tier groupings rate,184.58,100% of CMS APC rate,1194.25,85% of total billed charges,184.58,100% of CMS apc rate,64.17,2503,1053.75
Outpatient Medical Services,SURGERY,43246,PEG TUBE PROCEDURE,360,842,N/A,not seperately reimbursable,1591,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,574.53,100% of AR ASC tier groupings rate,282.41,33.54% of total billed charges,1520,100% of BCBS ASC tier groupings rate,1520,100% of BCBS ASC tier groupings rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,842,100% of CIGNA ASC tier groupings rate,191.7,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,3263.38,100% of CMS ASC tier groupings rate,963,100% of CMS ASC tier groupings rate,631.5,75% of total billed charges,715.7,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,N/A,not seperately reimbursable,227.34,27% of total billed charges,1260.23,100% of OK APC rate,193.66,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2500,100% of CMS ASC tier groupings rate,282.91,33.6% of total billed charges,1304.18,227% of AR ASC tier groupings rate,1343.31,233.81% of AR ASC tier groupings rate,1304.18,227% of AR ASC tier groupings rate,1062,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,547.3,65% of total billed charges,842,100% of total billed charges,842,100% of total billed charges,631.5,75% of total billed charges,803,100% of SHARP ASC tier groupings rate,421,50% of total billed charges,282.41,33.54% of total billed charges,799.9,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1280,100% of UHC ASC tier groupings rate,N/A,not seperately reimbursable,715.7,85% of total billed charges,N/A,not seperately reimbursable,191.7,3263.38,631.50
Outpatient Medical Services,SURGERY,11042,DEBRIDEMENT,360,1282,649.5,175% of CMS APC rate,1591,100% of CMS fee schedule,371.14,100% of CMS APC rate,382.27,103% of CMS APC rate,145.5,100% of AR ASC tier groupings rate,429.98,33.54% of total billed charges,312,100% of BCBS ASC tier groupings rate,312,100% of BCBS ASC tier groupings rate,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,1229.71,100% of CIGNA ASC tier groupings rate,57.92,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,371.14,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,683.86,100% of CMS fee schedule,963,100% of CMS ASC tier groupings rate,961.5,75% of total billed charges,1089.7,85% of total billed charges,1516,100% of CMS ASC tier groupings rate,371.14,100% of CMS APC rate,346.14,27% of total billed charges,258.55,100% of OK APC rate,294.86,23% of total billed charges,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,430.75,33.6% of total billed charges,330.29,227% of AR ASC tier groupings rate,340.19,233.81% of AR ASC tier groupings rate,330.29,227% of AR ASC tier groupings rate,350,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,833.3,65% of total billed charges,1282,100% of total billed charges,1282,100% of total billed charges,961.5,75% of total billed charges,196,100% of SHARP ASC tier groupings rate,641,50% of total billed charges,429.98,33.54% of total billed charges,1217.9,95% of total billed charges,371.14,100% of CMS APC rate,371.14,100% of CMS APC rate,392,100% of UHC ASC tier groupings rate,371.14,100% of CMS APC rate,1089.7,85% of total billed charges,371.14,100% of CMS apc rate,57.92,2500,961.50
Outpatient Medical Services,EMERGENCY,90471,INJECTION VACCINE/TOXOID/RABIE,260,88,115.69,175% of CMS APC rate,72.16,82% total billed charges,66.11,100% of CMS APC rate,68.09,103% of CMS APC rate,13.14,100% of AR fee schedule,29.52,33.54% of total billed charges,55.82,100% of BCBS fee schedule,55.82,100% of BCBS fee schedule,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,52.8,60% of total billed charges,13.14,100% of CMS fee schedule,57.2,65% of total billed charges,66.11,100% of CMS APC rate,61.6,70% of total billed charges,66,75% of toal billed charges,N/A,not seperately reimbursable,66,75% of total billed charges,66,75% of total billed charges,74.8,85% of total billed charges,66,75% of total billed charges,66.11,100% of CMS APC rate,23.76,27% of total billed charges,48.93,100% of OK APC rate,20.24,23% of total billed charges,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,52.8,60% of total billed charges,29.57,33.6% of total billed charges,29.83,227% of AR fee schedule,30.72,233.81% of AR fee schedule,29.83,227% of AR fee schedule,61.6,70% of total billed charges,67.76,77% of total billed charges,57.2,65% of total billed charges,88,100% of total billed charges,88,100% of total billed charges,66,75% of total billed charges,N/A,not seperately reimbursable,44,50% of total billed charges,29.52,33.54% of total billed charges,83.6,95% of total billed charges,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,159,pays based on per day visit,66.11,100% of CMS APC rate,74.8,85% of total billed charges,66.11,100% of CMS apc rate,13.14,159,66.00
Outpatient Medical Services,EMERGENCY,96360,IV INFUSION HYDRATION,260,615,342.5,175% of CMS APC rate,504.3,82% total billed charges,195.72,100% of CMS APC rate,201.59,103% of CMS APC rate,N/A,not seperately reimbursable,206.27,33.54% of total billed charges,169.61,100% of BCBS fee schedule,169.61,100% of BCBS fee schedule,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,N/A,not seperately reimbursable,30.38,100% of CMS fee schedule,399.75,65% of total billed charges,195.72,100% of CMS APC rate,430.5,70% of total billed charges,461.25,75% of toal billed charges,N/A,not seperately reimbursable,461.25,75% of total billed charges,461.25,75% of total billed charges,522.75,85% of total billed charges,461.25,75% of total billed charges,195.72,100% of CMS APC rate,166.05,27% of total billed charges,148.68,100% of OK APC rate,141.45,23% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,369,60% of total billed charges,206.64,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,430.5,70% of total billed charges,473.55,77% of total billed charges,399.75,65% of total billed charges,615,100% of total billed charges,615,100% of total billed charges,461.25,75% of total billed charges,N/A,not seperately reimbursable,307.5,50% of total billed charges,206.27,33.54% of total billed charges,584.25,95% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,159,pays based on per day visit,195.72,100% of CMS APC rate,522.75,85% of total billed charges,195.72,100% of CMS apc rate,30.38,615,461.25
Outpatient Medical Services,EMERGENCY,96361,IV INFUSION HYDRATION EACH ADD,260,161,75,175% of CMS APC rate,132.02,82% total billed charges,42.86,100% of CMS APC rate,44.14,103% of CMS APC rate,N/A,not seperately reimbursable,54,33.54% of total billed charges,36.09,pays based on per visit rate,36.09,pays based on per visit rate,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,N/A,not seperately reimbursable,12.11,100% of CMS fee schedule,104.65,65% of total billed charges,42.86,100% of CMS APC rate,112.7,70% of total billed charges,120.75,75% of toal billed charges,N/A,not seperately reimbursable,120.75,75% of total billed charges,120.75,75% of total billed charges,136.85,85% of total billed charges,120.75,75% of total billed charges,42.86,100% of CMS APC rate,43.47,27% of total billed charges,30.84,100% of OK APC rate,37.03,23% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,96.6,60% of total billed charges,54.1,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,112.7,70% of total billed charges,123.97,77% of total billed charges,104.65,65% of total billed charges,161,100% of total billed charges,161,100% of total billed charges,120.75,75% of total billed charges,N/A,not seperately reimbursable,80.5,50% of total billed charges,54,33.54% of total billed charges,152.95,95% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,159,pays based on per day visit,42.86,100% of CMS APC rate,136.85,85% of total billed charges,42.86,100% of CMS apc rate,12.11,161,120.75
Outpatient Medical Services,EMERGENCY,96365,IV INFUSION MED IST HOUR,260,676,342.5,175% of CMS APC rate,554.32,82% total billed charges,195.72,100% of CMS APC rate,201.59,103% of CMS APC rate,90.58,100% of AR fee schedule,226.73,33.54% of total billed charges,169.61,100% of BCBS fee schedule,169.61,100% of BCBS fee schedule,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,N/A,not seperately reimbursable,62.46,100% of CMS fee schedule,439.4,65% of total billed charges,195.72,100% of CMS APC rate,473.2,70% of total billed charges,507,75% of toal billed charges,N/A,not seperately reimbursable,507,75% of total billed charges,507,75% of total billed charges,574.6,85% of total billed charges,507,75% of total billed charges,195.72,100% of CMS APC rate,182.52,27% of total billed charges,148.68,100% of OK APC rate,155.48,23% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,405.6,60% of total billed charges,227.14,33.6% of total billed charges,205.62,227% of AR fee schedule,211.79,233.81% of AR fee schedule,205.62,227% of AR fee schedule,473.2,70% of total billed charges,520.52,77% of total billed charges,439.4,65% of total billed charges,676,100% of total billed charges,676,100% of total billed charges,507,75% of total billed charges,N/A,not seperately reimbursable,338,50% of total billed charges,226.73,33.54% of total billed charges,642.2,95% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,159,pays based on per day visit,195.72,100% of CMS APC rate,574.6,85% of total billed charges,195.72,100% of CMS apc rate,62.46,676,507.00
Outpatient Medical Services,EMERGENCY,96366,"IV INFUSION MED EACH ADD""L HOU",260,44,75,175% of CMS APC rate,36.08,82% total billed charges,42.86,100% of CMS APC rate,44.14,103% of CMS APC rate,N/A,not seperately reimbursable,14.76,33.54% of total billed charges,35.18,100% of BCBS fee schedule,35.18,100% of BCBS fee schedule,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,N/A,not seperately reimbursable,19.7,100% of CMS fee schedule,28.6,65% of total billed charges,42.86,100% of CMS APC rate,30.8,70% of total billed charges,33,75% of toal billed charges,N/A,not seperately reimbursable,33,75% of total billed charges,33,75% of total billed charges,37.4,85% of total billed charges,33,75% of total billed charges,42.86,100% of CMS APC rate,11.88,27% of total billed charges,30.84,100% of OK APC rate,10.12,23% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,26.4,60% of total billed charges,14.78,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,30.8,70% of total billed charges,33.88,77% of total billed charges,28.6,65% of total billed charges,44,100% of total billed charges,44,100% of total billed charges,33,75% of total billed charges,N/A,not seperately reimbursable,22,50% of total billed charges,14.76,33.54% of total billed charges,41.8,95% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,159,pays based on per day visit,42.86,100% of CMS APC rate,37.4,85% of total billed charges,42.86,100% of CMS apc rate,10.12,159,33.00
Outpatient Medical Services,EMERGENCY,96376,IV PUSH SAME MED AFTER 30 MIN,260,167,N/A,not seperately reimbursable,136.94,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,56.01,33.54% of total billed charges,31.3,100% of BCBS fee schedule,31.3,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,108.55,65% of total billed charges,N/A,not seperately reimbursable,116.9,70% of total billed charges,125.25,75% of toal billed charges,N/A,not seperately reimbursable,125.25,75% of total billed charges,125.25,75% of total billed charges,141.95,85% of total billed charges,125.25,75% of total billed charges,N/A,not seperately reimbursable,45.09,27% of total billed charges,N/A,not seperately reimbursable,38.41,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,100.2,60% of total billed charges,56.11,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,116.9,70% of total billed charges,128.59,77% of total billed charges,108.55,65% of total billed charges,167,100% of total billed charges,167,100% of total billed charges,125.25,75% of total billed charges,N/A,not seperately reimbursable,83.5,50% of total billed charges,56.01,33.54% of total billed charges,158.65,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,159,pays based on per day visit,N/A,not seperately reimbursable,141.95,85% of total billed charges,N/A,not seperately reimbursable,31.3,167,125.25
Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT LONG ARM,450,433,389.96,175% of CMS APC rate,355.06,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,145.23,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,259.8,60% of total billed charges,270.54,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,324.75,75% of total billed charges,324.75,75% of total billed charges,368.05,85% of total billed charges,324.75,75% of total billed charges,222.83,100% of CMS APC rate,116.91,27% of total billed charges,174.5,100% of OK APC rate,99.59,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,145.49,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,281.45,65% of total billed charges,433,100% of total billed charges,433,100% of total billed charges,324.75,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,216.5,50% of total billed charges,145.23,33.54% of total billed charges,411.35,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,368.05,85% of total billed charges,222.83,100% of CMS apc rate,86.76,2500,324.75
Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT SHORT ARM,450,668,389.96,175% of CMS APC rate,547.76,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,224.05,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,400.8,60% of total billed charges,270.54,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,501,75% of total billed charges,501,75% of total billed charges,567.8,85% of total billed charges,501,75% of total billed charges,222.83,100% of CMS APC rate,180.36,27% of total billed charges,174.5,100% of OK APC rate,153.64,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,224.45,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,434.2,65% of total billed charges,668,100% of total billed charges,668,100% of total billed charges,501,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,334,50% of total billed charges,224.05,33.54% of total billed charges,634.6,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,567.8,85% of total billed charges,222.83,100% of CMS apc rate,86.76,2500,501.00
Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT FINGER,450,242,389.96,175% of CMS APC rate,198.44,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,81.17,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,145.2,60% of total billed charges,242,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,181.5,75% of total billed charges,181.5,75% of total billed charges,205.7,85% of total billed charges,181.5,75% of total billed charges,222.83,100% of CMS APC rate,65.34,27% of total billed charges,174.5,100% of OK APC rate,55.66,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,81.31,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,157.3,65% of total billed charges,242,100% of total billed charges,242,100% of total billed charges,181.5,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,121,50% of total billed charges,81.17,33.54% of total billed charges,229.9,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,205.7,85% of total billed charges,222.83,100% of CMS apc rate,55.66,2500,181.50
Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP SHOULDER,450,82,389.96,175% of CMS APC rate,67.24,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,27.5,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,49.2,60% of total billed charges,82,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,61.5,75% of total billed charges,61.5,75% of total billed charges,69.7,85% of total billed charges,61.5,75% of total billed charges,222.83,100% of CMS APC rate,22.14,27% of total billed charges,174.5,100% of OK APC rate,18.86,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,27.55,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,53.3,65% of total billed charges,82,100% of total billed charges,82,100% of total billed charges,61.5,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,41,50% of total billed charges,27.5,33.54% of total billed charges,77.9,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,69.7,85% of total billed charges,222.83,100% of CMS apc rate,18.86,2500,61.50
Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP ELBOW & WRIST,450,61,389.96,175% of CMS APC rate,50.02,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,20.46,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,36.6,60% of total billed charges,61,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,45.75,75% of total billed charges,45.75,75% of total billed charges,51.85,85% of total billed charges,45.75,75% of total billed charges,222.83,100% of CMS APC rate,16.47,27% of total billed charges,174.5,100% of OK APC rate,14.03,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,20.5,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,39.65,65% of total billed charges,61,100% of total billed charges,61,100% of total billed charges,45.75,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,30.5,50% of total billed charges,20.46,33.54% of total billed charges,57.95,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,51.85,85% of total billed charges,222.83,100% of CMS apc rate,14.03,2500,45.75
Outpatient Medical Services,EMERGENCY,26605,STRAP HAND & FINGER,450,116,389.96,175% of CMS APC rate,95.12,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,38.91,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,69.6,60% of total billed charges,116,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,87,75% of total billed charges,87,75% of total billed charges,98.6,85% of total billed charges,87,75% of total billed charges,222.83,100% of CMS APC rate,31.32,27% of total billed charges,174.5,100% of OK APC rate,26.68,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,38.98,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,75.4,65% of total billed charges,116,100% of total billed charges,116,100% of total billed charges,87,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,58,50% of total billed charges,38.91,33.54% of total billed charges,110.2,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,98.6,85% of total billed charges,222.83,100% of CMS apc rate,26.68,2500,87.00
Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT LONG LEG,450,606,389.96,175% of CMS APC rate,496.92,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,203.25,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,363.6,60% of total billed charges,270.54,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,454.5,75% of total billed charges,454.5,75% of total billed charges,515.1,85% of total billed charges,454.5,75% of total billed charges,222.83,100% of CMS APC rate,163.62,27% of total billed charges,174.5,100% of OK APC rate,139.38,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,203.62,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,393.9,65% of total billed charges,606,100% of total billed charges,606,100% of total billed charges,454.5,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,303,50% of total billed charges,203.25,33.54% of total billed charges,575.7,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,515.1,85% of total billed charges,222.83,100% of CMS apc rate,86.76,2500,454.50
Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT SHORT LEG,450,603,389.96,175% of CMS APC rate,494.46,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,202.25,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,361.8,60% of total billed charges,270.54,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,452.25,75% of total billed charges,452.25,75% of total billed charges,512.55,85% of total billed charges,452.25,75% of total billed charges,222.83,100% of CMS APC rate,162.81,27% of total billed charges,174.5,100% of OK APC rate,138.69,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,202.61,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,391.95,65% of total billed charges,603,100% of total billed charges,603,100% of total billed charges,452.25,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,301.5,50% of total billed charges,202.25,33.54% of total billed charges,572.85,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,512.55,85% of total billed charges,222.83,100% of CMS apc rate,86.76,2500,452.25
Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP KNEE,450,290,389.96,175% of CMS APC rate,237.8,82% total billed charges,222.83,100% of CMS APC rate,229.51,103% of CMS APC rate,86.76,100% of AR ASC tier groupings rate,97.27,33.54% of total billed charges,211,100% of BCBS ASC tier groupings rate,211,100% of BCBS ASC tier groupings rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,174,60% of total billed charges,270.54,100% of CMS fee schedule,1196,100% of CMS ASC tier groupings rate,222.83,100% of CMS APC rate,1564.1,100% of CMS ASC tier groupings rate,1300,100% of CMS ASC tier groupings rate,404.44,100% of CMS fee schedule,217.5,75% of total billed charges,217.5,75% of total billed charges,246.5,85% of total billed charges,217.5,75% of total billed charges,222.83,100% of CMS APC rate,78.3,27% of total billed charges,174.5,100% of OK APC rate,66.7,23% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,2500,100% of CMS ASC tier groupings rate,97.44,33.6% of total billed charges,196.95,227% of AR ASC tier groupings rate,202.85,233.81% of AR ASC tier groupings rate,196.95,227% of AR ASC tier groupings rate,219,100% of AR ASC tier groupings rate,1275,100% of CMS ASC tier groupings rate,188.5,65% of total billed charges,290,100% of total billed charges,290,100% of total billed charges,217.5,75% of total billed charges,132,100% of SHARP ASC tier groupings rate,145,50% of total billed charges,97.27,33.54% of total billed charges,275.5,95% of total billed charges,222.83,100% of CMS APC rate,222.83,100% of CMS APC rate,N/A,not seperately reimbursable,222.83,100% of CMS APC rate,246.5,85% of total billed charges,222.83,100% of CMS apc rate,66.7,2500,217.50
Outpatient Medical Services,EMERGENCY,96372,IM/SQ INJECTION ANY MED,450,250,115.69,175% of CMS APC rate,205,82% total billed charges,66.11,100% of CMS APC rate,68.09,103% of CMS APC rate,51,pays based on per visit rate,83.85,33.54% of total billed charges,55.82,100% of BCBS fee schedule,55.82,100% of BCBS fee schedule,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,N/A,not seperately reimbursable,13.14,100% of CMS fee schedule,162.5,65% of total billed charges,66.11,100% of CMS APC rate,175,70% of total billed charges,187.5,75% of toal billed charges,117.46,100% of CMS fee schedule,187.5,75% of total billed charges,187.5,75% of total billed charges,212.5,85% of total billed charges,187.5,75% of total billed charges,66.11,100% of CMS APC rate,67.5,27% of total billed charges,48.93,100% of OK APC rate,57.5,23% of total billed charges,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,150,60% of total billed charges,84,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,175,70% of total billed charges,192.5,77% of total billed charges,162.5,65% of total billed charges,250,100% of total billed charges,250,100% of total billed charges,187.5,75% of total billed charges,N/A,not seperately reimbursable,125,50% of total billed charges,83.85,33.54% of total billed charges,237.5,95% of total billed charges,66.11,100% of CMS APC rate,66.11,100% of CMS APC rate,N/A,not seperately reimbursable,66.11,100% of CMS APC rate,212.5,85% of total billed charges,66.11,100% of CMS apc rate,13.14,250,187.50
Outpatient Medical Services,EMERGENCY,99281,E.R.EM LEVEL 1,450,443,143.13,175% of CMS APC rate,372,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,51,pays based on per visit rate,148.58,33.54% of total billed charges,97.46,pays based on per visit rate,261.37,pays based on per visit rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,335.56,60% of total billed charges,21.67,100% of CMS fee schedule,287.95,pays based on per visit rate,81.79,100% of CMS APC rate,310.1,70% of total billed charges,332.25,pays based on per visit rate,105.74,100% of CMS fee schedule,332.25,75% of total billed charges,332.25,75% of total billed charges,376.55,85% of total billed charges,779,pays based on per visit rate,81.79,100% of CMS APC rate,119.61,27% of total billed charges,56.33,100% of OK APC rate,101.89,23% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,500,60% of total billed charges,148.85,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,310.1,70% of total billed charges,341.11,77% of total billed charges,287.95,65% of total billed charges,443,100% of total billed charges,443,100% of total billed charges,332.25,75% of total billed charges,N/A,not seperately reimbursable,221.5,50% of total billed charges,148.58,33.54% of total billed charges,420.85,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,406,58.1% of total billed charges,81.79,100% of CMS APC rate,376.55,85% of total billed charges,81.79,100% of CMS apc rate,21.67,779,332.25
Outpatient Medical Services,EMERGENCY,99282,E.R.EM LEVEL-2,450,530,257.44,175% of CMS APC rate,372,82% total billed charges,147.11,100% of CMS APC rate,151.52,103% of CMS APC rate,51,pays based on per visit rate,177.76,33.54% of total billed charges,116.6,pays based on per visit rate,312.7,pays based on per visit rate,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,542.06,60% of total billed charges,41.76,100% of CMS fee schedule,344.5,pays based on per visit rate,147.11,100% of CMS APC rate,371,70% of total billed charges,397.5,pays based on per visit rate,194.79,100% of CMS fee schedule,397.5,75% of total billed charges,397.5,75% of total billed charges,450.5,85% of total billed charges,779,pays based on per visit rate,147.11,100% of CMS APC rate,143.1,27% of total billed charges,103.55,100% of OK APC rate,121.9,23% of total billed charges,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,1375,60% of total billed charges,178.08,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,371,70% of total billed charges,408.1,77% of total billed charges,344.5,65% of total billed charges,530,100% of total billed charges,530,100% of total billed charges,397.5,75% of total billed charges,N/A,not seperately reimbursable,265,50% of total billed charges,177.76,33.54% of total billed charges,503.5,95% of total billed charges,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,691,58.1% of total billed charges,147.11,100% of CMS APC rate,450.5,85% of total billed charges,147.11,100% of CMS apc rate,41.76,1375,397.50
Outpatient Medical Services,EMERGENCY,99283,E.R.EM LEVEL-3,450,720,450.12,175% of CMS APC rate,486,82% total billed charges,257.22,100% of CMS APC rate,264.93,103% of CMS APC rate,51,pays based on per visit rate,241.49,33.54% of total billed charges,158.4,pays based on per visit rate,424.8,pays based on per visit rate,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,707.26,60% of total billed charges,62.68,100% of CMS fee schedule,468,pays based on per visit rate,257.22,100% of CMS APC rate,504,70% of total billed charges,540,pays based on per visit rate,339.81,100% of CMS fee schedule,540,75% of total billed charges,540,75% of total billed charges,612,85% of total billed charges,779,pays based on per visit rate,257.22,100% of CMS APC rate,194.4,27% of total billed charges,180.72,100% of OK APC rate,165.6,23% of total billed charges,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,1375,60% of total billed charges,241.92,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,504,70% of total billed charges,554.4,77% of total billed charges,468,65% of total billed charges,720,100% of total billed charges,720,100% of total billed charges,540,75% of total billed charges,N/A,not seperately reimbursable,360,50% of total billed charges,241.49,33.54% of total billed charges,684,95% of total billed charges,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,1038,58.1% of total billed charges,257.22,100% of CMS APC rate,612,85% of total billed charges,257.22,100% of CMS apc rate,51,1375,540.00
Outpatient Medical Services,EMERGENCY,99284,E.R.EM LEVEL 4,450,973,692.24,175% of CMS APC rate,574,82% total billed charges,395.56,100% of CMS APC rate,407.43,103% of CMS APC rate,51,pays based on per visit rate,326.34,33.54% of total billed charges,214.06,pays based on per visit rate,574.07,pays based on per visit rate,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,826,60% of total billed charges,114.72,100% of CMS fee schedule,632.45,pays based on per visit rate,395.56,100% of CMS APC rate,681.1,70% of total billed charges,729.75,pays based on per visit rate,527.5,100% of CMS fee schedule,729.75,75% of total billed charges,729.75,75% of total billed charges,827.05,85% of total billed charges,779,pays based on per visit rate,395.56,100% of CMS APC rate,262.71,27% of total billed charges,284.66,100% of OK APC rate,223.79,23% of total billed charges,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,1375,60% of total billed charges,326.93,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,681.1,70% of total billed charges,749.21,77% of total billed charges,632.45,65% of total billed charges,973,100% of total billed charges,973,100% of total billed charges,729.75,75% of total billed charges,N/A,not seperately reimbursable,486.5,50% of total billed charges,326.34,33.54% of total billed charges,924.35,95% of total billed charges,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,1507,58.1% of total billed charges,395.56,100% of CMS APC rate,827.05,85% of total billed charges,395.56,100% of CMS apc rate,51,1507,729.75
Outpatient Medical Services,EMERGENCY,99291,ER CRITICAL CARE,450,1248,1369.8,175% of CMS APC rate,1023.36,82% total billed charges,782.75,100% of CMS APC rate,806.22,103% of CMS APC rate,51,pays based on per visit rate,418.58,33.54% of total billed charges,274.56,22% of total billed charges,736.32,59% of total billed charges,782.75,100% of CMS APC rate,782.75,100% of CMS APC rate,1610.7,60% of total billed charges,212.7,100% of CMS fee schedule,811.2,pays based on per visit rate,782.75,100% of CMS APC rate,873.6,70% of total billed charges,936,pays based on per visit rate,1056.85,100% of CMS fee schedule,936,75% of total billed charges,936,75% of total billed charges,1060.8,85% of total billed charges,936,75% of total billed charges,782.75,100% of CMS APC rate,336.96,27% of total billed charges,539.45,100% of OK APC rate,287.04,23% of total billed charges,782.75,100% of CMS APC rate,782.75,100% of CMS APC rate,782.75,100% of CMS APC rate,2175,60% of total billed charges,419.33,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,873.6,70% of total billed charges,960.96,77% of total billed charges,811.2,65% of total billed charges,1248,100% of total billed charges,1248,100% of total billed charges,936,75% of total billed charges,N/A,not seperately reimbursable,624,50% of total billed charges,418.58,33.54% of total billed charges,1185.6,95% of total billed charges,782.75,100% of CMS APC rate,782.75,100% of CMS APC rate,1986,58.1% of total billed charges,782.75,100% of CMS APC rate,1060.8,85% of total billed charges,782.75,100% of CMS apc rate,51,2175,936.00
Outpatient Medical Services,EMERGENCY,99282,E.R.EM LEVEL-2 WITH 25 MODIFIER,450,389,257.44,175% of CMS APC rate,372,82% total billed charges,147.11,100% of CMS APC rate,151.52,103% of CMS APC rate,51,pays based on per visit rate,130.47,33.54% of total billed charges,85.58,pays based on per visit rate,229.51,pays based on per visit rate,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,542.06,60% of total billed charges,41.76,100% of CMS fee schedule,252.85,pays based on per visit rate,147.11,100% of CMS APC rate,272.3,70% of total billed charges,291.75,pays based on per visit rate,194.79,100% of CMS fee schedule,291.75,75% of total billed charges,291.75,75% of total billed charges,330.65,85% of total billed charges,779,pays based on per visit rate,147.11,100% of CMS APC rate,105.03,27% of total billed charges,103.55,100% of OK APC rate,89.47,23% of total billed charges,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,1375,60% of total billed charges,130.7,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,272.3,70% of total billed charges,299.53,77% of total billed charges,252.85,65% of total billed charges,389,100% of total billed charges,389,100% of total billed charges,291.75,75% of total billed charges,N/A,not seperately reimbursable,194.5,50% of total billed charges,130.47,33.54% of total billed charges,369.55,95% of total billed charges,147.11,100% of CMS APC rate,147.11,100% of CMS APC rate,691,58.1% of total billed charges,147.11,100% of CMS APC rate,330.65,85% of total billed charges,147.11,100% of CMS apc rate,41.76,1375,291.75
Outpatient Medical Services,EMERGENCY,99283,E.R.EM LEVEL-3 WITH 25 MODIFIER,450,766,450.12,175% of CMS APC rate,486,82% total billed charges,257.22,100% of CMS APC rate,264.93,103% of CMS APC rate,51,pays based on per visit rate,256.92,33.54% of total billed charges,168.52,pays based on per visit rate,451.94,pays based on per visit rate,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,707.26,60% of total billed charges,62.68,100% of CMS fee schedule,497.9,pays based on per visit rate,257.22,100% of CMS APC rate,536.2,70% of total billed charges,574.5,pays based on per visit rate,339.81,100% of CMS fee schedule,574.5,75% of total billed charges,574.5,75% of total billed charges,651.1,85% of total billed charges,779,pays based on per visit rate,257.22,100% of CMS APC rate,206.82,27% of total billed charges,180.72,100% of OK APC rate,176.18,23% of total billed charges,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,1375,60% of total billed charges,257.38,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,536.2,70% of total billed charges,589.82,77% of total billed charges,497.9,65% of total billed charges,766,100% of total billed charges,766,100% of total billed charges,574.5,75% of total billed charges,N/A,not seperately reimbursable,383,50% of total billed charges,256.92,33.54% of total billed charges,727.7,95% of total billed charges,257.22,100% of CMS APC rate,257.22,100% of CMS APC rate,1038,58.1% of total billed charges,257.22,100% of CMS APC rate,651.1,85% of total billed charges,257.22,100% of CMS apc rate,51,1375,574.50
Outpatient Medical Services,EMERGENCY,99284,E.R.EM LEVEL 4 WITH 25 MODIFIER,450,1067,692.24,175% of CMS APC rate,574,82% total billed charges,395.56,100% of CMS APC rate,407.43,103% of CMS APC rate,51,pays based on per visit rate,357.87,33.54% of total billed charges,234.74,pays based on per visit rate,629.53,pays based on per visit rate,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,826,60% of total billed charges,114.72,100% of CMS fee schedule,693.55,pays based on per visit rate,395.56,100% of CMS APC rate,746.9,70% of total billed charges,800.25,pays based on per visit rate,527.5,100% of CMS fee schedule,800.25,75% of total billed charges,800.25,75% of total billed charges,906.95,85% of total billed charges,779,pays based on per visit rate,395.56,100% of CMS APC rate,288.09,27% of total billed charges,284.66,100% of OK APC rate,245.41,23% of total billed charges,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,1375,60% of total billed charges,358.51,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,746.9,70% of total billed charges,821.59,77% of total billed charges,693.55,65% of total billed charges,1067,100% of total billed charges,1067,100% of total billed charges,800.25,75% of total billed charges,N/A,not seperately reimbursable,533.5,50% of total billed charges,357.87,33.54% of total billed charges,1013.65,95% of total billed charges,395.56,100% of CMS APC rate,395.56,100% of CMS APC rate,1507,58.1% of total billed charges,395.56,100% of CMS APC rate,906.95,85% of total billed charges,395.56,100% of CMS apc rate,51,1507,800.25
Outpatient Medical Services,EMERGENCY,99285,E.R.EM LEVEL 5 WITH 25 MODIFIER,450,1542,996.7,175% of CMS APC rate,946,82% total billed charges,569.54,100% of CMS APC rate,586.62,103% of CMS APC rate,51,pays based on per visit rate,517.19,33.54% of total billed charges,339.24,pays based on per visit rate,909.78,pays based on per visit rate,569.54,100% of CMS APC rate,569.54,100% of CMS APC rate,1239,60% of total billed charges,166.67,100% of CMS fee schedule,1002.3,pays based on per visit rate,569.54,100% of CMS APC rate,1079.4,70% of total billed charges,1156.5,pays based on per visit rate,764.99,100% of CMS fee schedule,1000,75% of total billed charges,1156.5,75% of total billed charges,1310.7,85% of total billed charges,779,pays based on per visit rate,569.54,100% of CMS APC rate,416.34,27% of total billed charges,408.25,100% of OK APC rate,354.66,23% of total billed charges,569.54,100% of CMS APC rate,569.54,100% of CMS APC rate,569.54,100% of CMS APC rate,2175,60% of total billed charges,518.11,33.6% of total billed charges,115.77,pays based on per visit rate,119.24,233.81% of AR ASC tier groupings rate,115.77,227% of AR fee schedule,1079.4,70% of total billed charges,1187.34,77% of total billed charges,1002.3,65% of total billed charges,1542,100% of total billed charges,1542,100% of total billed charges,1156.5,75% of total billed charges,N/A,not seperately reimbursable,771,50% of total billed charges,517.19,33.54% of total billed charges,1464.9,95% of total billed charges,569.54,100% of CMS APC rate,569.54,100% of CMS APC rate,1780,58.1% of total billed charges,569.54,100% of CMS APC rate,1310.7,85% of total billed charges,569.54,100% of CMS apc rate,51,2175,1156.50
Outpatient Medical Services,LAB,J2920,METHYLPREDNISOLONE(SOLU-MEDROL) 40MG/1ml,250,15,N/A,not seperately reimbursable,5.22,122% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,26.05,100% of AR fee schedule,5.03,33.54% of total billed charges,3.3,22% of total billed charges,8.85,59% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.75,65% of total billed charges,N/A,not seperately reimbursable,10.5,70% of total billed charges,4.51,106% of CMS fee schedule,N/A,not seperately reimbursable,11.25,75% of total billed charges,11.25,75% of total billed charges,12.75,85% of total billed charges,11.25,75% of total billed charges,N/A,not seperately reimbursable,4.05,27% of total billed charges,N/A,not seperately reimbursable,3.45,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9,60% of total billed charges,5.04,33.6% of total billed charges,59.13,227% of AR fee schedule,60.91,233.81% of AR fee schedule,59.13,227% of AR fee schedule,10.5,70% of total billed charges,11.55,77% of total billed charges,9.75,65% of total billed charges,15,100% of total billed charges,15,100% of total billed charges,11.25,75% of total billed charges,N/A,not seperately reimbursable,7.5,50% of total billed charges,5.03,33.54% of total billed charges,14.25,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.72,58.1% of total billed charges,N/A,not seperately reimbursable,12.75,85% of total billed charges,N/A,not seperately reimbursable,3.3,60.91,11.25
Outpatient Medical Services,LAB,80299,APIXABAN (ELIQUIS) 5 MG TABLET,250,16,32.62,175% of CMS fee schedule,13.12,82% total billed charges,18.64,100% of CMS fee schedule,19.19,103% of CMS fee schedule,40.55,100% of AR fee schedule,5.37,33.54% of total billed charges,19.11,100% of BCBS fee schedule,19.11,100% of BCBS fee schedule,18.64,100% of CMS fee schedule,18.64,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.91,100% of CMS fee schedule,18.64,100% of CMS fee schedule,11.2,70% of total billed charges,28.91,100% of CMS fee schedule,N/A,not seperately reimbursable,12,75% of total billed charges,18.64,100% of CMS fee schedule,13.6,85% of total billed charges,12,75% of total billed charges,18.64,100% of CMS fee schedule,4.32,27% of total billed charges,16.58,100% of OK fee schedule,15.66,100% of TX fee schedule,18.64,100% of CMS fee schedule,18.64,100% of CMS fee schedule,18.64,100% of CMS fee schedule,9.6,60% of total billed charges,5.38,33.6% of total billed charges,92.05,227% of AR fee schedule,94.81,233.81% of AR fee schedule,92.05,227% of AR fee schedule,11.2,70% of total billed charges,12.32,77% of total billed charges,10.4,65% of total billed charges,16,100% of total billed charges,16,100% of total billed charges,12,75% of total billed charges,1.96,100% of SHARP fee schedule,8,50% of total billed charges,5.37,33.54% of total billed charges,15.2,95% of total billed charges,18.64,100% of CMS fee schedule,18.64,100% of CMS fee schedule,28.24,120% of UHC fee schedule,18.64,100% of CMS fee schedule,13.6,85% of total billed charges,18.64,100% of CMS fee schedule,1.96,94.81,12.00
Outpatient Medical Services,LAB,C9113,PANTOPRAZOLE (PROTONIX) 40 MG TABLET,250,5,N/A,not seperately reimbursable,3.75,75% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,21,pays based on per visit rate,1.68,33.54% of total billed charges,1.1,22% of total billed charges,2.95,59% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.25,65% of total billed charges,N/A,not seperately reimbursable,3.5,70% of total billed charges,3.75,75% of toal billed charges,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3,60% of total billed charges,1.68,33.6% of total billed charges,47.67,pays based on per visit rate,49.1,233.81% of AR ASC tier groupings rate,47.67,227% of AR fee schedule,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.91,58.1% of total billed charges,N/A,not seperately reimbursable,4.25,85% of total billed charges,N/A,not seperately reimbursable,1.1,49.1,3.75
Outpatient Medical Services,LAB,94664,ALBUTEROL / IPRATROP(DUONEB) 0.5/3MG 3ML,250,5,330.64,175% of CMS APC rate,4.1,pays based on per visit rate,188.94,100% of CMS APC rate,194.6,103% of CMS APC rate,27,100% of AR fee schedule,1.68,33.54% of total billed charges,169.81,100% of BCBS fee schedule,169.81,100% of BCBS fee schedule,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,N/A,not seperately reimbursable,5,100% of CMS fee schedule,3.25,65% of total billed charges,188.94,100% of CMS APC rate,3.5,70% of total billed charges,3.75,75% of toal billed charges,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,188.94,100% of CMS APC rate,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,3,60% of total billed charges,1.68,33.6% of total billed charges,61.29,227% of AR fee schedule,63.13,233.81% of AR fee schedule,61.29,227% of AR fee schedule,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,N/A,not seperately reimbursable,188.94,100% of CMS APC rate,4.25,85% of total billed charges,188.94,100% of CMS apc rate,1.15,330.64,3.75
Outpatient Medical Services,LAB,J1644,HEPARIN 5000 UNITS vial,250,6,N/A,not seperately reimbursable,0.32,122% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.32,100% of AR fee schedule,2.01,33.54% of total billed charges,0.23,100% of BCBS fee schedule,0.23,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.9,65% of total billed charges,N/A,not seperately reimbursable,4.2,70% of total billed charges,0.24,106% of CMS fee schedule,N/A,not seperately reimbursable,4.5,75% of total billed charges,4.5,75% of total billed charges,5.1,85% of total billed charges,4.5,75% of total billed charges,N/A,not seperately reimbursable,1.62,27% of total billed charges,N/A,not seperately reimbursable,1.38,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.6,60% of total billed charges,2.02,33.6% of total billed charges,52.94,227% of AR fee schedule,54.52,233.81% of AR fee schedule,52.94,227% of AR fee schedule,4.2,70% of total billed charges,4.62,77% of total billed charges,3.9,65% of total billed charges,6,100% of total billed charges,6,100% of total billed charges,4.5,75% of total billed charges,N/A,not seperately reimbursable,3,50% of total billed charges,2.01,33.54% of total billed charges,5.7,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.1,85% of total billed charges,N/A,not seperately reimbursable,0.23,54.52,4.50
Outpatient Medical Services,LAB,96360,SODIUM CHLORIDE 0.9% 1BAG 1000ML,258,7,342.5,175% of CMS APC rate,5.74,82% total billed charges,195.72,100% of CMS APC rate,201.59,103% of CMS APC rate,N/A,not seperately reimbursable,2.35,33.54% of total billed charges,169.61,100% of BCBS fee schedule,169.61,100% of BCBS fee schedule,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,N/A,not seperately reimbursable,7,100% of CMS fee schedule,4.55,65% of total billed charges,195.72,100% of CMS APC rate,4.9,70% of total billed charges,5.25,75% of toal billed charges,N/A,not seperately reimbursable,5.25,75% of total billed charges,5.25,75% of total billed charges,5.95,85% of total billed charges,5.25,75% of total billed charges,195.72,100% of CMS APC rate,1.89,27% of total billed charges,148.68,100% of OK APC rate,1.61,23% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,4.2,60% of total billed charges,2.35,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.9,70% of total billed charges,5.39,77% of total billed charges,4.55,65% of total billed charges,7,100% of total billed charges,7,100% of total billed charges,5.25,75% of total billed charges,N/A,not seperately reimbursable,3.5,50% of total billed charges,2.35,33.54% of total billed charges,6.65,95% of total billed charges,195.72,100% of CMS APC rate,195.72,100% of CMS APC rate,N/A,not seperately reimbursable,195.72,100% of CMS APC rate,5.95,85% of total billed charges,195.72,100% of CMS apc rate,1.61,342.5,5.25
Outpatient Medical Services,LAB,J7030,NORMAL SALINE 100ML + ADAPTER,258,10,N/A,not seperately reimbursable,3.28,122% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.35,33.54% of total billed charges,2.86,100% of BCBS fee schedule,2.86,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6.5,65% of total billed charges,N/A,not seperately reimbursable,7,70% of total billed charges,2.71,106% of CMS fee schedule,N/A,not seperately reimbursable,7.5,75% of total billed charges,7.5,75% of total billed charges,8.5,85% of total billed charges,7.5,75% of total billed charges,N/A,not seperately reimbursable,2.7,27% of total billed charges,N/A,not seperately reimbursable,2.3,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6,60% of total billed charges,3.36,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7,70% of total billed charges,7.7,77% of total billed charges,6.5,65% of total billed charges,10,100% of total billed charges,10,100% of total billed charges,7.5,75% of total billed charges,N/A,not seperately reimbursable,5,50% of total billed charges,3.35,33.54% of total billed charges,9.5,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.5,85% of total billed charges,N/A,not seperately reimbursable,2.3,10,7.50
Outpatient Medical Services,LAB,96375,ADDITIONAL IV PUSH NEW MED,260,236,75,175% of CMS APC rate,193.52,82% total billed charges,42.86,100% of CMS APC rate,44.14,103% of CMS APC rate,N/A,not seperately reimbursable,79.15,33.54% of total billed charges,35.18,100% of BCBS fee schedule,35.18,100% of BCBS fee schedule,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,N/A,not seperately reimbursable,14.64,100% of CMS fee schedule,153.4,65% of total billed charges,42.86,100% of CMS APC rate,165.2,70% of total billed charges,177,75% of toal billed charges,N/A,not seperately reimbursable,177,75% of total billed charges,177,75% of total billed charges,200.6,85% of total billed charges,177,75% of total billed charges,42.86,100% of CMS APC rate,63.72,27% of total billed charges,30.84,100% of OK APC rate,54.28,23% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,141.6,60% of total billed charges,79.3,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,165.2,70% of total billed charges,181.72,77% of total billed charges,153.4,65% of total billed charges,236,100% of total billed charges,236,100% of total billed charges,177,75% of total billed charges,N/A,not seperately reimbursable,118,50% of total billed charges,79.15,33.54% of total billed charges,224.2,95% of total billed charges,42.86,100% of CMS APC rate,42.86,100% of CMS APC rate,159,pays based on per day visit,42.86,100% of CMS APC rate,200.6,85% of total billed charges,42.86,100% of CMS apc rate,14.64,236,177.00
Outpatient Medical Services,LAB,36415,VENIPUNCTURE,300,21,15.9,175% of CMS fee schedule,17.22,82% total billed charges,9.09,100% of CMS fee schedule,9.36,103% of CMS fee schedule,N/A,not seperately reimbursable,7.04,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,3,100% of CMS fee schedule,13.65,65% of total billed charges,9.09,100% of CMS fee schedule,14.7,70% of total billed charges,15.75,75% of toal billed charges,8.57,100% of CMS fee schedule,15.75,75% of total billed charges,3,100% of CMS fee schedule,17.85,85% of total billed charges,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,5.67,27% of total billed charges,N/A,not seperately reimbursable,4.83,23% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,12.6,60% of total billed charges,7.06,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.7,pays based on per visit rate,16.17,77% of total billed charges,13.65,65% of total billed charges,21,100% of total billed charges,21,100% of total billed charges,15.75,75% of total billed charges,N/A,not seperately reimbursable,10.5,50% of total billed charges,7.04,33.54% of total billed charges,19.95,95% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,4.32,120% of UHC fee schedule,9.09,100% of CMS fee schedule,17.85,85% of total billed charges,9.09,100% of CMS fee schedule,3,21,15.75
Outpatient Medical Services,LAB,36415,VENIPUNCTURE,300,21,15.9,175% of CMS fee schedule,17.22,82% total billed charges,9.09,100% of CMS fee schedule,9.36,103% of CMS fee schedule,N/A,not seperately reimbursable,7.04,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,3,100% of CMS fee schedule,13.65,65% of total billed charges,9.09,100% of CMS fee schedule,14.7,70% of total billed charges,15.75,75% of toal billed charges,8.57,100% of CMS fee schedule,15.75,75% of total billed charges,3,100% of CMS fee schedule,17.85,85% of total billed charges,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,5.67,27% of total billed charges,N/A,not seperately reimbursable,4.83,23% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,12.6,60% of total billed charges,7.06,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.7,pays based on per visit rate,16.17,77% of total billed charges,13.65,65% of total billed charges,21,100% of total billed charges,21,100% of total billed charges,15.75,75% of total billed charges,N/A,not seperately reimbursable,10.5,50% of total billed charges,7.04,33.54% of total billed charges,19.95,95% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,4.32,120% of UHC fee schedule,9.09,100% of CMS fee schedule,17.85,85% of total billed charges,9.09,100% of CMS fee schedule,3,21,15.75
Outpatient Medical Services,LAB,36415,COLLECTION FEE - DRUG SCREEN,300,25,15.9,175% of CMS fee schedule,20.5,82% total billed charges,9.09,100% of CMS fee schedule,9.36,103% of CMS fee schedule,N/A,not seperately reimbursable,8.39,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,3,100% of CMS fee schedule,16.25,65% of total billed charges,9.09,100% of CMS fee schedule,17.5,70% of total billed charges,18.75,75% of toal billed charges,8.57,100% of CMS fee schedule,18.75,75% of total billed charges,3,100% of CMS fee schedule,21.25,85% of total billed charges,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,6.75,27% of total billed charges,N/A,not seperately reimbursable,5.75,23% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,15,60% of total billed charges,8.4,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.5,pays based on per visit rate,19.25,77% of total billed charges,16.25,65% of total billed charges,25,100% of total billed charges,25,100% of total billed charges,18.75,75% of total billed charges,N/A,not seperately reimbursable,12.5,50% of total billed charges,8.39,33.54% of total billed charges,23.75,95% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,4.32,120% of UHC fee schedule,9.09,100% of CMS fee schedule,21.25,85% of total billed charges,9.09,100% of CMS fee schedule,3,25,18.75
Outpatient Medical Services,LAB,80048,BASIC METAB,300,58,14.8,175% of CMS fee schedule,47.56,82% total billed charges,8.46,100% of CMS fee schedule,8.71,103% of CMS fee schedule,12.09,100% of AR fee schedule,19.45,33.54% of total billed charges,10.34,100% of BCBS fee schedule,10.34,100% of BCBS fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,11.06,100% of CIGNA fee schedule,8.46,100% of CMS fee schedule,17.87,100% of CMS fee schedule,8.46,100% of CMS fee schedule,40.6,70% of total billed charges,17.87,100% of CMS fee schedule,10.58,100% of CMS fee schedule,43.5,75% of total billed charges,8.46,100% of CMS fee schedule,49.3,85% of total billed charges,43.5,75% of total billed charges,8.46,100% of CMS fee schedule,15.66,27% of total billed charges,7.53,100% of OK fee schedule,7.9,100% of TX fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,34.8,60% of total billed charges,19.49,33.6% of total billed charges,27.44,227% of AR fee schedule,28.27,233.81% of AR fee schedule,27.44,227% of AR fee schedule,40.6,pays based on per visit rate,44.66,77% of total billed charges,37.7,65% of total billed charges,58,100% of total billed charges,58,100% of total billed charges,43.5,75% of total billed charges,0.99,100% of SHARP fee schedule,29,50% of total billed charges,19.45,33.54% of total billed charges,55.1,95% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,17.45,120% of UHC fee schedule,8.46,100% of CMS fee schedule,49.3,85% of total billed charges,8.46,100% of CMS fee schedule,0.99,58,43.50
Outpatient Medical Services,LAB,80048,BASIC METAB,300,57,14.8,175% of CMS fee schedule,46.74,82% total billed charges,8.46,100% of CMS fee schedule,8.71,103% of CMS fee schedule,12.09,100% of AR fee schedule,19.12,33.54% of total billed charges,10.34,100% of BCBS fee schedule,10.34,100% of BCBS fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,11.06,100% of CIGNA fee schedule,8.46,100% of CMS fee schedule,17.87,100% of CMS fee schedule,8.46,100% of CMS fee schedule,39.9,70% of total billed charges,17.87,100% of CMS fee schedule,10.58,100% of CMS fee schedule,42.75,75% of total billed charges,8.46,100% of CMS fee schedule,48.45,85% of total billed charges,42.75,75% of total billed charges,8.46,100% of CMS fee schedule,15.39,27% of total billed charges,7.53,100% of OK fee schedule,7.9,100% of TX fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,34.2,60% of total billed charges,19.15,33.6% of total billed charges,27.44,227% of AR fee schedule,28.27,233.81% of AR fee schedule,27.44,227% of AR fee schedule,39.9,pays based on per visit rate,43.89,77% of total billed charges,37.05,65% of total billed charges,57,100% of total billed charges,57,100% of total billed charges,42.75,75% of total billed charges,0.99,100% of SHARP fee schedule,28.5,50% of total billed charges,19.12,33.54% of total billed charges,54.15,95% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,17.45,120% of UHC fee schedule,8.46,100% of CMS fee schedule,48.45,85% of total billed charges,8.46,100% of CMS fee schedule,0.99,57,42.75
Outpatient Medical Services,LAB,80053,COMPREHENSI,300,79,18.48,175% of CMS fee schedule,64.78,82% total billed charges,10.56,100% of CMS fee schedule,10.87,103% of CMS fee schedule,15.1,100% of AR fee schedule,26.5,33.54% of total billed charges,12.91,100% of BCBS fee schedule,12.91,100% of BCBS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,13.79,100% of CIGNA fee schedule,10.56,100% of CMS fee schedule,22.31,100% of CMS fee schedule,10.56,100% of CMS fee schedule,55.3,70% of total billed charges,22.31,100% of CMS fee schedule,42.24,100% of CMS fee schedule,59.25,75% of total billed charges,10.56,100% of CMS fee schedule,67.15,85% of total billed charges,59.25,75% of total billed charges,10.56,100% of CMS fee schedule,21.33,27% of total billed charges,9.39,100% of OK fee schedule,9.86,100% of TX fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,47.4,60% of total billed charges,26.54,33.6% of total billed charges,34.28,227% of AR fee schedule,35.31,233.81% of AR fee schedule,34.28,227% of AR fee schedule,55.3,pays based on per visit rate,60.83,77% of total billed charges,51.35,65% of total billed charges,79,100% of total billed charges,79,100% of total billed charges,59.25,75% of total billed charges,1.23,100% of SHARP fee schedule,39.5,50% of total billed charges,26.5,33.54% of total billed charges,75.05,95% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,21.8,120% of UHC fee schedule,10.56,100% of CMS fee schedule,67.15,85% of total billed charges,10.56,100% of CMS fee schedule,1.23,79,59.25
Outpatient Medical Services,LAB,80053,COMPREHENSIVE PANEL,300,150,18.48,175% of CMS fee schedule,123,82% total billed charges,10.56,100% of CMS fee schedule,10.87,103% of CMS fee schedule,15.1,100% of AR fee schedule,50.31,33.54% of total billed charges,12.91,100% of BCBS fee schedule,12.91,100% of BCBS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,13.79,100% of CIGNA fee schedule,10.56,100% of CMS fee schedule,22.31,100% of CMS fee schedule,10.56,100% of CMS fee schedule,105,70% of total billed charges,22.31,100% of CMS fee schedule,42.24,100% of CMS fee schedule,112.5,75% of total billed charges,10.56,100% of CMS fee schedule,127.5,85% of total billed charges,112.5,75% of total billed charges,10.56,100% of CMS fee schedule,40.5,27% of total billed charges,9.39,100% of OK fee schedule,9.86,100% of TX fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,90,60% of total billed charges,50.4,33.6% of total billed charges,34.28,227% of AR fee schedule,35.31,233.81% of AR fee schedule,34.28,227% of AR fee schedule,105,pays based on per visit rate,115.5,77% of total billed charges,97.5,65% of total billed charges,150,100% of total billed charges,150,100% of total billed charges,112.5,75% of total billed charges,1.23,100% of SHARP fee schedule,75,50% of total billed charges,50.31,33.54% of total billed charges,142.5,95% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,21.8,120% of UHC fee schedule,10.56,100% of CMS fee schedule,127.5,85% of total billed charges,10.56,100% of CMS fee schedule,1.23,150,112.50
Outpatient Medical Services,LAB,80053,COMPREHENSIVE PANEL,300,152,18.48,175% of CMS fee schedule,124.64,82% total billed charges,10.56,100% of CMS fee schedule,10.87,103% of CMS fee schedule,15.1,100% of AR fee schedule,50.98,33.54% of total billed charges,12.91,100% of BCBS fee schedule,12.91,100% of BCBS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,13.79,100% of CIGNA fee schedule,10.56,100% of CMS fee schedule,22.31,100% of CMS fee schedule,10.56,100% of CMS fee schedule,106.4,70% of total billed charges,22.31,100% of CMS fee schedule,42.24,100% of CMS fee schedule,114,75% of total billed charges,10.56,100% of CMS fee schedule,129.2,85% of total billed charges,114,75% of total billed charges,10.56,100% of CMS fee schedule,41.04,27% of total billed charges,9.39,100% of OK fee schedule,9.86,100% of TX fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,91.2,60% of total billed charges,51.07,33.6% of total billed charges,34.28,227% of AR fee schedule,35.31,233.81% of AR fee schedule,34.28,227% of AR fee schedule,106.4,pays based on per visit rate,117.04,77% of total billed charges,98.8,65% of total billed charges,152,100% of total billed charges,152,100% of total billed charges,114,75% of total billed charges,1.23,100% of SHARP fee schedule,76,50% of total billed charges,50.98,33.54% of total billed charges,144.4,95% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,21.8,120% of UHC fee schedule,10.56,100% of CMS fee schedule,129.2,85% of total billed charges,10.56,100% of CMS fee schedule,1.23,152,114.00
Outpatient Medical Services,LAB,80061,LIPID PROFILE,300,235,23.43,175% of CMS fee schedule,192.7,82% total billed charges,13.39,100% of CMS fee schedule,13.79,103% of CMS fee schedule,18.16,100% of AR fee schedule,69,100% of AR fee schedule,16.37,100% of BCBS fee schedule,16.37,100% of BCBS fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,17.49,100% of CIGNA fee schedule,13.39,100% of CMS fee schedule,26.84,100% of CMS fee schedule,13.39,100% of CMS fee schedule,164.5,70% of total billed charges,26.84,100% of CMS fee schedule,16.74,100% of CMS fee schedule,176.25,75% of total billed charges,13.39,100% of CMS fee schedule,199.75,85% of total billed charges,176.25,75% of total billed charges,13.39,100% of CMS fee schedule,63.45,27% of total billed charges,11.91,100% of OK fee schedule,12.5,100% of TX fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,141,60% of total billed charges,78.96,33.6% of total billed charges,41.22,227% of AR fee schedule,42.46,233.81% of AR fee schedule,41.22,227% of AR fee schedule,164.5,pays based on per visit rate,180.95,77% of total billed charges,152.75,65% of total billed charges,235,100% of total billed charges,235,100% of total billed charges,176.25,75% of total billed charges,1.56,100% of SHARP fee schedule,117.5,50% of total billed charges,69,100% of SPREEMO fee schedule,223.25,95% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,27.64,120% of UHC fee schedule,13.39,100% of CMS fee schedule,199.75,85% of total billed charges,13.39,100% of CMS fee schedule,1.56,235,176.25
Outpatient Medical Services,LAB,80061,LIPID PROFILE,300,233,23.43,175% of CMS fee schedule,191.06,82% total billed charges,13.39,100% of CMS fee schedule,13.79,103% of CMS fee schedule,18.16,100% of AR fee schedule,69,100% of AR fee schedule,16.37,100% of BCBS fee schedule,16.37,100% of BCBS fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,17.49,100% of CIGNA fee schedule,13.39,100% of CMS fee schedule,26.84,100% of CMS fee schedule,13.39,100% of CMS fee schedule,163.1,70% of total billed charges,26.84,100% of CMS fee schedule,16.74,100% of CMS fee schedule,174.75,75% of total billed charges,13.39,100% of CMS fee schedule,198.05,85% of total billed charges,174.75,75% of total billed charges,13.39,100% of CMS fee schedule,62.91,27% of total billed charges,11.91,100% of OK fee schedule,12.5,100% of TX fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,139.8,60% of total billed charges,78.29,33.6% of total billed charges,41.22,227% of AR fee schedule,42.46,233.81% of AR fee schedule,41.22,227% of AR fee schedule,163.1,pays based on per visit rate,179.41,77% of total billed charges,151.45,65% of total billed charges,233,100% of total billed charges,233,100% of total billed charges,174.75,75% of total billed charges,1.56,100% of SHARP fee schedule,116.5,50% of total billed charges,69,100% of SPREEMO fee schedule,221.35,95% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,27.64,120% of UHC fee schedule,13.39,100% of CMS fee schedule,198.05,85% of total billed charges,13.39,100% of CMS fee schedule,1.56,233,174.75
Outpatient Medical Services,LAB,80074,HEPATITIS PANEL,300,179,83.35,175% of CMS fee schedule,146.78,82% total billed charges,47.63,100% of CMS fee schedule,49.05,103% of CMS fee schedule,68.01,100% of AR fee schedule,60.04,33.54% of total billed charges,58.22,100% of BCBS fee schedule,58.22,100% of BCBS fee schedule,47.63,100% of CMS fee schedule,47.63,100% of CMS fee schedule,62.23,100% of CIGNA fee schedule,47.63,100% of CMS fee schedule,100.52,100% of CMS fee schedule,47.63,100% of CMS fee schedule,125.3,70% of total billed charges,100.52,100% of CMS fee schedule,59.54,100% of CMS fee schedule,134.25,75% of total billed charges,47.63,100% of CMS fee schedule,152.15,85% of total billed charges,134.25,75% of total billed charges,47.63,100% of CMS fee schedule,48.33,27% of total billed charges,42.37,100% of OK fee schedule,44.46,100% of TX fee schedule,47.63,100% of CMS fee schedule,47.63,100% of CMS fee schedule,47.63,100% of CMS fee schedule,107.4,60% of total billed charges,60.14,33.6% of total billed charges,154.38,227% of AR fee schedule,159.01,233.81% of AR fee schedule,154.38,227% of AR fee schedule,125.3,pays based on per visit rate,137.83,77% of total billed charges,116.35,65% of total billed charges,179,100% of total billed charges,179,100% of total billed charges,134.25,75% of total billed charges,4.63,100% of SHARP fee schedule,89.5,50% of total billed charges,60.04,33.54% of total billed charges,170.05,95% of total billed charges,47.63,100% of CMS fee schedule,47.63,100% of CMS fee schedule,98.22,120% of UHC fee schedule,47.63,100% of CMS fee schedule,152.15,85% of total billed charges,47.63,100% of CMS fee schedule,4.63,179,134.25
Outpatient Medical Services,LAB,80076,LIVER FUNCTION PANEL,300,27,14.29,175% of CMS fee schedule,22.14,82% total billed charges,8.17,100% of CMS fee schedule,8.41,103% of CMS fee schedule,11.67,100% of AR fee schedule,9.06,33.54% of total billed charges,9.99,100% of BCBS fee schedule,9.99,100% of BCBS fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,10.67,100% of CIGNA fee schedule,8.17,100% of CMS fee schedule,17.24,100% of CMS fee schedule,8.17,100% of CMS fee schedule,18.9,70% of total billed charges,17.24,100% of CMS fee schedule,10.21,100% of CMS fee schedule,20.25,75% of total billed charges,8.17,100% of CMS fee schedule,22.95,85% of total billed charges,20.25,75% of total billed charges,8.17,100% of CMS fee schedule,7.29,27% of total billed charges,7.27,100% of OK fee schedule,7.63,100% of TX fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,16.2,60% of total billed charges,9.07,33.6% of total billed charges,26.49,227% of AR fee schedule,27.29,233.81% of AR fee schedule,26.49,227% of AR fee schedule,18.9,pays based on per visit rate,20.79,77% of total billed charges,17.55,65% of total billed charges,27,100% of total billed charges,27,100% of total billed charges,20.25,75% of total billed charges,0.95,100% of SHARP fee schedule,13.5,50% of total billed charges,9.06,33.54% of total billed charges,25.65,95% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,16.85,120% of UHC fee schedule,8.17,100% of CMS fee schedule,22.95,85% of total billed charges,8.17,100% of CMS fee schedule,0.95,27.29,20.25
Outpatient Medical Services,LAB,80076,LIVER FUNCTION PANEL,300,28,14.29,175% of CMS fee schedule,22.96,82% total billed charges,8.17,100% of CMS fee schedule,8.41,103% of CMS fee schedule,11.67,100% of AR fee schedule,9.39,33.54% of total billed charges,9.99,100% of BCBS fee schedule,9.99,100% of BCBS fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,10.67,100% of CIGNA fee schedule,8.17,100% of CMS fee schedule,17.24,100% of CMS fee schedule,8.17,100% of CMS fee schedule,19.6,70% of total billed charges,17.24,100% of CMS fee schedule,10.21,100% of CMS fee schedule,21,75% of total billed charges,8.17,100% of CMS fee schedule,23.8,85% of total billed charges,21,75% of total billed charges,8.17,100% of CMS fee schedule,7.56,27% of total billed charges,7.27,100% of OK fee schedule,7.63,100% of TX fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,16.8,60% of total billed charges,9.41,33.6% of total billed charges,26.49,227% of AR fee schedule,27.29,233.81% of AR fee schedule,26.49,227% of AR fee schedule,19.6,pays based on per visit rate,21.56,77% of total billed charges,18.2,65% of total billed charges,28,100% of total billed charges,28,100% of total billed charges,21,75% of total billed charges,0.95,100% of SHARP fee schedule,14,50% of total billed charges,9.39,33.54% of total billed charges,26.6,95% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,16.85,120% of UHC fee schedule,8.17,100% of CMS fee schedule,23.8,85% of total billed charges,8.17,100% of CMS fee schedule,0.95,28,21.00
Outpatient Medical Services,LAB,80307,SAP 10 DRUG SCREEN,300,252,108.74,175% of CMS fee schedule,206.64,82% total billed charges,62.14,100% of CMS fee schedule,64,103% of CMS fee schedule,79.81,100% of AR fee schedule,84.52,33.54% of total billed charges,71.12,100% of BCBS fee schedule,71.12,100% of BCBS fee schedule,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,81.18,100% of CIGNA fee schedule,62.14,100% of CMS fee schedule,163.8,65% of total billed charges,62.14,100% of CMS fee schedule,176.4,70% of total billed charges,189,75% of toal billed charges,77.68,100% of CMS fee schedule,189,75% of total billed charges,62.14,100% of CMS fee schedule,214.2,85% of total billed charges,189,75% of total billed charges,62.14,100% of CMS fee schedule,68.04,27% of total billed charges,55.27,100% of OK fee schedule,54.31,100% of TX fee schedule,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,151.2,60% of total billed charges,84.67,33.6% of total billed charges,181.17,227% of AR fee schedule,186.6,233.81% of AR fee schedule,181.17,227% of AR fee schedule,176.4,pays based on per visit rate,194.04,77% of total billed charges,163.8,65% of total billed charges,252,100% of total billed charges,252,100% of total billed charges,189,75% of total billed charges,5.66,100% of SHARP fee schedule,126,50% of total billed charges,84.52,33.54% of total billed charges,239.4,95% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,114.92,120% of UHC fee schedule,62.14,100% of CMS fee schedule,214.2,85% of total billed charges,62.14,100% of CMS fee schedule,5.66,252,189.00
Outpatient Medical Services,LAB,80320,ALCOHOL,300,38,N/A,not seperately reimbursable,31.16,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.22,100% of AR fee schedule,12.75,33.54% of total billed charges,21.25,100% of BCBS fee schedule,21.25,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.8,60% of CIGNA fee schedule,N/A,not seperately reimbursable,24.7,65% of total billed charges,N/A,not seperately reimbursable,26.6,70% of total billed charges,28.5,75% of toal billed charges,N/A,not seperately reimbursable,28.5,75% of total billed charges,28.5,75% of total billed charges,32.3,85% of total billed charges,28.5,75% of total billed charges,N/A,not seperately reimbursable,10.26,27% of total billed charges,N/A,not seperately reimbursable,9.42,100% of TX fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.8,60% of total billed charges,14.66,100% of CMS fee schedule,36.82,227% of AR fee schedule,37.92,233.81% of AR fee schedule,36.82,227% of AR fee schedule,26.6,pays based on per visit rate,29.26,77% of total billed charges,24.7,65% of total billed charges,38,100% of total billed charges,38,100% of total billed charges,28.5,75% of total billed charges,1.42,100% of SHARP fee schedule,19,50% of total billed charges,12.75,33.54% of total billed charges,36.1,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,33.86,120% of UHC fee schedule,N/A,not seperately reimbursable,32.3,85% of total billed charges,N/A,not seperately reimbursable,1.42,38,28.50
Outpatient Medical Services,LAB,81001,CHARGE FOR URINE W/MICRO,300,64,5.54,175% of CMS fee schedule,52.48,82% total billed charges,3.17,100% of CMS fee schedule,3.26,103% of CMS fee schedule,4.52,100% of AR fee schedule,21.47,33.54% of total billed charges,3.87,100% of BCBS fee schedule,3.87,100% of BCBS fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,4.14,100% of CIGNA fee schedule,3.17,100% of CMS fee schedule,6.68,100% of CMS fee schedule,3.17,100% of CMS fee schedule,44.8,70% of total billed charges,6.68,100% of CMS fee schedule,3.96,100% of CMS fee schedule,48,75% of total billed charges,3.17,100% of CMS fee schedule,54.4,85% of total billed charges,48,75% of total billed charges,3.17,100% of CMS fee schedule,17.28,27% of total billed charges,2.82,100% of OK fee schedule,2.96,100% of TX fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,38.4,60% of total billed charges,21.5,33.6% of total billed charges,10.26,227% of AR fee schedule,10.57,233.81% of AR fee schedule,10.26,227% of AR fee schedule,44.8,pays based on per visit rate,49.28,77% of total billed charges,41.6,65% of total billed charges,64,100% of total billed charges,64,100% of total billed charges,48,75% of total billed charges,0.37,100% of SHARP fee schedule,32,50% of total billed charges,21.47,33.54% of total billed charges,60.8,95% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,6.54,120% of UHC fee schedule,3.17,100% of CMS fee schedule,54.4,85% of total billed charges,3.17,100% of CMS fee schedule,0.37,64,48.00
Outpatient Medical Services,LAB,81001,CHARGE FOR URINE W/MICRO,300,64,5.54,175% of CMS fee schedule,52.48,82% total billed charges,3.17,100% of CMS fee schedule,3.26,103% of CMS fee schedule,4.52,100% of AR fee schedule,21.47,33.54% of total billed charges,3.87,100% of BCBS fee schedule,3.87,100% of BCBS fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,4.14,100% of CIGNA fee schedule,3.17,100% of CMS fee schedule,6.68,100% of CMS fee schedule,3.17,100% of CMS fee schedule,44.8,70% of total billed charges,6.68,100% of CMS fee schedule,3.96,100% of CMS fee schedule,48,75% of total billed charges,3.17,100% of CMS fee schedule,54.4,85% of total billed charges,48,75% of total billed charges,3.17,100% of CMS fee schedule,17.28,27% of total billed charges,2.82,100% of OK fee schedule,2.96,100% of TX fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,38.4,60% of total billed charges,21.5,33.6% of total billed charges,10.26,227% of AR fee schedule,10.57,233.81% of AR fee schedule,10.26,227% of AR fee schedule,44.8,pays based on per visit rate,49.28,77% of total billed charges,41.6,65% of total billed charges,64,100% of total billed charges,64,100% of total billed charges,48,75% of total billed charges,0.37,100% of SHARP fee schedule,32,50% of total billed charges,21.47,33.54% of total billed charges,60.8,95% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,6.54,120% of UHC fee schedule,3.17,100% of CMS fee schedule,54.4,85% of total billed charges,3.17,100% of CMS fee schedule,0.37,64,48.00
Outpatient Medical Services,LAB,81003,CHARGE FOR UA W/O MICRO,300,41,3.93,175% of CMS fee schedule,33.62,82% total billed charges,2.25,100% of CMS fee schedule,2.31,103% of CMS fee schedule,3.2,100% of AR fee schedule,13.75,33.54% of total billed charges,2.74,100% of BCBS fee schedule,2.74,100% of BCBS fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,2.93,100% of CIGNA fee schedule,2.25,100% of CMS fee schedule,4.74,100% of CMS fee schedule,2.25,100% of CMS fee schedule,28.7,70% of total billed charges,4.74,100% of CMS fee schedule,2.81,100% of CMS fee schedule,30.75,75% of total billed charges,2.25,100% of CMS fee schedule,34.85,85% of total billed charges,30.75,75% of total billed charges,2.25,100% of CMS fee schedule,11.07,27% of total billed charges,2,100% of OK fee schedule,2.09,100% of TX fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,24.6,60% of total billed charges,13.78,33.6% of total billed charges,7.26,227% of AR fee schedule,7.48,233.81% of AR fee schedule,7.26,227% of AR fee schedule,28.7,pays based on per visit rate,31.57,77% of total billed charges,26.65,65% of total billed charges,41,100% of total billed charges,41,100% of total billed charges,30.75,75% of total billed charges,0.26,100% of SHARP fee schedule,20.5,50% of total billed charges,13.75,33.54% of total billed charges,38.95,95% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,4.63,120% of UHC fee schedule,2.25,100% of CMS fee schedule,34.85,85% of total billed charges,2.25,100% of CMS fee schedule,0.26,41,30.75
Outpatient Medical Services,LAB,81003,CHARGE FOR UA W/O MICRO,300,42,3.93,175% of CMS fee schedule,34.44,82% total billed charges,2.25,100% of CMS fee schedule,2.31,103% of CMS fee schedule,3.2,100% of AR fee schedule,14.09,33.54% of total billed charges,2.74,100% of BCBS fee schedule,2.74,100% of BCBS fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,2.93,100% of CIGNA fee schedule,2.25,100% of CMS fee schedule,4.74,100% of CMS fee schedule,2.25,100% of CMS fee schedule,29.4,70% of total billed charges,4.74,100% of CMS fee schedule,2.81,100% of CMS fee schedule,31.5,75% of total billed charges,2.25,100% of CMS fee schedule,35.7,85% of total billed charges,31.5,75% of total billed charges,2.25,100% of CMS fee schedule,11.34,27% of total billed charges,2,100% of OK fee schedule,2.09,100% of TX fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,25.2,60% of total billed charges,14.11,33.6% of total billed charges,7.26,227% of AR fee schedule,7.48,233.81% of AR fee schedule,7.26,227% of AR fee schedule,29.4,pays based on per visit rate,32.34,77% of total billed charges,27.3,65% of total billed charges,42,100% of total billed charges,42,100% of total billed charges,31.5,75% of total billed charges,0.26,100% of SHARP fee schedule,21,50% of total billed charges,14.09,33.54% of total billed charges,39.9,95% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,4.63,120% of UHC fee schedule,2.25,100% of CMS fee schedule,35.7,85% of total billed charges,2.25,100% of CMS fee schedule,0.26,42,31.50
Outpatient Medical Services,LAB,81025,HCG URINE,300,134,15.06,175% of CMS fee schedule,109.88,82% total billed charges,8.61,100% of CMS fee schedule,8.86,103% of CMS fee schedule,9.03,100% of AR fee schedule,44.94,33.54% of total billed charges,8.83,100% of BCBS fee schedule,8.83,100% of BCBS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,11.26,100% of CIGNA fee schedule,8.61,100% of CMS fee schedule,13.35,100% of CMS fee schedule,8.61,100% of CMS fee schedule,93.8,70% of total billed charges,13.35,100% of CMS fee schedule,10.76,100% of CMS fee schedule,100.5,75% of total billed charges,8.61,100% of CMS fee schedule,113.9,85% of total billed charges,100.5,75% of total billed charges,8.61,100% of CMS fee schedule,36.18,27% of total billed charges,7.66,100% of OK fee schedule,7.23,100% of TX fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,80.4,60% of total billed charges,45.02,33.6% of total billed charges,20.5,227% of AR fee schedule,21.11,233.81% of AR fee schedule,20.5,227% of AR fee schedule,93.8,pays based on per visit rate,103.18,77% of total billed charges,87.1,65% of total billed charges,134,100% of total billed charges,134,100% of total billed charges,100.5,75% of total billed charges,0.9,100% of SHARP fee schedule,67,50% of total billed charges,44.94,33.54% of total billed charges,127.3,95% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,13.04,120% of UHC fee schedule,8.61,100% of CMS fee schedule,113.9,85% of total billed charges,8.61,100% of CMS fee schedule,0.9,134,100.50
Outpatient Medical Services,LAB,81025,HCG URINE,300,149,15.06,175% of CMS fee schedule,122.18,82% total billed charges,8.61,100% of CMS fee schedule,8.86,103% of CMS fee schedule,9.03,100% of AR fee schedule,49.97,33.54% of total billed charges,8.83,100% of BCBS fee schedule,8.83,100% of BCBS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,11.26,100% of CIGNA fee schedule,8.61,100% of CMS fee schedule,13.35,100% of CMS fee schedule,8.61,100% of CMS fee schedule,104.3,70% of total billed charges,13.35,100% of CMS fee schedule,10.76,100% of CMS fee schedule,111.75,75% of total billed charges,8.61,100% of CMS fee schedule,126.65,85% of total billed charges,111.75,75% of total billed charges,8.61,100% of CMS fee schedule,40.23,27% of total billed charges,7.66,100% of OK fee schedule,7.23,100% of TX fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,89.4,60% of total billed charges,50.06,33.6% of total billed charges,20.5,227% of AR fee schedule,21.11,233.81% of AR fee schedule,20.5,227% of AR fee schedule,104.3,pays based on per visit rate,114.73,77% of total billed charges,96.85,65% of total billed charges,149,100% of total billed charges,149,100% of total billed charges,111.75,75% of total billed charges,0.9,100% of SHARP fee schedule,74.5,50% of total billed charges,49.97,33.54% of total billed charges,141.55,95% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,13.04,120% of UHC fee schedule,8.61,100% of CMS fee schedule,126.65,85% of total billed charges,8.61,100% of CMS fee schedule,0.9,149,111.75
Outpatient Medical Services,LAB,82009,ACETONE QUAL,300,49,7.9,175% of CMS fee schedule,40.18,82% total billed charges,4.51,100% of CMS fee schedule,4.65,103% of CMS fee schedule,6.46,100% of AR fee schedule,16.43,33.54% of total billed charges,5.52,100% of BCBS fee schedule,5.52,100% of BCBS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,5.91,100% of CIGNA fee schedule,4.51,100% of CMS fee schedule,9.54,100% of CMS fee schedule,4.51,100% of CMS fee schedule,34.3,70% of total billed charges,9.54,100% of CMS fee schedule,5.65,100% of CMS fee schedule,36.75,75% of total billed charges,4.52,100% of CMS fee schedule,41.65,85% of total billed charges,36.75,75% of total billed charges,4.51,100% of CMS fee schedule,13.23,27% of total billed charges,4.02,100% of OK fee schedule,4.22,100% of TX fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,29.4,60% of total billed charges,16.46,33.6% of total billed charges,14.66,227% of AR fee schedule,15.1,233.81% of AR fee schedule,14.66,227% of AR fee schedule,34.3,pays based on per visit rate,37.73,77% of total billed charges,31.85,65% of total billed charges,49,100% of total billed charges,49,100% of total billed charges,36.75,75% of total billed charges,0.53,100% of SHARP fee schedule,24.5,50% of total billed charges,16.43,33.54% of total billed charges,46.55,95% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,9.31,120% of UHC fee schedule,4.51,100% of CMS fee schedule,41.65,85% of total billed charges,4.51,100% of CMS fee schedule,0.53,49,36.75
Outpatient Medical Services,LAB,82043,MICROALBUMIN URINE,300,24,10.11,175% of CMS fee schedule,19.68,82% total billed charges,5.78,100% of CMS fee schedule,5.95,103% of CMS fee schedule,8.27,100% of AR fee schedule,8.05,33.54% of total billed charges,7.06,100% of BCBS fee schedule,7.06,100% of BCBS fee schedule,5.78,100% of CMS fee schedule,5.78,100% of CMS fee schedule,7.56,100% of CIGNA fee schedule,5.78,100% of CMS fee schedule,12.21,100% of CMS fee schedule,5.78,100% of CMS fee schedule,16.8,70% of total billed charges,12.21,100% of CMS fee schedule,7.23,100% of CMS fee schedule,18,75% of total billed charges,5.78,100% of CMS fee schedule,20.4,85% of total billed charges,18,75% of total billed charges,5.78,100% of CMS fee schedule,6.48,27% of total billed charges,5.14,100% of OK fee schedule,5.39,100% of TX fee schedule,5.78,100% of CMS fee schedule,5.78,100% of CMS fee schedule,5.78,100% of CMS fee schedule,14.4,60% of total billed charges,8.06,33.6% of total billed charges,18.77,227% of AR fee schedule,19.34,233.81% of AR fee schedule,18.77,227% of AR fee schedule,16.8,pays based on per visit rate,18.48,77% of total billed charges,15.6,65% of total billed charges,24,100% of total billed charges,24,100% of total billed charges,18,75% of total billed charges,0.67,100% of SHARP fee schedule,12,50% of total billed charges,8.05,33.54% of total billed charges,22.8,95% of total billed charges,5.78,100% of CMS fee schedule,5.78,100% of CMS fee schedule,11.94,120% of UHC fee schedule,5.78,100% of CMS fee schedule,20.4,85% of total billed charges,5.78,100% of CMS fee schedule,0.67,24,18.00
Outpatient Medical Services,LAB,82140,AMMONIA,300,33,25.49,175% of CMS fee schedule,27.06,82% total billed charges,14.57,100% of CMS fee schedule,15,103% of CMS fee schedule,12.49,100% of AR fee schedule,11.07,33.54% of total billed charges,17.81,100% of BCBS fee schedule,17.81,100% of BCBS fee schedule,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,19.03,100% of CIGNA fee schedule,14.57,100% of CMS fee schedule,18.47,100% of CMS fee schedule,14.57,100% of CMS fee schedule,23.1,70% of total billed charges,18.47,100% of CMS fee schedule,18.21,100% of CMS fee schedule,24.75,75% of total billed charges,14.57,100% of CMS fee schedule,28.05,85% of total billed charges,24.75,75% of total billed charges,14.57,100% of CMS fee schedule,8.91,27% of total billed charges,12.96,100% of OK fee schedule,13.6,100% of TX fee schedule,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,19.8,60% of total billed charges,11.09,33.6% of total billed charges,28.35,227% of AR fee schedule,29.2,233.81% of AR fee schedule,28.35,227% of AR fee schedule,23.1,pays based on per visit rate,25.41,77% of total billed charges,21.45,65% of total billed charges,33,100% of total billed charges,33,100% of total billed charges,24.75,75% of total billed charges,1.7,100% of SHARP fee schedule,16.5,50% of total billed charges,11.07,33.54% of total billed charges,31.35,95% of total billed charges,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,30.05,120% of UHC fee schedule,14.57,100% of CMS fee schedule,28.05,85% of total billed charges,14.57,100% of CMS fee schedule,1.7,33,24.75
Outpatient Medical Services,LAB,82150,AMYLASE,300,45,11.34,175% of CMS fee schedule,36.9,82% total billed charges,6.48,100% of CMS fee schedule,6.67,103% of CMS fee schedule,9.26,100% of AR fee schedule,31,100% of AR fee schedule,7.92,100% of BCBS fee schedule,7.92,100% of BCBS fee schedule,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,8.46,100% of CIGNA fee schedule,6.48,100% of CMS fee schedule,13.68,100% of CMS fee schedule,6.48,100% of CMS fee schedule,31.5,70% of total billed charges,13.68,100% of CMS fee schedule,8.1,100% of CMS fee schedule,33.75,75% of total billed charges,6.48,100% of CMS fee schedule,38.25,85% of total billed charges,33.75,75% of total billed charges,6.48,100% of CMS fee schedule,12.15,27% of total billed charges,5.76,100% of OK fee schedule,6.05,100% of TX fee schedule,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,27,60% of total billed charges,15.12,33.6% of total billed charges,21.02,227% of AR fee schedule,21.65,233.81% of AR fee schedule,21.02,227% of AR fee schedule,31.5,pays based on per visit rate,34.65,77% of total billed charges,29.25,65% of total billed charges,45,100% of total billed charges,45,100% of total billed charges,33.75,75% of total billed charges,0.76,100% of SHARP fee schedule,22.5,50% of total billed charges,31,100% of SPREEMO fee schedule,42.75,95% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,13.38,120% of UHC fee schedule,6.48,100% of CMS fee schedule,38.25,85% of total billed charges,6.48,100% of CMS fee schedule,0.76,45,33.75
Outpatient Medical Services,LAB,82248,DIRECT BILIRUBIN,300,106,8.78,175% of CMS fee schedule,86.92,82% total billed charges,5.01,100% of CMS fee schedule,5.17,103% of CMS fee schedule,7.17,100% of AR fee schedule,35.55,33.54% of total billed charges,6.13,100% of BCBS fee schedule,6.13,100% of BCBS fee schedule,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.55,100% of CIGNA fee schedule,5.01,100% of CMS fee schedule,10.59,100% of CMS fee schedule,5.01,100% of CMS fee schedule,74.2,70% of total billed charges,10.59,100% of CMS fee schedule,6.28,100% of CMS fee schedule,79.5,75% of total billed charges,5.02,100% of CMS fee schedule,90.1,85% of total billed charges,79.5,75% of total billed charges,5.01,100% of CMS fee schedule,28.62,27% of total billed charges,4.47,100% of OK fee schedule,4.68,100% of TX fee schedule,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,63.6,60% of total billed charges,35.62,33.6% of total billed charges,16.28,227% of AR fee schedule,16.76,233.81% of AR fee schedule,16.28,227% of AR fee schedule,74.2,pays based on per visit rate,81.62,77% of total billed charges,68.9,65% of total billed charges,106,100% of total billed charges,106,100% of total billed charges,79.5,75% of total billed charges,0.58,100% of SHARP fee schedule,53,50% of total billed charges,35.55,33.54% of total billed charges,100.7,95% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,10.36,120% of UHC fee schedule,5.01,100% of CMS fee schedule,90.1,85% of total billed charges,5.01,100% of CMS fee schedule,0.58,106,79.50
Outpatient Medical Services,LAB,82306,VITAMIN D 25 HYDROXY,300,105,51.8,175% of CMS fee schedule,86.1,82% total billed charges,29.6,100% of CMS fee schedule,30.48,103% of CMS fee schedule,42.27,100% of AR fee schedule,35.22,33.54% of total billed charges,36.18,100% of BCBS fee schedule,36.18,100% of BCBS fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,38.67,100% of CIGNA fee schedule,29.6,100% of CMS fee schedule,62.49,100% of CMS fee schedule,29.6,100% of CMS fee schedule,73.5,70% of total billed charges,62.49,100% of CMS fee schedule,37,100% of CMS fee schedule,78.75,75% of total billed charges,29.6,100% of CMS fee schedule,89.25,85% of total billed charges,78.75,75% of total billed charges,29.6,100% of CMS fee schedule,28.35,27% of total billed charges,26.33,100% of OK fee schedule,27.63,100% of TX fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,63,60% of total billed charges,35.28,33.6% of total billed charges,95.95,227% of AR fee schedule,98.83,233.81% of AR fee schedule,95.95,227% of AR fee schedule,73.5,pays based on per visit rate,80.85,77% of total billed charges,68.25,65% of total billed charges,105,100% of total billed charges,105,100% of total billed charges,78.75,75% of total billed charges,2.88,100% of SHARP fee schedule,52.5,50% of total billed charges,35.22,33.54% of total billed charges,99.75,95% of total billed charges,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,61.06,120% of UHC fee schedule,29.6,100% of CMS fee schedule,89.25,85% of total billed charges,29.6,100% of CMS fee schedule,2.88,105,78.75
Outpatient Medical Services,LAB,82306,VITAMIN D 25 HYDROXY,300,101,51.8,175% of CMS fee schedule,82.82,82% total billed charges,29.6,100% of CMS fee schedule,30.48,103% of CMS fee schedule,42.27,100% of AR fee schedule,33.88,33.54% of total billed charges,36.18,100% of BCBS fee schedule,36.18,100% of BCBS fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,38.67,100% of CIGNA fee schedule,29.6,100% of CMS fee schedule,62.49,100% of CMS fee schedule,29.6,100% of CMS fee schedule,70.7,70% of total billed charges,62.49,100% of CMS fee schedule,37,100% of CMS fee schedule,75.75,75% of total billed charges,29.6,100% of CMS fee schedule,85.85,85% of total billed charges,75.75,75% of total billed charges,29.6,100% of CMS fee schedule,27.27,27% of total billed charges,26.33,100% of OK fee schedule,27.63,100% of TX fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,60.6,60% of total billed charges,33.94,33.6% of total billed charges,95.95,227% of AR fee schedule,98.83,233.81% of AR fee schedule,95.95,227% of AR fee schedule,70.7,pays based on per visit rate,77.77,77% of total billed charges,65.65,65% of total billed charges,101,100% of total billed charges,101,100% of total billed charges,75.75,75% of total billed charges,2.88,100% of SHARP fee schedule,50.5,50% of total billed charges,33.88,33.54% of total billed charges,95.95,95% of total billed charges,29.6,100% of CMS fee schedule,29.6,100% of CMS fee schedule,61.06,120% of UHC fee schedule,29.6,100% of CMS fee schedule,85.85,85% of total billed charges,29.6,100% of CMS fee schedule,2.88,101,75.75
Outpatient Medical Services,LAB,82550,CPK TOTAL,300,26,11.39,175% of CMS fee schedule,21.32,82% total billed charges,6.51,100% of CMS fee schedule,6.7,103% of CMS fee schedule,9.31,100% of AR fee schedule,13,100% of AR fee schedule,7.95,100% of BCBS fee schedule,7.95,100% of BCBS fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,8.5,100% of CIGNA fee schedule,6.51,100% of CMS fee schedule,13.76,100% of CMS fee schedule,6.51,100% of CMS fee schedule,18.2,70% of total billed charges,13.76,100% of CMS fee schedule,8.14,100% of CMS fee schedule,19.5,75% of total billed charges,6.51,100% of CMS fee schedule,22.1,85% of total billed charges,19.5,75% of total billed charges,6.51,100% of CMS fee schedule,7.02,27% of total billed charges,5.79,100% of OK fee schedule,6.07,100% of TX fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,15.6,60% of total billed charges,8.74,33.6% of total billed charges,21.13,227% of AR fee schedule,21.77,233.81% of AR fee schedule,21.13,227% of AR fee schedule,18.2,pays based on per visit rate,20.02,77% of total billed charges,16.9,65% of total billed charges,26,100% of total billed charges,26,100% of total billed charges,19.5,75% of total billed charges,0.76,100% of SHARP fee schedule,13,50% of total billed charges,13,100% of SPREEMO fee schedule,24.7,95% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,13.44,120% of UHC fee schedule,6.51,100% of CMS fee schedule,22.1,85% of total billed charges,6.51,100% of CMS fee schedule,0.76,26,19.50
Outpatient Medical Services,LAB,82550,CPK TOTAL,300,26,11.39,175% of CMS fee schedule,21.32,82% total billed charges,6.51,100% of CMS fee schedule,6.7,103% of CMS fee schedule,9.31,100% of AR fee schedule,13,100% of AR fee schedule,7.95,100% of BCBS fee schedule,7.95,100% of BCBS fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,8.5,100% of CIGNA fee schedule,6.51,100% of CMS fee schedule,13.76,100% of CMS fee schedule,6.51,100% of CMS fee schedule,18.2,70% of total billed charges,13.76,100% of CMS fee schedule,8.14,100% of CMS fee schedule,19.5,75% of total billed charges,6.51,100% of CMS fee schedule,22.1,85% of total billed charges,19.5,75% of total billed charges,6.51,100% of CMS fee schedule,7.02,27% of total billed charges,5.79,100% of OK fee schedule,6.07,100% of TX fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,15.6,60% of total billed charges,8.74,33.6% of total billed charges,21.13,227% of AR fee schedule,21.77,233.81% of AR fee schedule,21.13,227% of AR fee schedule,18.2,pays based on per visit rate,20.02,77% of total billed charges,16.9,65% of total billed charges,26,100% of total billed charges,26,100% of total billed charges,19.5,75% of total billed charges,0.76,100% of SHARP fee schedule,13,50% of total billed charges,13,100% of SPREEMO fee schedule,24.7,95% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,13.44,120% of UHC fee schedule,6.51,100% of CMS fee schedule,22.1,85% of total billed charges,6.51,100% of CMS fee schedule,0.76,26,19.50
Outpatient Medical Services,LAB,82565,CREATININE,300,112,8.96,175% of CMS fee schedule,91.84,82% total billed charges,5.12,100% of CMS fee schedule,5.27,103% of CMS fee schedule,7.31,100% of AR fee schedule,22,100% of AR fee schedule,6.26,100% of BCBS fee schedule,6.26,100% of BCBS fee schedule,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,6.69,100% of CIGNA fee schedule,5.12,100% of CMS fee schedule,10.83,100% of CMS fee schedule,5.12,100% of CMS fee schedule,78.4,70% of total billed charges,10.83,100% of CMS fee schedule,6.4,100% of CMS fee schedule,84,75% of total billed charges,5.12,100% of CMS fee schedule,95.2,85% of total billed charges,84,75% of total billed charges,5.12,100% of CMS fee schedule,30.24,27% of total billed charges,4.55,100% of OK fee schedule,4.78,100% of TX fee schedule,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,67.2,60% of total billed charges,37.63,33.6% of total billed charges,16.59,227% of AR fee schedule,17.09,233.81% of AR fee schedule,16.59,227% of AR fee schedule,78.4,pays based on per visit rate,86.24,77% of total billed charges,72.8,65% of total billed charges,112,100% of total billed charges,112,100% of total billed charges,84,75% of total billed charges,0.6,100% of SHARP fee schedule,56,50% of total billed charges,22,100% of SPREEMO fee schedule,106.4,95% of total billed charges,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,10.57,120% of UHC fee schedule,5.12,100% of CMS fee schedule,95.2,85% of total billed charges,5.12,100% of CMS fee schedule,0.6,112,84.00
Outpatient Medical Services,LAB,82570,URINE CREATININE,300,43,9.06,175% of CMS fee schedule,35.26,82% total billed charges,5.18,100% of CMS fee schedule,5.33,103% of CMS fee schedule,7.39,100% of AR fee schedule,14.42,33.54% of total billed charges,6.33,100% of BCBS fee schedule,6.33,100% of BCBS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,6.77,100% of CIGNA fee schedule,5.18,100% of CMS fee schedule,10.92,100% of CMS fee schedule,5.18,100% of CMS fee schedule,30.1,70% of total billed charges,10.92,100% of CMS fee schedule,6.48,100% of CMS fee schedule,32.25,75% of total billed charges,5.18,100% of CMS fee schedule,36.55,85% of total billed charges,32.25,75% of total billed charges,5.18,100% of CMS fee schedule,11.61,27% of total billed charges,4.61,100% of OK fee schedule,4.83,100% of TX fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,25.8,60% of total billed charges,14.45,33.6% of total billed charges,16.78,227% of AR fee schedule,17.28,233.81% of AR fee schedule,16.78,227% of AR fee schedule,30.1,pays based on per visit rate,33.11,77% of total billed charges,27.95,65% of total billed charges,43,100% of total billed charges,43,100% of total billed charges,32.25,75% of total billed charges,0.6,100% of SHARP fee schedule,21.5,50% of total billed charges,14.42,33.54% of total billed charges,40.85,95% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,10.67,120% of UHC fee schedule,5.18,100% of CMS fee schedule,36.55,85% of total billed charges,5.18,100% of CMS fee schedule,0.6,43,32.25
Outpatient Medical Services,LAB,82607,VIT B-12,300,52,26.39,175% of CMS fee schedule,42.64,82% total billed charges,15.08,100% of CMS fee schedule,15.53,103% of CMS fee schedule,21.52,100% of AR fee schedule,17.44,33.54% of total billed charges,18.43,100% of BCBS fee schedule,18.43,100% of BCBS fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,19.7,100% of CIGNA fee schedule,15.08,100% of CMS fee schedule,31.82,100% of CMS fee schedule,15.08,100% of CMS fee schedule,36.4,70% of total billed charges,31.82,100% of CMS fee schedule,18.85,100% of CMS fee schedule,39,75% of total billed charges,15.08,100% of CMS fee schedule,44.2,85% of total billed charges,39,75% of total billed charges,15.08,100% of CMS fee schedule,14.04,27% of total billed charges,13.41,100% of OK fee schedule,14.07,100% of TX fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,31.2,60% of total billed charges,17.47,33.6% of total billed charges,48.85,227% of AR fee schedule,50.32,233.81% of AR fee schedule,48.85,227% of AR fee schedule,36.4,pays based on per visit rate,40.04,77% of total billed charges,33.8,65% of total billed charges,52,100% of total billed charges,52,100% of total billed charges,39,75% of total billed charges,1.76,100% of SHARP fee schedule,26,50% of total billed charges,17.44,33.54% of total billed charges,49.4,95% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,31.09,120% of UHC fee schedule,15.08,100% of CMS fee schedule,44.2,85% of total billed charges,15.08,100% of CMS fee schedule,1.76,52,39.00
Outpatient Medical Services,LAB,82607,VIT B-12,300,52,26.39,175% of CMS fee schedule,42.64,82% total billed charges,15.08,100% of CMS fee schedule,15.53,103% of CMS fee schedule,21.52,100% of AR fee schedule,17.44,33.54% of total billed charges,18.43,100% of BCBS fee schedule,18.43,100% of BCBS fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,19.7,100% of CIGNA fee schedule,15.08,100% of CMS fee schedule,31.82,100% of CMS fee schedule,15.08,100% of CMS fee schedule,36.4,70% of total billed charges,31.82,100% of CMS fee schedule,18.85,100% of CMS fee schedule,39,75% of total billed charges,15.08,100% of CMS fee schedule,44.2,85% of total billed charges,39,75% of total billed charges,15.08,100% of CMS fee schedule,14.04,27% of total billed charges,13.41,100% of OK fee schedule,14.07,100% of TX fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,31.2,60% of total billed charges,17.47,33.6% of total billed charges,48.85,227% of AR fee schedule,50.32,233.81% of AR fee schedule,48.85,227% of AR fee schedule,36.4,pays based on per visit rate,40.04,77% of total billed charges,33.8,65% of total billed charges,52,100% of total billed charges,52,100% of total billed charges,39,75% of total billed charges,1.76,100% of SHARP fee schedule,26,50% of total billed charges,17.44,33.54% of total billed charges,49.4,95% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,31.09,120% of UHC fee schedule,15.08,100% of CMS fee schedule,44.2,85% of total billed charges,15.08,100% of CMS fee schedule,1.76,52,39.00
Outpatient Medical Services,LAB,82652,VITAMIN D,300,397,67.37,175% of CMS fee schedule,325.54,82% total billed charges,38.5,100% of CMS fee schedule,39.65,103% of CMS fee schedule,54.96,100% of AR fee schedule,133.15,33.54% of total billed charges,47.06,100% of BCBS fee schedule,47.06,100% of BCBS fee schedule,38.5,100% of CMS fee schedule,38.5,100% of CMS fee schedule,50.31,100% of CIGNA fee schedule,38.5,100% of CMS fee schedule,81.27,100% of CMS fee schedule,38.5,100% of CMS fee schedule,277.9,70% of total billed charges,81.27,100% of CMS fee schedule,48.13,100% of CMS fee schedule,297.75,75% of total billed charges,38.5,100% of CMS fee schedule,337.45,85% of total billed charges,297.75,75% of total billed charges,38.5,100% of CMS fee schedule,107.19,27% of total billed charges,34.25,100% of OK fee schedule,35.94,100% of TX fee schedule,38.5,100% of CMS fee schedule,38.5,100% of CMS fee schedule,38.5,100% of CMS fee schedule,238.2,60% of total billed charges,133.39,33.6% of total billed charges,124.76,227% of AR fee schedule,128.5,233.81% of AR fee schedule,124.76,227% of AR fee schedule,277.9,pays based on per visit rate,305.69,77% of total billed charges,258.05,65% of total billed charges,397,100% of total billed charges,397,100% of total billed charges,297.75,75% of total billed charges,3.74,100% of SHARP fee schedule,198.5,50% of total billed charges,133.15,33.54% of total billed charges,377.15,95% of total billed charges,38.5,100% of CMS fee schedule,38.5,100% of CMS fee schedule,79.4,120% of UHC fee schedule,38.5,100% of CMS fee schedule,337.45,85% of total billed charges,38.5,100% of CMS fee schedule,3.74,397,297.75
Outpatient Medical Services,LAB,82728,FERRITIN LEVEL,300,47,23.85,175% of CMS fee schedule,38.54,82% total billed charges,13.63,100% of CMS fee schedule,14.03,103% of CMS fee schedule,19.46,100% of AR fee schedule,15.76,33.54% of total billed charges,16.67,100% of BCBS fee schedule,16.67,100% of BCBS fee schedule,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,17.81,100% of CIGNA fee schedule,13.63,100% of CMS fee schedule,28.76,100% of CMS fee schedule,13.63,100% of CMS fee schedule,32.9,70% of total billed charges,28.76,100% of CMS fee schedule,17.04,100% of CMS fee schedule,35.25,75% of total billed charges,13.63,100% of CMS fee schedule,39.95,85% of total billed charges,35.25,75% of total billed charges,13.63,100% of CMS fee schedule,12.69,27% of total billed charges,12.12,100% of OK fee schedule,12.73,100% of TX fee schedule,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,28.2,60% of total billed charges,15.79,33.6% of total billed charges,44.17,227% of AR fee schedule,45.5,233.81% of AR fee schedule,44.17,227% of AR fee schedule,32.9,pays based on per visit rate,36.19,77% of total billed charges,30.55,65% of total billed charges,47,100% of total billed charges,47,100% of total billed charges,35.25,75% of total billed charges,1.59,100% of SHARP fee schedule,23.5,50% of total billed charges,15.76,33.54% of total billed charges,44.65,95% of total billed charges,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,28.09,120% of UHC fee schedule,13.63,100% of CMS fee schedule,39.95,85% of total billed charges,13.63,100% of CMS fee schedule,1.59,47,35.25
Outpatient Medical Services,LAB,82746,FOLIC ACID,300,51,25.72,175% of CMS fee schedule,41.82,82% total billed charges,14.7,100% of CMS fee schedule,15.14,103% of CMS fee schedule,21,100% of AR fee schedule,17.11,33.54% of total billed charges,17.97,100% of BCBS fee schedule,17.97,100% of BCBS fee schedule,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,19.22,100% of CIGNA fee schedule,14.7,100% of CMS fee schedule,31.04,100% of CMS fee schedule,14.7,100% of CMS fee schedule,35.7,70% of total billed charges,31.04,100% of CMS fee schedule,18.38,100% of CMS fee schedule,38.25,75% of total billed charges,14.7,100% of CMS fee schedule,43.35,85% of total billed charges,38.25,75% of total billed charges,14.7,100% of CMS fee schedule,13.77,27% of total billed charges,13.08,100% of OK fee schedule,13.73,100% of TX fee schedule,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,30.6,60% of total billed charges,17.14,33.6% of total billed charges,47.67,227% of AR fee schedule,49.1,233.81% of AR fee schedule,47.67,227% of AR fee schedule,35.7,pays based on per visit rate,39.27,77% of total billed charges,33.15,65% of total billed charges,51,100% of total billed charges,51,100% of total billed charges,38.25,75% of total billed charges,1.72,100% of SHARP fee schedule,25.5,50% of total billed charges,17.11,33.54% of total billed charges,48.45,95% of total billed charges,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,30.32,120% of UHC fee schedule,14.7,100% of CMS fee schedule,43.35,85% of total billed charges,14.7,100% of CMS fee schedule,1.72,51,38.25
Outpatient Medical Services,LAB,83036,GLYCOHEMOGLOBIN,300,34,16.99,175% of CMS fee schedule,27.88,82% total billed charges,9.71,100% of CMS fee schedule,10,103% of CMS fee schedule,13.87,100% of AR fee schedule,11.4,33.54% of total billed charges,11.87,100% of BCBS fee schedule,11.87,100% of BCBS fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,12.68,100% of CIGNA fee schedule,9.71,100% of CMS fee schedule,20.49,100% of CMS fee schedule,9.71,100% of CMS fee schedule,23.8,70% of total billed charges,20.49,100% of CMS fee schedule,12.14,100% of CMS fee schedule,25.5,75% of total billed charges,9.71,100% of CMS fee schedule,28.9,85% of total billed charges,25.5,75% of total billed charges,9.71,100% of CMS fee schedule,9.18,27% of total billed charges,8.64,100% of OK fee schedule,9.06,100% of TX fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,20.4,60% of total billed charges,11.42,33.6% of total billed charges,31.48,227% of AR fee schedule,32.43,233.81% of AR fee schedule,31.48,227% of AR fee schedule,23.8,pays based on per visit rate,26.18,77% of total billed charges,22.1,65% of total billed charges,34,100% of total billed charges,34,100% of total billed charges,25.5,75% of total billed charges,1.13,100% of SHARP fee schedule,17,50% of total billed charges,11.4,33.54% of total billed charges,32.3,95% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,20.02,120% of UHC fee schedule,9.71,100% of CMS fee schedule,28.9,85% of total billed charges,9.71,100% of CMS fee schedule,1.13,34,25.50
Outpatient Medical Services,LAB,83036,GLYCOHEMOGLOBIN,300,34,16.99,175% of CMS fee schedule,27.88,82% total billed charges,9.71,100% of CMS fee schedule,10,103% of CMS fee schedule,13.87,100% of AR fee schedule,11.4,33.54% of total billed charges,11.87,100% of BCBS fee schedule,11.87,100% of BCBS fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,12.68,100% of CIGNA fee schedule,9.71,100% of CMS fee schedule,20.49,100% of CMS fee schedule,9.71,100% of CMS fee schedule,23.8,70% of total billed charges,20.49,100% of CMS fee schedule,12.14,100% of CMS fee schedule,25.5,75% of total billed charges,9.71,100% of CMS fee schedule,28.9,85% of total billed charges,25.5,75% of total billed charges,9.71,100% of CMS fee schedule,9.18,27% of total billed charges,8.64,100% of OK fee schedule,9.06,100% of TX fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,20.4,60% of total billed charges,11.42,33.6% of total billed charges,31.48,227% of AR fee schedule,32.43,233.81% of AR fee schedule,31.48,227% of AR fee schedule,23.8,pays based on per visit rate,26.18,77% of total billed charges,22.1,65% of total billed charges,34,100% of total billed charges,34,100% of total billed charges,25.5,75% of total billed charges,1.13,100% of SHARP fee schedule,17,50% of total billed charges,11.4,33.54% of total billed charges,32.3,95% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,20.02,120% of UHC fee schedule,9.71,100% of CMS fee schedule,28.9,85% of total billed charges,9.71,100% of CMS fee schedule,1.13,34,25.50
Outpatient Medical Services,LAB,83550,I & IBC (B),300,30,15.29,175% of CMS fee schedule,24.6,82% total billed charges,8.74,100% of CMS fee schedule,9,103% of CMS fee schedule,12.48,100% of AR fee schedule,10.06,33.54% of total billed charges,10.68,100% of BCBS fee schedule,10.68,100% of BCBS fee schedule,8.74,100% of CMS fee schedule,8.74,100% of CMS fee schedule,11.42,100% of CIGNA fee schedule,8.74,100% of CMS fee schedule,18.45,100% of CMS fee schedule,8.74,100% of CMS fee schedule,21,70% of total billed charges,18.45,100% of CMS fee schedule,10.93,100% of CMS fee schedule,22.5,75% of total billed charges,8.74,100% of CMS fee schedule,25.5,85% of total billed charges,22.5,75% of total billed charges,8.74,100% of CMS fee schedule,8.1,27% of total billed charges,7.77,100% of OK fee schedule,8.16,100% of TX fee schedule,8.74,100% of CMS fee schedule,8.74,100% of CMS fee schedule,8.74,100% of CMS fee schedule,18,60% of total billed charges,10.08,33.6% of total billed charges,28.33,227% of AR fee schedule,29.18,233.81% of AR fee schedule,28.33,227% of AR fee schedule,21,pays based on per visit rate,23.1,77% of total billed charges,19.5,65% of total billed charges,30,100% of total billed charges,30,100% of total billed charges,22.5,75% of total billed charges,1.02,100% of SHARP fee schedule,15,50% of total billed charges,10.06,33.54% of total billed charges,28.5,95% of total billed charges,8.74,100% of CMS fee schedule,8.74,100% of CMS fee schedule,18.02,120% of UHC fee schedule,8.74,100% of CMS fee schedule,25.5,85% of total billed charges,8.74,100% of CMS fee schedule,1.02,30,22.50
Outpatient Medical Services,LAB,83605,LACTIC ACID,300,37,20.24,175% of CMS fee schedule,30.34,82% total billed charges,11.57,100% of CMS fee schedule,11.91,103% of CMS fee schedule,15.25,100% of AR fee schedule,12.41,33.54% of total billed charges,13.06,100% of BCBS fee schedule,13.06,100% of BCBS fee schedule,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,15.12,100% of CIGNA fee schedule,11.57,100% of CMS fee schedule,22.55,100% of CMS fee schedule,11.57,100% of CMS fee schedule,25.9,70% of total billed charges,22.55,100% of CMS fee schedule,14.46,100% of CMS fee schedule,27.75,75% of total billed charges,11.57,100% of CMS fee schedule,31.45,85% of total billed charges,27.75,75% of total billed charges,11.57,100% of CMS fee schedule,9.99,27% of total billed charges,10.29,100% of OK fee schedule,9.97,100% of TX fee schedule,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,22.2,60% of total billed charges,12.43,33.6% of total billed charges,34.62,227% of AR fee schedule,35.66,233.81% of AR fee schedule,34.62,227% of AR fee schedule,25.9,pays based on per visit rate,28.49,77% of total billed charges,24.05,65% of total billed charges,37,100% of total billed charges,37,100% of total billed charges,27.75,75% of total billed charges,1.25,100% of SHARP fee schedule,18.5,50% of total billed charges,12.41,33.54% of total billed charges,35.15,95% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,22.03,120% of UHC fee schedule,11.57,100% of CMS fee schedule,31.45,85% of total billed charges,11.57,100% of CMS fee schedule,1.25,37,27.75
Outpatient Medical Services,LAB,83655,LEAD,300,126,21.19,175% of CMS fee schedule,103.32,82% total billed charges,12.11,100% of CMS fee schedule,12.47,103% of CMS fee schedule,17.28,100% of AR fee schedule,42.26,33.54% of total billed charges,14.8,100% of BCBS fee schedule,14.8,100% of BCBS fee schedule,12.11,100% of CMS fee schedule,12.11,100% of CMS fee schedule,15.82,100% of CIGNA fee schedule,12.11,100% of CMS fee schedule,25.55,100% of CMS fee schedule,12.11,100% of CMS fee schedule,88.2,70% of total billed charges,25.55,100% of CMS fee schedule,15.14,100% of CMS fee schedule,94.5,75% of total billed charges,12.11,100% of CMS fee schedule,107.1,85% of total billed charges,94.5,75% of total billed charges,12.11,100% of CMS fee schedule,34.02,27% of total billed charges,10.77,100% of OK fee schedule,11.3,100% of TX fee schedule,12.11,100% of CMS fee schedule,12.11,100% of CMS fee schedule,12.11,100% of CMS fee schedule,75.6,60% of total billed charges,42.34,33.6% of total billed charges,39.23,227% of AR fee schedule,40.4,233.81% of AR fee schedule,39.23,227% of AR fee schedule,88.2,pays based on per visit rate,97.02,77% of total billed charges,81.9,65% of total billed charges,126,100% of total billed charges,126,100% of total billed charges,94.5,75% of total billed charges,1.41,100% of SHARP fee schedule,63,50% of total billed charges,42.26,33.54% of total billed charges,119.7,95% of total billed charges,12.11,100% of CMS fee schedule,12.11,100% of CMS fee schedule,24.97,120% of UHC fee schedule,12.11,100% of CMS fee schedule,107.1,85% of total billed charges,12.11,100% of CMS fee schedule,1.41,126,94.50
Outpatient Medical Services,LAB,83690,LIPASE,300,138,12.05,175% of CMS fee schedule,113.16,82% total billed charges,6.89,100% of CMS fee schedule,7.09,103% of CMS fee schedule,9.84,100% of AR fee schedule,46.29,33.54% of total billed charges,8.42,100% of BCBS fee schedule,8.42,100% of BCBS fee schedule,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,9,100% of CIGNA fee schedule,6.89,100% of CMS fee schedule,14.54,100% of CMS fee schedule,6.89,100% of CMS fee schedule,96.6,70% of total billed charges,14.54,100% of CMS fee schedule,8.61,100% of CMS fee schedule,103.5,75% of total billed charges,6.89,100% of CMS fee schedule,117.3,85% of total billed charges,103.5,75% of total billed charges,6.89,100% of CMS fee schedule,37.26,27% of total billed charges,6.13,100% of OK fee schedule,6.43,100% of TX fee schedule,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,82.8,60% of total billed charges,46.37,33.6% of total billed charges,22.34,227% of AR fee schedule,23.01,233.81% of AR fee schedule,22.34,227% of AR fee schedule,96.6,pays based on per visit rate,106.26,77% of total billed charges,89.7,65% of total billed charges,138,100% of total billed charges,138,100% of total billed charges,103.5,75% of total billed charges,0.8,100% of SHARP fee schedule,69,50% of total billed charges,46.29,33.54% of total billed charges,131.1,95% of total billed charges,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,14.2,120% of UHC fee schedule,6.89,100% of CMS fee schedule,117.3,85% of total billed charges,6.89,100% of CMS fee schedule,0.8,138,103.50
Outpatient Medical Services,LAB,83735,MAGNESIUM,300,23,11.72,175% of CMS fee schedule,18.86,82% total billed charges,6.7,100% of CMS fee schedule,6.9,103% of CMS fee schedule,9.57,100% of AR fee schedule,7.71,33.54% of total billed charges,8.18,100% of BCBS fee schedule,8.18,100% of BCBS fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,8.76,100% of CIGNA fee schedule,6.7,100% of CMS fee schedule,14.15,100% of CMS fee schedule,6.7,100% of CMS fee schedule,16.1,70% of total billed charges,14.15,100% of CMS fee schedule,8.38,100% of CMS fee schedule,17.25,75% of total billed charges,6.7,100% of CMS fee schedule,19.55,85% of total billed charges,17.25,75% of total billed charges,6.7,100% of CMS fee schedule,6.21,27% of total billed charges,5.96,100% of OK fee schedule,6.25,100% of TX fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,13.8,60% of total billed charges,7.73,33.6% of total billed charges,21.72,227% of AR fee schedule,22.38,233.81% of AR fee schedule,21.72,227% of AR fee schedule,16.1,pays based on per visit rate,17.71,77% of total billed charges,14.95,65% of total billed charges,23,100% of total billed charges,23,100% of total billed charges,17.25,75% of total billed charges,0.78,100% of SHARP fee schedule,11.5,50% of total billed charges,7.71,33.54% of total billed charges,21.85,95% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,13.82,120% of UHC fee schedule,6.7,100% of CMS fee schedule,19.55,85% of total billed charges,6.7,100% of CMS fee schedule,0.78,23,17.25
Outpatient Medical Services,LAB,83735,MAGNESIUM,300,23,11.72,175% of CMS fee schedule,18.86,82% total billed charges,6.7,100% of CMS fee schedule,6.9,103% of CMS fee schedule,9.57,100% of AR fee schedule,7.71,33.54% of total billed charges,8.18,100% of BCBS fee schedule,8.18,100% of BCBS fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,8.76,100% of CIGNA fee schedule,6.7,100% of CMS fee schedule,14.15,100% of CMS fee schedule,6.7,100% of CMS fee schedule,16.1,70% of total billed charges,14.15,100% of CMS fee schedule,8.38,100% of CMS fee schedule,17.25,75% of total billed charges,6.7,100% of CMS fee schedule,19.55,85% of total billed charges,17.25,75% of total billed charges,6.7,100% of CMS fee schedule,6.21,27% of total billed charges,5.96,100% of OK fee schedule,6.25,100% of TX fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,13.8,60% of total billed charges,7.73,33.6% of total billed charges,21.72,227% of AR fee schedule,22.38,233.81% of AR fee schedule,21.72,227% of AR fee schedule,16.1,pays based on per visit rate,17.71,77% of total billed charges,14.95,65% of total billed charges,23,100% of total billed charges,23,100% of total billed charges,17.25,75% of total billed charges,0.78,100% of SHARP fee schedule,11.5,50% of total billed charges,7.71,33.54% of total billed charges,21.85,95% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,13.82,120% of UHC fee schedule,6.7,100% of CMS fee schedule,19.55,85% of total billed charges,6.7,100% of CMS fee schedule,0.78,23,17.25
Outpatient Medical Services,LAB,83880,BNP,300,118,68.7,175% of CMS fee schedule,96.76,82% total billed charges,39.26,100% of CMS fee schedule,40.43,103% of CMS fee schedule,47.43,100% of AR fee schedule,39.58,33.54% of total billed charges,42.95,100% of BCBS fee schedule,42.95,100% of BCBS fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,51.3,100% of CIGNA fee schedule,39.26,100% of CMS fee schedule,71.66,100% of CMS fee schedule,39.26,100% of CMS fee schedule,82.6,70% of total billed charges,71.66,100% of CMS fee schedule,49.08,100% of CMS fee schedule,88.5,75% of total billed charges,39.26,100% of CMS fee schedule,100.3,85% of total billed charges,88.5,75% of total billed charges,39.26,100% of CMS fee schedule,31.86,27% of total billed charges,34.92,100% of OK fee schedule,32.98,100% of TX fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,70.8,60% of total billed charges,39.65,33.6% of total billed charges,107.67,227% of AR fee schedule,110.9,233.81% of AR fee schedule,107.67,227% of AR fee schedule,82.6,pays based on per visit rate,90.86,77% of total billed charges,76.7,65% of total billed charges,118,100% of total billed charges,118,100% of total billed charges,88.5,75% of total billed charges,3.44,100% of SHARP fee schedule,59,50% of total billed charges,39.58,33.54% of total billed charges,112.1,95% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,70.01,120% of UHC fee schedule,39.26,100% of CMS fee schedule,100.3,85% of total billed charges,39.26,100% of CMS fee schedule,3.44,118,88.50
Outpatient Medical Services,LAB,83880,BNP,300,116,68.7,175% of CMS fee schedule,95.12,82% total billed charges,39.26,100% of CMS fee schedule,40.43,103% of CMS fee schedule,47.43,100% of AR fee schedule,38.91,33.54% of total billed charges,42.95,100% of BCBS fee schedule,42.95,100% of BCBS fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,51.3,100% of CIGNA fee schedule,39.26,100% of CMS fee schedule,71.66,100% of CMS fee schedule,39.26,100% of CMS fee schedule,81.2,70% of total billed charges,71.66,100% of CMS fee schedule,49.08,100% of CMS fee schedule,87,75% of total billed charges,39.26,100% of CMS fee schedule,98.6,85% of total billed charges,87,75% of total billed charges,39.26,100% of CMS fee schedule,31.32,27% of total billed charges,34.92,100% of OK fee schedule,32.98,100% of TX fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,69.6,60% of total billed charges,38.98,33.6% of total billed charges,107.67,227% of AR fee schedule,110.9,233.81% of AR fee schedule,107.67,227% of AR fee schedule,81.2,pays based on per visit rate,89.32,77% of total billed charges,75.4,65% of total billed charges,116,100% of total billed charges,116,100% of total billed charges,87,75% of total billed charges,3.44,100% of SHARP fee schedule,58,50% of total billed charges,38.91,33.54% of total billed charges,110.2,95% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,70.01,120% of UHC fee schedule,39.26,100% of CMS fee schedule,98.6,85% of total billed charges,39.26,100% of CMS fee schedule,3.44,116,87.00
Outpatient Medical Services,LAB,83970,PTH - INTACT,300,142,72.24,175% of CMS fee schedule,116.44,82% total billed charges,41.28,100% of CMS fee schedule,42.51,103% of CMS fee schedule,58.94,100% of AR fee schedule,47.63,33.54% of total billed charges,50.45,100% of BCBS fee schedule,50.45,100% of BCBS fee schedule,41.28,100% of CMS fee schedule,41.28,100% of CMS fee schedule,53.93,100% of CIGNA fee schedule,41.28,100% of CMS fee schedule,87.12,100% of CMS fee schedule,41.28,100% of CMS fee schedule,99.4,70% of total billed charges,87.12,100% of CMS fee schedule,51.6,100% of CMS fee schedule,106.5,75% of total billed charges,41.28,100% of CMS fee schedule,120.7,85% of total billed charges,106.5,75% of total billed charges,41.28,100% of CMS fee schedule,38.34,27% of total billed charges,36.72,100% of OK fee schedule,38.52,100% of TX fee schedule,41.28,100% of CMS fee schedule,41.28,100% of CMS fee schedule,41.28,100% of CMS fee schedule,85.2,60% of total billed charges,47.71,33.6% of total billed charges,133.79,227% of AR fee schedule,137.81,233.81% of AR fee schedule,133.79,227% of AR fee schedule,99.4,pays based on per visit rate,109.34,77% of total billed charges,92.3,65% of total billed charges,142,100% of total billed charges,142,100% of total billed charges,106.5,75% of total billed charges,4.01,100% of SHARP fee schedule,71,50% of total billed charges,47.63,33.54% of total billed charges,134.9,95% of total billed charges,41.28,100% of CMS fee schedule,41.28,100% of CMS fee schedule,85.13,120% of UHC fee schedule,41.28,100% of CMS fee schedule,120.7,85% of total billed charges,41.28,100% of CMS fee schedule,4.01,142,106.50
Outpatient Medical Services,LAB,84100,PHOSPHORUS,300,17,8.29,175% of CMS fee schedule,13.94,82% total billed charges,4.74,100% of CMS fee schedule,4.88,103% of CMS fee schedule,6.78,100% of AR fee schedule,5.7,33.54% of total billed charges,5.8,100% of BCBS fee schedule,5.8,100% of BCBS fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,6.19,100% of CIGNA fee schedule,4.74,100% of CMS fee schedule,10.01,100% of CMS fee schedule,4.74,100% of CMS fee schedule,11.9,70% of total billed charges,10.01,100% of CMS fee schedule,5.93,100% of CMS fee schedule,12.75,75% of total billed charges,4.74,100% of CMS fee schedule,14.45,85% of total billed charges,12.75,75% of total billed charges,4.74,100% of CMS fee schedule,4.59,27% of total billed charges,4.22,100% of OK fee schedule,4.43,100% of TX fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,10.2,60% of total billed charges,5.71,33.6% of total billed charges,15.39,227% of AR fee schedule,15.85,233.81% of AR fee schedule,15.39,227% of AR fee schedule,11.9,pays based on per visit rate,13.09,77% of total billed charges,11.05,65% of total billed charges,17,100% of total billed charges,17,100% of total billed charges,12.75,75% of total billed charges,0.55,100% of SHARP fee schedule,8.5,50% of total billed charges,5.7,33.54% of total billed charges,16.15,95% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,9.78,120% of UHC fee schedule,4.74,100% of CMS fee schedule,14.45,85% of total billed charges,4.74,100% of CMS fee schedule,0.55,17,12.75
Outpatient Medical Services,LAB,84100,PHOSPHORUS,300,18,8.29,175% of CMS fee schedule,14.76,82% total billed charges,4.74,100% of CMS fee schedule,4.88,103% of CMS fee schedule,6.78,100% of AR fee schedule,6.04,33.54% of total billed charges,5.8,100% of BCBS fee schedule,5.8,100% of BCBS fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,6.19,100% of CIGNA fee schedule,4.74,100% of CMS fee schedule,10.01,100% of CMS fee schedule,4.74,100% of CMS fee schedule,12.6,70% of total billed charges,10.01,100% of CMS fee schedule,5.93,100% of CMS fee schedule,13.5,75% of total billed charges,4.74,100% of CMS fee schedule,15.3,85% of total billed charges,13.5,75% of total billed charges,4.74,100% of CMS fee schedule,4.86,27% of total billed charges,4.22,100% of OK fee schedule,4.43,100% of TX fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,10.8,60% of total billed charges,6.05,33.6% of total billed charges,15.39,227% of AR fee schedule,15.85,233.81% of AR fee schedule,15.39,227% of AR fee schedule,12.6,pays based on per visit rate,13.86,77% of total billed charges,11.7,65% of total billed charges,18,100% of total billed charges,18,100% of total billed charges,13.5,75% of total billed charges,0.55,100% of SHARP fee schedule,9,50% of total billed charges,6.04,33.54% of total billed charges,17.1,95% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,9.78,120% of UHC fee schedule,4.74,100% of CMS fee schedule,15.3,85% of total billed charges,4.74,100% of CMS fee schedule,0.55,18,13.50
Outpatient Medical Services,LAB,84132,POTASSIUM,300,16,8.33,175% of CMS fee schedule,13.12,82% total billed charges,4.76,100% of CMS fee schedule,4.9,103% of CMS fee schedule,6.56,100% of AR fee schedule,23,100% of AR fee schedule,5.62,100% of BCBS fee schedule,5.62,100% of BCBS fee schedule,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,6.21,100% of CIGNA fee schedule,4.76,100% of CMS fee schedule,9.71,100% of CMS fee schedule,4.76,100% of CMS fee schedule,11.2,70% of total billed charges,9.71,100% of CMS fee schedule,5.95,100% of CMS fee schedule,12,75% of total billed charges,4.76,100% of CMS fee schedule,13.6,85% of total billed charges,12,75% of total billed charges,4.76,100% of CMS fee schedule,4.32,27% of total billed charges,4.23,100% of OK fee schedule,4.29,100% of TX fee schedule,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,9.6,60% of total billed charges,5.38,33.6% of total billed charges,14.89,227% of AR fee schedule,15.34,233.81% of AR fee schedule,14.89,227% of AR fee schedule,11.2,pays based on per visit rate,12.32,77% of total billed charges,10.4,65% of total billed charges,16,100% of total billed charges,16,100% of total billed charges,12,75% of total billed charges,0.54,100% of SHARP fee schedule,8,50% of total billed charges,23,100% of SPREEMO fee schedule,15.2,95% of total billed charges,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,9.48,120% of UHC fee schedule,4.76,100% of CMS fee schedule,13.6,85% of total billed charges,4.76,100% of CMS fee schedule,0.54,23,12.00
Outpatient Medical Services,LAB,84156,PROTEIN URINE,300,22,6.42,175% of CMS fee schedule,18.04,82% total billed charges,3.67,100% of CMS fee schedule,3.78,103% of CMS fee schedule,5.25,100% of AR fee schedule,7.38,33.54% of total billed charges,4.48,100% of BCBS fee schedule,4.48,100% of BCBS fee schedule,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.8,100% of CIGNA fee schedule,3.67,100% of CMS fee schedule,7.74,100% of CMS fee schedule,3.67,100% of CMS fee schedule,15.4,70% of total billed charges,7.74,100% of CMS fee schedule,4.59,100% of CMS fee schedule,16.5,75% of total billed charges,3.67,100% of CMS fee schedule,18.7,85% of total billed charges,16.5,75% of total billed charges,3.67,100% of CMS fee schedule,5.94,27% of total billed charges,3.26,100% of OK fee schedule,3.42,100% of TX fee schedule,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,13.2,60% of total billed charges,7.39,33.6% of total billed charges,11.92,227% of AR fee schedule,12.28,233.81% of AR fee schedule,11.92,227% of AR fee schedule,15.4,pays based on per visit rate,16.94,77% of total billed charges,14.3,65% of total billed charges,22,100% of total billed charges,22,100% of total billed charges,16.5,75% of total billed charges,0.43,100% of SHARP fee schedule,11,50% of total billed charges,7.38,33.54% of total billed charges,20.9,95% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,7.56,120% of UHC fee schedule,3.67,100% of CMS fee schedule,18.7,85% of total billed charges,3.67,100% of CMS fee schedule,0.43,22,16.50
Outpatient Medical Services,LAB,84403,TESTOSTERONE,300,332,45.16,175% of CMS fee schedule,272.24,82% total billed charges,25.81,100% of CMS fee schedule,26.58,103% of CMS fee schedule,36.87,100% of AR fee schedule,111.35,33.54% of total billed charges,31.55,100% of BCBS fee schedule,31.55,100% of BCBS fee schedule,25.81,100% of CMS fee schedule,25.81,100% of CMS fee schedule,33.73,100% of CIGNA fee schedule,25.81,100% of CMS fee schedule,54.5,100% of CMS fee schedule,25.81,100% of CMS fee schedule,232.4,70% of total billed charges,54.5,100% of CMS fee schedule,32.26,100% of CMS fee schedule,249,75% of total billed charges,25.81,100% of CMS fee schedule,282.2,85% of total billed charges,249,75% of total billed charges,25.81,100% of CMS fee schedule,89.64,27% of total billed charges,22.96,100% of OK fee schedule,24.09,100% of TX fee schedule,25.81,100% of CMS fee schedule,25.81,100% of CMS fee schedule,25.81,100% of CMS fee schedule,199.2,60% of total billed charges,111.55,33.6% of total billed charges,83.69,227% of AR fee schedule,86.21,233.81% of AR fee schedule,83.69,227% of AR fee schedule,232.4,pays based on per visit rate,255.64,77% of total billed charges,215.8,65% of total billed charges,332,100% of total billed charges,332,100% of total billed charges,249,75% of total billed charges,3.01,100% of SHARP fee schedule,166,50% of total billed charges,111.35,33.54% of total billed charges,315.4,95% of total billed charges,25.81,100% of CMS fee schedule,25.81,100% of CMS fee schedule,53.26,120% of UHC fee schedule,25.81,100% of CMS fee schedule,282.2,85% of total billed charges,25.81,100% of CMS fee schedule,3.01,332,249.00
Outpatient Medical Services,LAB,84436,T4,300,28,12.02,175% of CMS fee schedule,22.96,82% total billed charges,6.87,100% of CMS fee schedule,7.07,103% of CMS fee schedule,8.9,100% of AR fee schedule,37,100% of AR fee schedule,8.39,100% of BCBS fee schedule,8.39,100% of BCBS fee schedule,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,8.98,100% of CIGNA fee schedule,6.87,100% of CMS fee schedule,13.14,100% of CMS fee schedule,6.87,100% of CMS fee schedule,19.6,70% of total billed charges,13.14,100% of CMS fee schedule,8.59,100% of CMS fee schedule,21,75% of total billed charges,6.87,100% of CMS fee schedule,23.8,85% of total billed charges,21,75% of total billed charges,6.87,100% of CMS fee schedule,7.56,27% of total billed charges,6.11,100% of OK fee schedule,6.41,100% of TX fee schedule,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,16.8,60% of total billed charges,9.41,33.6% of total billed charges,20.2,227% of AR fee schedule,20.81,233.81% of AR fee schedule,20.2,227% of AR fee schedule,19.6,pays based on per visit rate,21.56,77% of total billed charges,18.2,65% of total billed charges,28,100% of total billed charges,28,100% of total billed charges,21,75% of total billed charges,0.8,100% of SHARP fee schedule,14,50% of total billed charges,37,100% of SPREEMO fee schedule,26.6,95% of total billed charges,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,14.17,120% of UHC fee schedule,6.87,100% of CMS fee schedule,23.8,85% of total billed charges,6.87,100% of CMS fee schedule,0.8,37,21.00
Outpatient Medical Services,LAB,84439,FREE T4,300,50,15.78,175% of CMS fee schedule,41,82% total billed charges,9.02,100% of CMS fee schedule,9.29,103% of CMS fee schedule,12.88,100% of AR fee schedule,37,100% of AR fee schedule,11.02,100% of BCBS fee schedule,11.02,100% of BCBS fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,11.78,100% of CIGNA fee schedule,9.02,100% of CMS fee schedule,19.04,100% of CMS fee schedule,9.02,100% of CMS fee schedule,35,70% of total billed charges,19.04,100% of CMS fee schedule,11.28,100% of CMS fee schedule,37.5,75% of total billed charges,9.02,100% of CMS fee schedule,42.5,85% of total billed charges,37.5,75% of total billed charges,9.02,100% of CMS fee schedule,13.5,27% of total billed charges,8.02,100% of OK fee schedule,8.42,100% of TX fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,30,60% of total billed charges,16.8,33.6% of total billed charges,29.24,227% of AR fee schedule,30.11,233.81% of AR fee schedule,29.24,227% of AR fee schedule,35,pays based on per visit rate,38.5,77% of total billed charges,32.5,65% of total billed charges,50,100% of total billed charges,50,100% of total billed charges,37.5,75% of total billed charges,1.05,100% of SHARP fee schedule,25,50% of total billed charges,37,100% of SPREEMO fee schedule,47.5,95% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,18.6,120% of UHC fee schedule,9.02,100% of CMS fee schedule,42.5,85% of total billed charges,9.02,100% of CMS fee schedule,1.05,50,37.50
Outpatient Medical Services,LAB,84439,FREE T4,300,50,15.78,175% of CMS fee schedule,41,82% total billed charges,9.02,100% of CMS fee schedule,9.29,103% of CMS fee schedule,12.88,100% of AR fee schedule,37,100% of AR fee schedule,11.02,100% of BCBS fee schedule,11.02,100% of BCBS fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,11.78,100% of CIGNA fee schedule,9.02,100% of CMS fee schedule,19.04,100% of CMS fee schedule,9.02,100% of CMS fee schedule,35,70% of total billed charges,19.04,100% of CMS fee schedule,11.28,100% of CMS fee schedule,37.5,75% of total billed charges,9.02,100% of CMS fee schedule,42.5,85% of total billed charges,37.5,75% of total billed charges,9.02,100% of CMS fee schedule,13.5,27% of total billed charges,8.02,100% of OK fee schedule,8.42,100% of TX fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,30,60% of total billed charges,16.8,33.6% of total billed charges,29.24,227% of AR fee schedule,30.11,233.81% of AR fee schedule,29.24,227% of AR fee schedule,35,pays based on per visit rate,38.5,77% of total billed charges,32.5,65% of total billed charges,50,100% of total billed charges,50,100% of total billed charges,37.5,75% of total billed charges,1.05,100% of SHARP fee schedule,25,50% of total billed charges,37,100% of SPREEMO fee schedule,47.5,95% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,18.6,120% of UHC fee schedule,9.02,100% of CMS fee schedule,42.5,85% of total billed charges,9.02,100% of CMS fee schedule,1.05,50,37.50
Outpatient Medical Services,LAB,84443,TSH,300,65,29.4,175% of CMS fee schedule,53.3,82% total billed charges,16.8,100% of CMS fee schedule,17.3,103% of CMS fee schedule,23.98,100% of AR fee schedule,56,100% of AR fee schedule,20.54,100% of BCBS fee schedule,20.54,100% of BCBS fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,21.95,100% of CIGNA fee schedule,16.8,100% of CMS fee schedule,35.46,100% of CMS fee schedule,16.8,100% of CMS fee schedule,45.5,70% of total billed charges,35.46,100% of CMS fee schedule,21,100% of CMS fee schedule,48.75,75% of total billed charges,16.8,100% of CMS fee schedule,55.25,85% of total billed charges,48.75,75% of total billed charges,16.8,100% of CMS fee schedule,17.55,27% of total billed charges,14.94,100% of OK fee schedule,15.68,100% of TX fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,39,60% of total billed charges,21.84,33.6% of total billed charges,54.43,227% of AR fee schedule,56.07,233.81% of AR fee schedule,54.43,227% of AR fee schedule,45.5,pays based on per visit rate,50.05,77% of total billed charges,42.25,65% of total billed charges,65,100% of total billed charges,65,100% of total billed charges,48.75,75% of total billed charges,1.96,100% of SHARP fee schedule,32.5,50% of total billed charges,56,100% of SPREEMO fee schedule,61.75,95% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,34.64,120% of UHC fee schedule,16.8,100% of CMS fee schedule,55.25,85% of total billed charges,16.8,100% of CMS fee schedule,1.96,65,48.75
Outpatient Medical Services,LAB,84443,TSH,300,65,29.4,175% of CMS fee schedule,53.3,82% total billed charges,16.8,100% of CMS fee schedule,17.3,103% of CMS fee schedule,23.98,100% of AR fee schedule,56,100% of AR fee schedule,20.54,100% of BCBS fee schedule,20.54,100% of BCBS fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,21.95,100% of CIGNA fee schedule,16.8,100% of CMS fee schedule,35.46,100% of CMS fee schedule,16.8,100% of CMS fee schedule,45.5,70% of total billed charges,35.46,100% of CMS fee schedule,21,100% of CMS fee schedule,48.75,75% of total billed charges,16.8,100% of CMS fee schedule,55.25,85% of total billed charges,48.75,75% of total billed charges,16.8,100% of CMS fee schedule,17.55,27% of total billed charges,14.94,100% of OK fee schedule,15.68,100% of TX fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,39,60% of total billed charges,21.84,33.6% of total billed charges,54.43,227% of AR fee schedule,56.07,233.81% of AR fee schedule,54.43,227% of AR fee schedule,45.5,pays based on per visit rate,50.05,77% of total billed charges,42.25,65% of total billed charges,65,100% of total billed charges,65,100% of total billed charges,48.75,75% of total billed charges,1.96,100% of SHARP fee schedule,32.5,50% of total billed charges,56,100% of SPREEMO fee schedule,61.75,95% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,34.64,120% of UHC fee schedule,16.8,100% of CMS fee schedule,55.25,85% of total billed charges,16.8,100% of CMS fee schedule,1.96,65,48.75
Outpatient Medical Services,LAB,84484,TROPONIN-HS,300,66,21.82,175% of CMS fee schedule,54.12,82% total billed charges,12.47,100% of CMS fee schedule,12.84,103% of CMS fee schedule,14.05,100% of AR fee schedule,22.14,33.54% of total billed charges,12.78,100% of BCBS fee schedule,12.78,100% of BCBS fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,16.3,100% of CIGNA fee schedule,12.47,100% of CMS fee schedule,20.78,100% of CMS fee schedule,12.47,100% of CMS fee schedule,46.2,70% of total billed charges,20.78,100% of CMS fee schedule,15.59,100% of CMS fee schedule,49.5,75% of total billed charges,12.47,100% of CMS fee schedule,56.1,85% of total billed charges,49.5,75% of total billed charges,12.47,100% of CMS fee schedule,17.82,27% of total billed charges,11.09,100% of OK fee schedule,10.47,100% of TX fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,39.6,60% of total billed charges,22.18,33.6% of total billed charges,31.89,227% of AR fee schedule,32.85,233.81% of AR fee schedule,31.89,227% of AR fee schedule,46.2,pays based on per visit rate,50.82,77% of total billed charges,42.9,65% of total billed charges,66,100% of total billed charges,66,100% of total billed charges,49.5,75% of total billed charges,1.31,100% of SHARP fee schedule,33,50% of total billed charges,22.14,33.54% of total billed charges,62.7,95% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,20.3,120% of UHC fee schedule,12.47,100% of CMS fee schedule,56.1,85% of total billed charges,12.47,100% of CMS fee schedule,1.31,66,49.50
Outpatient Medical Services,LAB,84484,TROPONIN,300,70,21.82,175% of CMS fee schedule,57.4,82% total billed charges,12.47,100% of CMS fee schedule,12.84,103% of CMS fee schedule,14.05,100% of AR fee schedule,23.48,33.54% of total billed charges,12.78,100% of BCBS fee schedule,12.78,100% of BCBS fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,16.3,100% of CIGNA fee schedule,12.47,100% of CMS fee schedule,20.78,100% of CMS fee schedule,12.47,100% of CMS fee schedule,49,70% of total billed charges,20.78,100% of CMS fee schedule,15.59,100% of CMS fee schedule,52.5,75% of total billed charges,12.47,100% of CMS fee schedule,59.5,85% of total billed charges,52.5,75% of total billed charges,12.47,100% of CMS fee schedule,18.9,27% of total billed charges,11.09,100% of OK fee schedule,10.47,100% of TX fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,42,60% of total billed charges,23.52,33.6% of total billed charges,31.89,227% of AR fee schedule,32.85,233.81% of AR fee schedule,31.89,227% of AR fee schedule,49,pays based on per visit rate,53.9,77% of total billed charges,45.5,65% of total billed charges,70,100% of total billed charges,70,100% of total billed charges,52.5,75% of total billed charges,1.31,100% of SHARP fee schedule,35,50% of total billed charges,23.48,33.54% of total billed charges,66.5,95% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,20.3,120% of UHC fee schedule,12.47,100% of CMS fee schedule,59.5,85% of total billed charges,12.47,100% of CMS fee schedule,1.31,70,52.50
Outpatient Medical Services,LAB,84550,URIC ACID,300,19,7.9,175% of CMS fee schedule,15.58,82% total billed charges,4.51,100% of CMS fee schedule,4.65,103% of CMS fee schedule,6.46,100% of AR fee schedule,22,100% of AR fee schedule,5.52,100% of BCBS fee schedule,5.52,100% of BCBS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,5.91,100% of CIGNA fee schedule,4.51,100% of CMS fee schedule,9.54,100% of CMS fee schedule,4.51,100% of CMS fee schedule,13.3,70% of total billed charges,9.54,100% of CMS fee schedule,5.65,100% of CMS fee schedule,14.25,75% of total billed charges,4.52,100% of CMS fee schedule,16.15,85% of total billed charges,14.25,75% of total billed charges,4.51,100% of CMS fee schedule,5.13,27% of total billed charges,4.02,100% of OK fee schedule,4.22,100% of TX fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,11.4,60% of total billed charges,6.38,33.6% of total billed charges,14.66,227% of AR fee schedule,15.1,233.81% of AR fee schedule,14.66,227% of AR fee schedule,13.3,pays based on per visit rate,14.63,77% of total billed charges,12.35,65% of total billed charges,19,100% of total billed charges,19,100% of total billed charges,14.25,75% of total billed charges,0.53,100% of SHARP fee schedule,9.5,50% of total billed charges,22,100% of SPREEMO fee schedule,18.05,95% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,9.31,120% of UHC fee schedule,4.51,100% of CMS fee schedule,16.15,85% of total billed charges,4.51,100% of CMS fee schedule,0.53,22,14.25
Outpatient Medical Services,LAB,84550,URIC ACID,300,19,7.9,175% of CMS fee schedule,15.58,82% total billed charges,4.51,100% of CMS fee schedule,4.65,103% of CMS fee schedule,6.46,100% of AR fee schedule,22,100% of AR fee schedule,5.52,100% of BCBS fee schedule,5.52,100% of BCBS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,5.91,100% of CIGNA fee schedule,4.51,100% of CMS fee schedule,9.54,100% of CMS fee schedule,4.51,100% of CMS fee schedule,13.3,70% of total billed charges,9.54,100% of CMS fee schedule,5.65,100% of CMS fee schedule,14.25,75% of total billed charges,4.52,100% of CMS fee schedule,16.15,85% of total billed charges,14.25,75% of total billed charges,4.51,100% of CMS fee schedule,5.13,27% of total billed charges,4.02,100% of OK fee schedule,4.22,100% of TX fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,11.4,60% of total billed charges,6.38,33.6% of total billed charges,14.66,227% of AR fee schedule,15.1,233.81% of AR fee schedule,14.66,227% of AR fee schedule,13.3,pays based on per visit rate,14.63,77% of total billed charges,12.35,65% of total billed charges,19,100% of total billed charges,19,100% of total billed charges,14.25,75% of total billed charges,0.53,100% of SHARP fee schedule,9.5,50% of total billed charges,22,100% of SPREEMO fee schedule,18.05,95% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,9.31,120% of UHC fee schedule,4.51,100% of CMS fee schedule,16.15,85% of total billed charges,4.51,100% of CMS fee schedule,0.53,22,14.25
Outpatient Medical Services,LAB,85007,CHARGE FOR MANUAL DIFF,300,29,6.65,175% of CMS fee schedule,23.78,82% total billed charges,3.8,100% of CMS fee schedule,3.91,103% of CMS fee schedule,4.92,100% of AR fee schedule,12,100% of AR fee schedule,4.2,100% of BCBS fee schedule,4.2,100% of BCBS fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,4.96,100% of CIGNA fee schedule,3.8,100% of CMS fee schedule,7.26,100% of CMS fee schedule,3.8,100% of CMS fee schedule,20.3,70% of total billed charges,7.26,100% of CMS fee schedule,4.75,100% of CMS fee schedule,21.75,75% of total billed charges,3.8,100% of CMS fee schedule,24.65,85% of total billed charges,21.75,75% of total billed charges,3.8,100% of CMS fee schedule,7.83,27% of total billed charges,3.38,100% of OK fee schedule,3.21,100% of TX fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,17.4,60% of total billed charges,9.74,33.6% of total billed charges,11.17,227% of AR fee schedule,11.5,233.81% of AR fee schedule,11.17,227% of AR fee schedule,20.3,pays based on per visit rate,22.33,77% of total billed charges,18.85,65% of total billed charges,29,100% of total billed charges,29,100% of total billed charges,21.75,75% of total billed charges,0.4,100% of SHARP fee schedule,14.5,50% of total billed charges,12,100% of SPREEMO fee schedule,27.55,95% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,7.1,120% of UHC fee schedule,3.8,100% of CMS fee schedule,24.65,85% of total billed charges,3.8,100% of CMS fee schedule,0.4,29,21.75
Outpatient Medical Services,LAB,85007,CHARGE FOR MANUAL DIFF,300,28,6.65,175% of CMS fee schedule,22.96,82% total billed charges,3.8,100% of CMS fee schedule,3.91,103% of CMS fee schedule,4.92,100% of AR fee schedule,12,100% of AR fee schedule,4.2,100% of BCBS fee schedule,4.2,100% of BCBS fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,4.96,100% of CIGNA fee schedule,3.8,100% of CMS fee schedule,7.26,100% of CMS fee schedule,3.8,100% of CMS fee schedule,19.6,70% of total billed charges,7.26,100% of CMS fee schedule,4.75,100% of CMS fee schedule,21,75% of total billed charges,3.8,100% of CMS fee schedule,23.8,85% of total billed charges,21,75% of total billed charges,3.8,100% of CMS fee schedule,7.56,27% of total billed charges,3.38,100% of OK fee schedule,3.21,100% of TX fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,16.8,60% of total billed charges,9.41,33.6% of total billed charges,11.17,227% of AR fee schedule,11.5,233.81% of AR fee schedule,11.17,227% of AR fee schedule,19.6,pays based on per visit rate,21.56,77% of total billed charges,18.2,65% of total billed charges,28,100% of total billed charges,28,100% of total billed charges,21,75% of total billed charges,0.4,100% of SHARP fee schedule,14,50% of total billed charges,12,100% of SPREEMO fee schedule,26.6,95% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,7.1,120% of UHC fee schedule,3.8,100% of CMS fee schedule,23.8,85% of total billed charges,3.8,100% of CMS fee schedule,0.4,28,21.00
Outpatient Medical Services,LAB,85025,CHARGE FOR CBC W/DIFF,300,135,13.59,175% of CMS fee schedule,110.7,82% total billed charges,7.77,100% of CMS fee schedule,8,103% of CMS fee schedule,11.1,100% of AR fee schedule,26,100% of AR fee schedule,9.49,100% of BCBS fee schedule,9.49,100% of BCBS fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,10.15,100% of CIGNA fee schedule,7.77,100% of CMS fee schedule,16.41,100% of CMS fee schedule,7.77,100% of CMS fee schedule,94.5,70% of total billed charges,16.41,100% of CMS fee schedule,9.71,100% of CMS fee schedule,101.25,75% of total billed charges,7.77,100% of CMS fee schedule,114.75,85% of total billed charges,101.25,75% of total billed charges,7.77,100% of CMS fee schedule,36.45,27% of total billed charges,6.91,100% of OK fee schedule,7.25,100% of TX fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,81,60% of total billed charges,45.36,33.6% of total billed charges,25.2,227% of AR fee schedule,25.95,233.81% of AR fee schedule,25.2,227% of AR fee schedule,94.5,pays based on per visit rate,103.95,77% of total billed charges,87.75,65% of total billed charges,135,100% of total billed charges,135,100% of total billed charges,101.25,75% of total billed charges,0.91,100% of SHARP fee schedule,67.5,50% of total billed charges,26,100% of SPREEMO fee schedule,128.25,95% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,16.04,120% of UHC fee schedule,7.77,100% of CMS fee schedule,114.75,85% of total billed charges,7.77,100% of CMS fee schedule,0.91,135,101.25
Outpatient Medical Services,LAB,85025,CHARGE FOR CBC W/DIFF,300,133,13.59,175% of CMS fee schedule,109.06,82% total billed charges,7.77,100% of CMS fee schedule,8,103% of CMS fee schedule,11.1,100% of AR fee schedule,26,100% of AR fee schedule,9.49,100% of BCBS fee schedule,9.49,100% of BCBS fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,10.15,100% of CIGNA fee schedule,7.77,100% of CMS fee schedule,16.41,100% of CMS fee schedule,7.77,100% of CMS fee schedule,93.1,70% of total billed charges,16.41,100% of CMS fee schedule,9.71,100% of CMS fee schedule,99.75,75% of total billed charges,7.77,100% of CMS fee schedule,113.05,85% of total billed charges,99.75,75% of total billed charges,7.77,100% of CMS fee schedule,35.91,27% of total billed charges,6.91,100% of OK fee schedule,7.25,100% of TX fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,79.8,60% of total billed charges,44.69,33.6% of total billed charges,25.2,227% of AR fee schedule,25.95,233.81% of AR fee schedule,25.2,227% of AR fee schedule,93.1,pays based on per visit rate,102.41,77% of total billed charges,86.45,65% of total billed charges,133,100% of total billed charges,133,100% of total billed charges,99.75,75% of total billed charges,0.91,100% of SHARP fee schedule,66.5,50% of total billed charges,26,100% of SPREEMO fee schedule,126.35,95% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,16.04,120% of UHC fee schedule,7.77,100% of CMS fee schedule,113.05,85% of total billed charges,7.77,100% of CMS fee schedule,0.91,133,99.75
Outpatient Medical Services,LAB,85027,CBC W/O DIFF,300,103,11.32,175% of CMS fee schedule,84.46,82% total billed charges,6.47,100% of CMS fee schedule,6.66,103% of CMS fee schedule,9.25,100% of AR fee schedule,26,100% of AR fee schedule,7.9,100% of BCBS fee schedule,7.9,100% of BCBS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,8.46,100% of CIGNA fee schedule,6.47,100% of CMS fee schedule,13.67,100% of CMS fee schedule,6.47,100% of CMS fee schedule,72.1,70% of total billed charges,13.67,100% of CMS fee schedule,8.09,100% of CMS fee schedule,77.25,75% of total billed charges,6.47,100% of CMS fee schedule,87.55,85% of total billed charges,77.25,75% of total billed charges,6.47,100% of CMS fee schedule,27.81,27% of total billed charges,5.75,100% of OK fee schedule,6.03,100% of TX fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,61.8,60% of total billed charges,34.61,33.6% of total billed charges,21,227% of AR fee schedule,21.63,233.81% of AR fee schedule,21,227% of AR fee schedule,72.1,pays based on per visit rate,79.31,77% of total billed charges,66.95,65% of total billed charges,103,100% of total billed charges,103,100% of total billed charges,77.25,75% of total billed charges,0.75,100% of SHARP fee schedule,51.5,50% of total billed charges,26,100% of SPREEMO fee schedule,97.85,95% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,13.34,120% of UHC fee schedule,6.47,100% of CMS fee schedule,87.55,85% of total billed charges,6.47,100% of CMS fee schedule,0.75,103,77.25
Outpatient Medical Services,LAB,85027,CBC WITH MANUAL DIFF,300,151,11.32,175% of CMS fee schedule,123.82,82% total billed charges,6.47,100% of CMS fee schedule,6.66,103% of CMS fee schedule,9.25,100% of AR fee schedule,26,100% of AR fee schedule,7.9,100% of BCBS fee schedule,7.9,100% of BCBS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,8.46,100% of CIGNA fee schedule,6.47,100% of CMS fee schedule,13.67,100% of CMS fee schedule,6.47,100% of CMS fee schedule,105.7,70% of total billed charges,13.67,100% of CMS fee schedule,8.09,100% of CMS fee schedule,113.25,75% of total billed charges,6.47,100% of CMS fee schedule,128.35,85% of total billed charges,113.25,75% of total billed charges,6.47,100% of CMS fee schedule,40.77,27% of total billed charges,5.75,100% of OK fee schedule,6.03,100% of TX fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,90.6,60% of total billed charges,50.74,33.6% of total billed charges,21,227% of AR fee schedule,21.63,233.81% of AR fee schedule,21,227% of AR fee schedule,105.7,pays based on per visit rate,116.27,77% of total billed charges,98.15,65% of total billed charges,151,100% of total billed charges,151,100% of total billed charges,113.25,75% of total billed charges,0.75,100% of SHARP fee schedule,75.5,50% of total billed charges,26,100% of SPREEMO fee schedule,143.45,95% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,13.34,120% of UHC fee schedule,6.47,100% of CMS fee schedule,128.35,85% of total billed charges,6.47,100% of CMS fee schedule,0.75,151,113.25
Outpatient Medical Services,LAB,85027,CBC W/O DIFF,300,105,11.32,175% of CMS fee schedule,86.1,82% total billed charges,6.47,100% of CMS fee schedule,6.66,103% of CMS fee schedule,9.25,100% of AR fee schedule,26,100% of AR fee schedule,7.9,100% of BCBS fee schedule,7.9,100% of BCBS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,8.46,100% of CIGNA fee schedule,6.47,100% of CMS fee schedule,13.67,100% of CMS fee schedule,6.47,100% of CMS fee schedule,73.5,70% of total billed charges,13.67,100% of CMS fee schedule,8.09,100% of CMS fee schedule,78.75,75% of total billed charges,6.47,100% of CMS fee schedule,89.25,85% of total billed charges,78.75,75% of total billed charges,6.47,100% of CMS fee schedule,28.35,27% of total billed charges,5.75,100% of OK fee schedule,6.03,100% of TX fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,63,60% of total billed charges,35.28,33.6% of total billed charges,21,227% of AR fee schedule,21.63,233.81% of AR fee schedule,21,227% of AR fee schedule,73.5,pays based on per visit rate,80.85,77% of total billed charges,68.25,65% of total billed charges,105,100% of total billed charges,105,100% of total billed charges,78.75,75% of total billed charges,0.75,100% of SHARP fee schedule,52.5,50% of total billed charges,26,100% of SPREEMO fee schedule,99.75,95% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,13.34,120% of UHC fee schedule,6.47,100% of CMS fee schedule,89.25,85% of total billed charges,6.47,100% of CMS fee schedule,0.75,105,78.75
Outpatient Medical Services,LAB,85379,D DIMER,300,172,17.81,175% of CMS fee schedule,141.04,82% total billed charges,10.18,100% of CMS fee schedule,10.48,103% of CMS fee schedule,14.53,100% of AR fee schedule,57.69,33.54% of total billed charges,12.44,100% of BCBS fee schedule,12.44,100% of BCBS fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,13.31,100% of CIGNA fee schedule,10.18,100% of CMS fee schedule,21.48,100% of CMS fee schedule,10.18,100% of CMS fee schedule,120.4,70% of total billed charges,21.48,100% of CMS fee schedule,12.73,100% of CMS fee schedule,129,75% of total billed charges,10.18,100% of CMS fee schedule,146.2,85% of total billed charges,129,75% of total billed charges,10.18,100% of CMS fee schedule,46.44,27% of total billed charges,9.05,100% of OK fee schedule,9.5,100% of TX fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,103.2,60% of total billed charges,57.79,33.6% of total billed charges,32.98,227% of AR fee schedule,33.97,233.81% of AR fee schedule,32.98,227% of AR fee schedule,120.4,pays based on per visit rate,132.44,77% of total billed charges,111.8,65% of total billed charges,172,100% of total billed charges,172,100% of total billed charges,129,75% of total billed charges,1.19,100% of SHARP fee schedule,86,50% of total billed charges,57.69,33.54% of total billed charges,163.4,95% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,20.98,120% of UHC fee schedule,10.18,100% of CMS fee schedule,146.2,85% of total billed charges,10.18,100% of CMS fee schedule,1.19,172,129.00
Outpatient Medical Services,LAB,85379,D-DIMER TRI,300,182,17.81,175% of CMS fee schedule,149.24,82% total billed charges,10.18,100% of CMS fee schedule,10.48,103% of CMS fee schedule,14.53,100% of AR fee schedule,61.04,33.54% of total billed charges,12.44,100% of BCBS fee schedule,12.44,100% of BCBS fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,13.31,100% of CIGNA fee schedule,10.18,100% of CMS fee schedule,21.48,100% of CMS fee schedule,10.18,100% of CMS fee schedule,127.4,70% of total billed charges,21.48,100% of CMS fee schedule,12.73,100% of CMS fee schedule,136.5,75% of total billed charges,10.18,100% of CMS fee schedule,154.7,85% of total billed charges,136.5,75% of total billed charges,10.18,100% of CMS fee schedule,49.14,27% of total billed charges,9.05,100% of OK fee schedule,9.5,100% of TX fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,109.2,60% of total billed charges,61.15,33.6% of total billed charges,32.98,227% of AR fee schedule,33.97,233.81% of AR fee schedule,32.98,227% of AR fee schedule,127.4,pays based on per visit rate,140.14,77% of total billed charges,118.3,65% of total billed charges,182,100% of total billed charges,182,100% of total billed charges,136.5,75% of total billed charges,1.19,100% of SHARP fee schedule,91,50% of total billed charges,61.04,33.54% of total billed charges,172.9,95% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,20.98,120% of UHC fee schedule,10.18,100% of CMS fee schedule,154.7,85% of total billed charges,10.18,100% of CMS fee schedule,1.19,182,136.50
Outpatient Medical Services,LAB,85610,PROTHROMBIN TIME,300,14,7.5,175% of CMS fee schedule,11.48,82% total billed charges,4.29,100% of CMS fee schedule,4.41,103% of CMS fee schedule,5.61,100% of AR fee schedule,19,100% of AR fee schedule,4.81,100% of BCBS fee schedule,4.81,100% of BCBS fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,5.61,100% of CIGNA fee schedule,4.29,100% of CMS fee schedule,8.3,100% of CMS fee schedule,4.29,100% of CMS fee schedule,9.8,70% of total billed charges,8.3,100% of CMS fee schedule,5.36,100% of CMS fee schedule,10.5,75% of total billed charges,4.29,100% of CMS fee schedule,11.9,85% of total billed charges,10.5,75% of total billed charges,4.29,100% of CMS fee schedule,3.78,27% of total billed charges,3.82,100% of OK fee schedule,3.67,100% of TX fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,8.4,60% of total billed charges,4.7,33.6% of total billed charges,12.73,227% of AR fee schedule,13.12,233.81% of AR fee schedule,12.73,227% of AR fee schedule,9.8,pays based on per visit rate,10.78,77% of total billed charges,9.1,65% of total billed charges,14,100% of total billed charges,14,100% of total billed charges,10.5,75% of total billed charges,0.46,100% of SHARP fee schedule,7,50% of total billed charges,19,100% of SPREEMO fee schedule,13.3,95% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,8.09,120% of UHC fee schedule,4.29,100% of CMS fee schedule,11.9,85% of total billed charges,4.29,100% of CMS fee schedule,0.46,19,10.50
Outpatient Medical Services,LAB,85610,PROTHROMBIN TIME,300,14,7.5,175% of CMS fee schedule,11.48,82% total billed charges,4.29,100% of CMS fee schedule,4.41,103% of CMS fee schedule,5.61,100% of AR fee schedule,19,100% of AR fee schedule,4.81,100% of BCBS fee schedule,4.81,100% of BCBS fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,5.61,100% of CIGNA fee schedule,4.29,100% of CMS fee schedule,8.3,100% of CMS fee schedule,4.29,100% of CMS fee schedule,9.8,70% of total billed charges,8.3,100% of CMS fee schedule,5.36,100% of CMS fee schedule,10.5,75% of total billed charges,4.29,100% of CMS fee schedule,11.9,85% of total billed charges,10.5,75% of total billed charges,4.29,100% of CMS fee schedule,3.78,27% of total billed charges,3.82,100% of OK fee schedule,3.67,100% of TX fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,8.4,60% of total billed charges,4.7,33.6% of total billed charges,12.73,227% of AR fee schedule,13.12,233.81% of AR fee schedule,12.73,227% of AR fee schedule,9.8,pays based on per visit rate,10.78,77% of total billed charges,9.1,65% of total billed charges,14,100% of total billed charges,14,100% of total billed charges,10.5,75% of total billed charges,0.46,100% of SHARP fee schedule,7,50% of total billed charges,19,100% of SPREEMO fee schedule,13.3,95% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,8.09,120% of UHC fee schedule,4.29,100% of CMS fee schedule,11.9,85% of total billed charges,4.29,100% of CMS fee schedule,0.46,19,10.50
Outpatient Medical Services,LAB,85651,SED RATE,300,71,7.47,175% of CMS fee schedule,58.22,82% total billed charges,4.26,100% of CMS fee schedule,4.39,103% of CMS fee schedule,5.07,100% of AR fee schedule,19,100% of AR fee schedule,4.49,100% of BCBS fee schedule,4.49,100% of BCBS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,5.59,100% of CIGNA fee schedule,4.26,100% of CMS fee schedule,7.5,100% of CMS fee schedule,4.26,100% of CMS fee schedule,49.7,70% of total billed charges,7.5,100% of CMS fee schedule,5.34,100% of CMS fee schedule,53.25,75% of total billed charges,4.27,100% of CMS fee schedule,60.35,85% of total billed charges,53.25,75% of total billed charges,4.26,100% of CMS fee schedule,19.17,27% of total billed charges,3.8,100% of OK fee schedule,3.59,100% of TX fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,42.6,60% of total billed charges,23.86,33.6% of total billed charges,11.51,227% of AR fee schedule,11.85,233.81% of AR fee schedule,11.51,227% of AR fee schedule,49.7,pays based on per visit rate,54.67,77% of total billed charges,46.15,65% of total billed charges,71,100% of total billed charges,71,100% of total billed charges,53.25,75% of total billed charges,0.45,100% of SHARP fee schedule,35.5,50% of total billed charges,19,100% of SPREEMO fee schedule,67.45,95% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,7.32,120% of UHC fee schedule,4.26,100% of CMS fee schedule,60.35,85% of total billed charges,4.26,100% of CMS fee schedule,0.45,71,53.25
Outpatient Medical Services,LAB,85651,SED RATE,300,73,7.47,175% of CMS fee schedule,59.86,82% total billed charges,4.26,100% of CMS fee schedule,4.39,103% of CMS fee schedule,5.07,100% of AR fee schedule,19,100% of AR fee schedule,4.49,100% of BCBS fee schedule,4.49,100% of BCBS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,5.59,100% of CIGNA fee schedule,4.26,100% of CMS fee schedule,7.5,100% of CMS fee schedule,4.26,100% of CMS fee schedule,51.1,70% of total billed charges,7.5,100% of CMS fee schedule,5.34,100% of CMS fee schedule,54.75,75% of total billed charges,4.27,100% of CMS fee schedule,62.05,85% of total billed charges,54.75,75% of total billed charges,4.26,100% of CMS fee schedule,19.71,27% of total billed charges,3.8,100% of OK fee schedule,3.59,100% of TX fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,43.8,60% of total billed charges,24.53,33.6% of total billed charges,11.51,227% of AR fee schedule,11.85,233.81% of AR fee schedule,11.51,227% of AR fee schedule,51.1,pays based on per visit rate,56.21,77% of total billed charges,47.45,65% of total billed charges,73,100% of total billed charges,73,100% of total billed charges,54.75,75% of total billed charges,0.45,100% of SHARP fee schedule,36.5,50% of total billed charges,19,100% of SPREEMO fee schedule,69.35,95% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,7.32,120% of UHC fee schedule,4.26,100% of CMS fee schedule,62.05,85% of total billed charges,4.26,100% of CMS fee schedule,0.45,73,54.75
Outpatient Medical Services,LAB,85730,PTT,300,21,10.51,175% of CMS fee schedule,17.22,82% total billed charges,6.01,100% of CMS fee schedule,6.19,103% of CMS fee schedule,8.58,100% of AR fee schedule,32,100% of AR fee schedule,7.34,100% of BCBS fee schedule,7.34,100% of BCBS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.86,100% of CIGNA fee schedule,6.01,100% of CMS fee schedule,12.68,100% of CMS fee schedule,6.01,100% of CMS fee schedule,14.7,70% of total billed charges,12.68,100% of CMS fee schedule,7.51,100% of CMS fee schedule,15.75,75% of total billed charges,6.01,100% of CMS fee schedule,17.85,85% of total billed charges,15.75,75% of total billed charges,6.01,100% of CMS fee schedule,5.67,27% of total billed charges,5.35,100% of OK fee schedule,5.6,100% of TX fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,12.6,60% of total billed charges,7.06,33.6% of total billed charges,19.48,227% of AR fee schedule,20.06,233.81% of AR fee schedule,19.48,227% of AR fee schedule,14.7,pays based on per visit rate,16.17,77% of total billed charges,13.65,65% of total billed charges,21,100% of total billed charges,21,100% of total billed charges,15.75,75% of total billed charges,0.7,100% of SHARP fee schedule,10.5,50% of total billed charges,32,100% of SPREEMO fee schedule,19.95,95% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,12.38,120% of UHC fee schedule,6.01,100% of CMS fee schedule,17.85,85% of total billed charges,6.01,100% of CMS fee schedule,0.7,32,15.75
Outpatient Medical Services,LAB,85730,PTT,300,21,10.51,175% of CMS fee schedule,17.22,82% total billed charges,6.01,100% of CMS fee schedule,6.19,103% of CMS fee schedule,8.58,100% of AR fee schedule,32,100% of AR fee schedule,7.34,100% of BCBS fee schedule,7.34,100% of BCBS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.86,100% of CIGNA fee schedule,6.01,100% of CMS fee schedule,12.68,100% of CMS fee schedule,6.01,100% of CMS fee schedule,14.7,70% of total billed charges,12.68,100% of CMS fee schedule,7.51,100% of CMS fee schedule,15.75,75% of total billed charges,6.01,100% of CMS fee schedule,17.85,85% of total billed charges,15.75,75% of total billed charges,6.01,100% of CMS fee schedule,5.67,27% of total billed charges,5.35,100% of OK fee schedule,5.6,100% of TX fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,12.6,60% of total billed charges,7.06,33.6% of total billed charges,19.48,227% of AR fee schedule,20.06,233.81% of AR fee schedule,19.48,227% of AR fee schedule,14.7,pays based on per visit rate,16.17,77% of total billed charges,13.65,65% of total billed charges,21,100% of total billed charges,21,100% of total billed charges,15.75,75% of total billed charges,0.7,100% of SHARP fee schedule,10.5,50% of total billed charges,32,100% of SPREEMO fee schedule,19.95,95% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,12.38,120% of UHC fee schedule,6.01,100% of CMS fee schedule,17.85,85% of total billed charges,6.01,100% of CMS fee schedule,0.7,32,15.75
Outpatient Medical Services,LAB,85730,PTT,300,42,10.51,175% of CMS fee schedule,34.44,82% total billed charges,6.01,100% of CMS fee schedule,6.19,103% of CMS fee schedule,8.58,100% of AR fee schedule,32,100% of AR fee schedule,7.34,100% of BCBS fee schedule,7.34,100% of BCBS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.86,100% of CIGNA fee schedule,6.01,100% of CMS fee schedule,12.68,100% of CMS fee schedule,6.01,100% of CMS fee schedule,29.4,70% of total billed charges,12.68,100% of CMS fee schedule,7.51,100% of CMS fee schedule,31.5,75% of total billed charges,6.01,100% of CMS fee schedule,35.7,85% of total billed charges,31.5,75% of total billed charges,6.01,100% of CMS fee schedule,11.34,27% of total billed charges,5.35,100% of OK fee schedule,5.6,100% of TX fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,25.2,60% of total billed charges,14.11,33.6% of total billed charges,19.48,227% of AR fee schedule,20.06,233.81% of AR fee schedule,19.48,227% of AR fee schedule,29.4,pays based on per visit rate,32.34,77% of total billed charges,27.3,65% of total billed charges,42,100% of total billed charges,42,100% of total billed charges,31.5,75% of total billed charges,0.7,100% of SHARP fee schedule,21,50% of total billed charges,32,100% of SPREEMO fee schedule,39.9,95% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,12.38,120% of UHC fee schedule,6.01,100% of CMS fee schedule,35.7,85% of total billed charges,6.01,100% of CMS fee schedule,0.7,42,31.50
Outpatient Medical Services,LAB,86003,SOUTHEASTERN RAST (1 OF 3 BUNDLE),300,21,9.13,175% of CMS fee schedule,17.22,82% total billed charges,5.22,100% of CMS fee schedule,5.37,103% of CMS fee schedule,7.46,100% of AR fee schedule,7.04,33.54% of total billed charges,6.38,100% of BCBS fee schedule,6.38,100% of BCBS fee schedule,5.22,100% of CMS fee schedule,5.22,100% of CMS fee schedule,6.81,100% of CIGNA fee schedule,5.22,100% of CMS fee schedule,11.01,100% of CMS fee schedule,5.22,100% of CMS fee schedule,14.7,70% of total billed charges,11.01,100% of CMS fee schedule,6.53,100% of CMS fee schedule,15.75,75% of total billed charges,5.22,100% of CMS fee schedule,17.85,85% of total billed charges,15.75,75% of total billed charges,5.22,100% of CMS fee schedule,5.67,27% of total billed charges,4.64,100% of OK fee schedule,4.87,100% of TX fee schedule,5.22,100% of CMS fee schedule,5.22,100% of CMS fee schedule,5.22,100% of CMS fee schedule,12.6,60% of total billed charges,7.06,33.6% of total billed charges,16.93,227% of AR fee schedule,17.44,233.81% of AR fee schedule,16.93,227% of AR fee schedule,14.7,pays based on per visit rate,16.17,77% of total billed charges,13.65,65% of total billed charges,21,100% of total billed charges,21,100% of total billed charges,15.75,75% of total billed charges,0.61,100% of SHARP fee schedule,10.5,50% of total billed charges,7.04,33.54% of total billed charges,19.95,95% of total billed charges,5.22,100% of CMS fee schedule,5.22,100% of CMS fee schedule,10.75,120% of UHC fee schedule,5.22,100% of CMS fee schedule,17.85,85% of total billed charges,5.22,100% of CMS fee schedule,0.61,21,15.75
Outpatient Medical Services,LAB,86039,ANA TITER,300,86,19.53,175% of CMS fee schedule,70.52,82% total billed charges,11.16,100% of CMS fee schedule,11.49,103% of CMS fee schedule,15.94,100% of AR fee schedule,28.84,33.54% of total billed charges,13.64,100% of BCBS fee schedule,13.64,100% of BCBS fee schedule,11.16,100% of CMS fee schedule,11.16,100% of CMS fee schedule,14.57,100% of CIGNA fee schedule,11.16,100% of CMS fee schedule,23.57,100% of CMS fee schedule,11.16,100% of CMS fee schedule,60.2,70% of total billed charges,23.57,100% of CMS fee schedule,13.95,100% of CMS fee schedule,64.5,75% of total billed charges,11.16,100% of CMS fee schedule,73.1,85% of total billed charges,64.5,75% of total billed charges,11.16,100% of CMS fee schedule,23.22,27% of total billed charges,9.93,100% of OK fee schedule,10.42,100% of TX fee schedule,11.16,100% of CMS fee schedule,11.16,100% of CMS fee schedule,11.16,100% of CMS fee schedule,51.6,60% of total billed charges,28.9,33.6% of total billed charges,36.18,227% of AR fee schedule,37.27,233.81% of AR fee schedule,36.18,227% of AR fee schedule,60.2,pays based on per visit rate,66.22,77% of total billed charges,55.9,65% of total billed charges,86,100% of total billed charges,86,100% of total billed charges,64.5,75% of total billed charges,1.3,100% of SHARP fee schedule,43,50% of total billed charges,28.84,33.54% of total billed charges,81.7,95% of total billed charges,11.16,100% of CMS fee schedule,11.16,100% of CMS fee schedule,23.03,120% of UHC fee schedule,11.16,100% of CMS fee schedule,73.1,85% of total billed charges,11.16,100% of CMS fee schedule,1.3,86,64.50
Outpatient Medical Services,LAB,86140,CRP,300,118,9.06,175% of CMS fee schedule,96.76,82% total billed charges,5.18,100% of CMS fee schedule,5.33,103% of CMS fee schedule,7.39,100% of AR fee schedule,39.58,33.54% of total billed charges,6.33,100% of BCBS fee schedule,6.33,100% of BCBS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,6.77,100% of CIGNA fee schedule,5.18,100% of CMS fee schedule,10.92,100% of CMS fee schedule,5.18,100% of CMS fee schedule,82.6,70% of total billed charges,10.92,100% of CMS fee schedule,6.48,100% of CMS fee schedule,88.5,75% of total billed charges,5.18,100% of CMS fee schedule,100.3,85% of total billed charges,88.5,75% of total billed charges,5.18,100% of CMS fee schedule,31.86,27% of total billed charges,4.61,100% of OK fee schedule,4.83,100% of TX fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,70.8,60% of total billed charges,39.65,33.6% of total billed charges,16.78,227% of AR fee schedule,17.28,233.81% of AR fee schedule,16.78,227% of AR fee schedule,82.6,pays based on per visit rate,90.86,77% of total billed charges,76.7,65% of total billed charges,118,100% of total billed charges,118,100% of total billed charges,88.5,75% of total billed charges,0.6,100% of SHARP fee schedule,59,50% of total billed charges,39.58,33.54% of total billed charges,112.1,95% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,10.67,120% of UHC fee schedule,5.18,100% of CMS fee schedule,100.3,85% of total billed charges,5.18,100% of CMS fee schedule,0.6,118,88.50
Outpatient Medical Services,LAB,86140,CRP,300,119,9.06,175% of CMS fee schedule,97.58,82% total billed charges,5.18,100% of CMS fee schedule,5.33,103% of CMS fee schedule,7.39,100% of AR fee schedule,39.91,33.54% of total billed charges,6.33,100% of BCBS fee schedule,6.33,100% of BCBS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,6.77,100% of CIGNA fee schedule,5.18,100% of CMS fee schedule,10.92,100% of CMS fee schedule,5.18,100% of CMS fee schedule,83.3,70% of total billed charges,10.92,100% of CMS fee schedule,6.48,100% of CMS fee schedule,89.25,75% of total billed charges,5.18,100% of CMS fee schedule,101.15,85% of total billed charges,89.25,75% of total billed charges,5.18,100% of CMS fee schedule,32.13,27% of total billed charges,4.61,100% of OK fee schedule,4.83,100% of TX fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,71.4,60% of total billed charges,39.98,33.6% of total billed charges,16.78,227% of AR fee schedule,17.28,233.81% of AR fee schedule,16.78,227% of AR fee schedule,83.3,pays based on per visit rate,91.63,77% of total billed charges,77.35,65% of total billed charges,119,100% of total billed charges,119,100% of total billed charges,89.25,75% of total billed charges,0.6,100% of SHARP fee schedule,59.5,50% of total billed charges,39.91,33.54% of total billed charges,113.05,95% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,10.67,120% of UHC fee schedule,5.18,100% of CMS fee schedule,101.15,85% of total billed charges,5.18,100% of CMS fee schedule,0.6,119,89.25
Outpatient Medical Services,LAB,86430,RA TEST,300,114,10.74,175% of CMS fee schedule,93.48,82% total billed charges,6.14,100% of CMS fee schedule,6.32,103% of CMS fee schedule,8.11,100% of AR fee schedule,21,100% of AR fee schedule,6.93,100% of BCBS fee schedule,6.93,100% of BCBS fee schedule,6.14,100% of CMS fee schedule,6.14,100% of CMS fee schedule,8.02,100% of CIGNA fee schedule,6.14,100% of CMS fee schedule,11.97,100% of CMS fee schedule,6.14,100% of CMS fee schedule,79.8,70% of total billed charges,11.97,100% of CMS fee schedule,7.68,100% of CMS fee schedule,85.5,75% of total billed charges,6.14,100% of CMS fee schedule,96.9,85% of total billed charges,85.5,75% of total billed charges,6.14,100% of CMS fee schedule,30.78,27% of total billed charges,5.46,100% of OK fee schedule,5.29,100% of TX fee schedule,6.14,100% of CMS fee schedule,6.14,100% of CMS fee schedule,6.14,100% of CMS fee schedule,68.4,60% of total billed charges,38.3,33.6% of total billed charges,18.41,227% of AR fee schedule,18.96,233.81% of AR fee schedule,18.41,227% of AR fee schedule,79.8,pays based on per visit rate,87.78,77% of total billed charges,74.1,65% of total billed charges,114,100% of total billed charges,114,100% of total billed charges,85.5,75% of total billed charges,0.66,100% of SHARP fee schedule,57,50% of total billed charges,21,100% of SPREEMO fee schedule,108.3,95% of total billed charges,6.14,100% of CMS fee schedule,6.14,100% of CMS fee schedule,11.71,120% of UHC fee schedule,6.14,100% of CMS fee schedule,96.9,85% of total billed charges,6.14,100% of CMS fee schedule,0.66,114,85.50
Outpatient Medical Services,LAB,86592,RPR ROUTINE,300,16,7.47,175% of CMS fee schedule,13.12,82% total billed charges,4.26,100% of CMS fee schedule,4.39,103% of CMS fee schedule,6.1,100% of AR fee schedule,5.37,33.54% of total billed charges,5.23,100% of BCBS fee schedule,5.23,100% of BCBS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,5.59,100% of CIGNA fee schedule,4.26,100% of CMS fee schedule,9.02,100% of CMS fee schedule,4.26,100% of CMS fee schedule,11.2,70% of total billed charges,9.02,100% of CMS fee schedule,5.34,100% of CMS fee schedule,12,75% of total billed charges,4.27,100% of CMS fee schedule,13.6,85% of total billed charges,12,75% of total billed charges,4.26,100% of CMS fee schedule,4.32,27% of total billed charges,3.8,100% of OK fee schedule,3.99,100% of TX fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,9.6,60% of total billed charges,5.38,33.6% of total billed charges,13.85,227% of AR fee schedule,14.26,233.81% of AR fee schedule,13.85,227% of AR fee schedule,11.2,pays based on per visit rate,12.32,77% of total billed charges,10.4,65% of total billed charges,16,100% of total billed charges,16,100% of total billed charges,12,75% of total billed charges,0.5,100% of SHARP fee schedule,8,50% of total billed charges,5.37,33.54% of total billed charges,15.2,95% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,8.8,120% of UHC fee schedule,4.26,100% of CMS fee schedule,13.6,85% of total billed charges,4.26,100% of CMS fee schedule,0.5,16,12.00
Outpatient Medical Services,LAB,86695,HERPES SIMPLEX VIRUS AB PANEL,300,94,23.08,175% of CMS fee schedule,77.08,82% total billed charges,13.19,100% of CMS fee schedule,13.58,103% of CMS fee schedule,13.55,100% of AR fee schedule,31.53,33.54% of total billed charges,16.12,100% of BCBS fee schedule,16.12,100% of BCBS fee schedule,13.19,100% of CMS fee schedule,13.19,100% of CMS fee schedule,17.23,100% of CIGNA fee schedule,13.19,100% of CMS fee schedule,20,100% of CMS fee schedule,13.19,100% of CMS fee schedule,65.8,70% of total billed charges,20,100% of CMS fee schedule,16.49,100% of CMS fee schedule,70.5,75% of total billed charges,13.19,100% of CMS fee schedule,79.9,85% of total billed charges,70.5,75% of total billed charges,13.19,100% of CMS fee schedule,25.38,27% of total billed charges,11.73,100% of OK fee schedule,12.31,100% of TX fee schedule,13.19,100% of CMS fee schedule,13.19,100% of CMS fee schedule,13.19,100% of CMS fee schedule,56.4,60% of total billed charges,31.58,33.6% of total billed charges,30.76,227% of AR fee schedule,31.68,233.81% of AR fee schedule,30.76,227% of AR fee schedule,65.8,pays based on per visit rate,72.38,77% of total billed charges,61.1,65% of total billed charges,94,100% of total billed charges,94,100% of total billed charges,70.5,75% of total billed charges,1.54,100% of SHARP fee schedule,47,50% of total billed charges,31.53,33.54% of total billed charges,89.3,95% of total billed charges,13.19,100% of CMS fee schedule,13.19,100% of CMS fee schedule,27.2,120% of UHC fee schedule,13.19,100% of CMS fee schedule,79.9,85% of total billed charges,13.19,100% of CMS fee schedule,1.54,94,70.50
Outpatient Medical Services,LAB,86696,HERPES SIMPLEX PANEL,300,137,33.86,175% of CMS fee schedule,112.34,82% total billed charges,19.35,100% of CMS fee schedule,19.93,103% of CMS fee schedule,27.64,100% of AR fee schedule,45.95,33.54% of total billed charges,23.66,100% of BCBS fee schedule,23.66,100% of BCBS fee schedule,19.35,100% of CMS fee schedule,19.35,100% of CMS fee schedule,25.29,100% of CIGNA fee schedule,19.35,100% of CMS fee schedule,40.85,100% of CMS fee schedule,19.35,100% of CMS fee schedule,95.9,70% of total billed charges,40.85,100% of CMS fee schedule,24.19,100% of CMS fee schedule,102.75,75% of total billed charges,19.35,100% of CMS fee schedule,116.45,85% of total billed charges,102.75,75% of total billed charges,19.35,100% of CMS fee schedule,36.99,27% of total billed charges,17.21,100% of OK fee schedule,18.07,100% of TX fee schedule,19.35,100% of CMS fee schedule,19.35,100% of CMS fee schedule,19.35,100% of CMS fee schedule,82.2,60% of total billed charges,46.03,33.6% of total billed charges,62.74,227% of AR fee schedule,64.63,233.81% of AR fee schedule,62.74,227% of AR fee schedule,95.9,pays based on per visit rate,105.49,77% of total billed charges,89.05,65% of total billed charges,137,100% of total billed charges,137,100% of total billed charges,102.75,75% of total billed charges,2.26,100% of SHARP fee schedule,68.5,50% of total billed charges,45.95,33.54% of total billed charges,130.15,95% of total billed charges,19.35,100% of CMS fee schedule,19.35,100% of CMS fee schedule,39.91,120% of UHC fee schedule,19.35,100% of CMS fee schedule,116.45,85% of total billed charges,19.35,100% of CMS fee schedule,2.26,137,102.75
Outpatient Medical Services,LAB,86703,HIV AB,300,49,23.99,175% of CMS fee schedule,40.18,82% total billed charges,13.71,100% of CMS fee schedule,14.12,103% of CMS fee schedule,19.59,100% of AR fee schedule,16.43,33.54% of total billed charges,16.75,100% of BCBS fee schedule,16.75,100% of BCBS fee schedule,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,17.91,100% of CIGNA fee schedule,13.71,100% of CMS fee schedule,28.95,100% of CMS fee schedule,13.71,100% of CMS fee schedule,34.3,70% of total billed charges,28.95,100% of CMS fee schedule,17.14,100% of CMS fee schedule,36.75,75% of total billed charges,13.71,100% of CMS fee schedule,41.65,85% of total billed charges,36.75,75% of total billed charges,13.71,100% of CMS fee schedule,13.23,27% of total billed charges,7.91,100% of OK fee schedule,12.79,100% of TX fee schedule,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,29.4,60% of total billed charges,16.46,33.6% of total billed charges,44.47,227% of AR fee schedule,45.8,233.81% of AR fee schedule,44.47,227% of AR fee schedule,34.3,pays based on per visit rate,37.73,77% of total billed charges,31.85,65% of total billed charges,49,100% of total billed charges,49,100% of total billed charges,36.75,75% of total billed charges,1.6,100% of SHARP fee schedule,24.5,50% of total billed charges,16.43,33.54% of total billed charges,46.55,95% of total billed charges,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,28.3,120% of UHC fee schedule,13.71,100% of CMS fee schedule,41.65,85% of total billed charges,13.71,100% of CMS fee schedule,1.6,49,36.75
Outpatient Medical Services,LAB,86756,RESP SYNTICAL VIRUS,300,43,27.8,175% of CMS fee schedule,35.26,82% total billed charges,15.89,100% of CMS fee schedule,16.36,103% of CMS fee schedule,18.4,100% of AR fee schedule,14.42,33.54% of total billed charges,16.29,100% of BCBS fee schedule,16.29,100% of BCBS fee schedule,15.89,100% of CMS fee schedule,15.89,100% of CMS fee schedule,20.76,100% of CIGNA fee schedule,15.89,100% of CMS fee schedule,27.21,100% of CMS fee schedule,15.89,100% of CMS fee schedule,30.1,70% of total billed charges,27.21,100% of CMS fee schedule,19.86,100% of CMS fee schedule,32.25,75% of total billed charges,15.89,100% of CMS fee schedule,36.55,85% of total billed charges,32.25,75% of total billed charges,15.89,100% of CMS fee schedule,11.61,27% of total billed charges,14.13,100% of OK fee schedule,13.35,100% of TX fee schedule,15.89,100% of CMS fee schedule,15.89,100% of CMS fee schedule,15.89,100% of CMS fee schedule,25.8,60% of total billed charges,14.45,33.6% of total billed charges,41.77,227% of AR fee schedule,43.02,233.81% of AR fee schedule,41.77,227% of AR fee schedule,30.1,pays based on per visit rate,33.11,77% of total billed charges,27.95,65% of total billed charges,43,100% of total billed charges,43,100% of total billed charges,32.25,75% of total billed charges,1.67,100% of SHARP fee schedule,21.5,50% of total billed charges,14.42,33.54% of total billed charges,40.85,95% of total billed charges,15.89,100% of CMS fee schedule,15.89,100% of CMS fee schedule,26.58,120% of UHC fee schedule,15.89,100% of CMS fee schedule,36.55,85% of total billed charges,15.89,100% of CMS fee schedule,1.67,43.02,32.25
Outpatient Medical Services,LAB,87040,BLOOD CULTU,300,34,18.06,175% of CMS fee schedule,27.88,82% total billed charges,10.32,100% of CMS fee schedule,10.62,103% of CMS fee schedule,14.75,100% of AR fee schedule,47,100% of AR fee schedule,12.62,100% of BCBS fee schedule,12.62,100% of BCBS fee schedule,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,13.49,100% of CIGNA fee schedule,10.32,100% of CMS fee schedule,21.8,100% of CMS fee schedule,10.32,100% of CMS fee schedule,23.8,70% of total billed charges,21.8,100% of CMS fee schedule,12.9,100% of CMS fee schedule,25.5,75% of total billed charges,10.32,100% of CMS fee schedule,28.9,85% of total billed charges,25.5,75% of total billed charges,10.32,100% of CMS fee schedule,9.18,27% of total billed charges,9.18,100% of OK fee schedule,9.63,100% of TX fee schedule,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,20.4,60% of total billed charges,11.42,33.6% of total billed charges,33.48,227% of AR fee schedule,34.49,233.81% of AR fee schedule,33.48,227% of AR fee schedule,23.8,pays based on per visit rate,26.18,77% of total billed charges,22.1,65% of total billed charges,34,100% of total billed charges,34,100% of total billed charges,25.5,75% of total billed charges,1.2,100% of SHARP fee schedule,17,50% of total billed charges,47,100% of SPREEMO fee schedule,32.3,95% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,21.3,120% of UHC fee schedule,10.32,100% of CMS fee schedule,28.9,85% of total billed charges,10.32,100% of CMS fee schedule,1.2,47,25.50
Outpatient Medical Services,LAB,87045,STOOL CULTURE,300,67,16.52,175% of CMS fee schedule,54.94,82% total billed charges,9.44,100% of CMS fee schedule,9.72,103% of CMS fee schedule,13.47,100% of AR fee schedule,47,100% of AR fee schedule,11.54,100% of BCBS fee schedule,11.54,100% of BCBS fee schedule,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,12.34,100% of CIGNA fee schedule,9.44,100% of CMS fee schedule,19.92,100% of CMS fee schedule,9.44,100% of CMS fee schedule,46.9,70% of total billed charges,19.92,100% of CMS fee schedule,11.8,100% of CMS fee schedule,50.25,75% of total billed charges,9.44,100% of CMS fee schedule,56.95,85% of total billed charges,50.25,75% of total billed charges,9.44,100% of CMS fee schedule,18.09,27% of total billed charges,8.4,100% of OK fee schedule,8.81,100% of TX fee schedule,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,40.2,60% of total billed charges,22.51,33.6% of total billed charges,30.58,227% of AR fee schedule,31.49,233.81% of AR fee schedule,30.58,227% of AR fee schedule,46.9,pays based on per visit rate,51.59,77% of total billed charges,43.55,65% of total billed charges,67,100% of total billed charges,67,100% of total billed charges,50.25,75% of total billed charges,1.1,100% of SHARP fee schedule,33.5,50% of total billed charges,47,100% of SPREEMO fee schedule,63.65,95% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,19.45,120% of UHC fee schedule,9.44,100% of CMS fee schedule,56.95,85% of total billed charges,9.44,100% of CMS fee schedule,1.1,67,50.25
Outpatient Medical Services,LAB,87070,CULTURE AEROBIC,300,59,15.08,175% of CMS fee schedule,48.38,82% total billed charges,8.61,100% of CMS fee schedule,8.87,103% of CMS fee schedule,12.3,100% of AR fee schedule,43.5,100% of AR fee schedule,10.53,100% of BCBS fee schedule,10.53,100% of BCBS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,11.26,100% of CIGNA fee schedule,8.61,100% of CMS fee schedule,18.18,100% of CMS fee schedule,8.61,100% of CMS fee schedule,41.3,70% of total billed charges,18.18,100% of CMS fee schedule,10.78,100% of CMS fee schedule,44.25,75% of total billed charges,8.62,100% of CMS fee schedule,50.15,85% of total billed charges,44.25,75% of total billed charges,8.61,100% of CMS fee schedule,15.93,27% of total billed charges,7.67,100% of OK fee schedule,8.04,100% of TX fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,35.4,60% of total billed charges,19.82,33.6% of total billed charges,27.92,227% of AR fee schedule,28.76,233.81% of AR fee schedule,27.92,227% of AR fee schedule,41.3,pays based on per visit rate,45.43,77% of total billed charges,38.35,65% of total billed charges,59,100% of total billed charges,59,100% of total billed charges,44.25,75% of total billed charges,1,100% of SHARP fee schedule,29.5,50% of total billed charges,43.5,100% of SPREEMO fee schedule,56.05,95% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,17.77,120% of UHC fee schedule,8.61,100% of CMS fee schedule,50.15,85% of total billed charges,8.61,100% of CMS fee schedule,1,59,44.25
Outpatient Medical Services,LAB,87070,CULTURE AEROBIC,300,59,15.08,175% of CMS fee schedule,48.38,82% total billed charges,8.61,100% of CMS fee schedule,8.87,103% of CMS fee schedule,12.3,100% of AR fee schedule,43.5,100% of AR fee schedule,10.53,100% of BCBS fee schedule,10.53,100% of BCBS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,11.26,100% of CIGNA fee schedule,8.61,100% of CMS fee schedule,18.18,100% of CMS fee schedule,8.61,100% of CMS fee schedule,41.3,70% of total billed charges,18.18,100% of CMS fee schedule,10.78,100% of CMS fee schedule,44.25,75% of total billed charges,8.62,100% of CMS fee schedule,50.15,85% of total billed charges,44.25,75% of total billed charges,8.61,100% of CMS fee schedule,15.93,27% of total billed charges,7.67,100% of OK fee schedule,8.04,100% of TX fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,35.4,60% of total billed charges,19.82,33.6% of total billed charges,27.92,227% of AR fee schedule,28.76,233.81% of AR fee schedule,27.92,227% of AR fee schedule,41.3,pays based on per visit rate,45.43,77% of total billed charges,38.35,65% of total billed charges,59,100% of total billed charges,59,100% of total billed charges,44.25,75% of total billed charges,1,100% of SHARP fee schedule,29.5,50% of total billed charges,43.5,100% of SPREEMO fee schedule,56.05,95% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,17.77,120% of UHC fee schedule,8.61,100% of CMS fee schedule,50.15,85% of total billed charges,8.61,100% of CMS fee schedule,1,59,44.25
Outpatient Medical Services,LAB,87077,ORGANISM ID,300,55,14.14,175% of CMS fee schedule,45.1,82% total billed charges,8.08,100% of CMS fee schedule,8.32,103% of CMS fee schedule,11.53,100% of AR fee schedule,18.45,33.54% of total billed charges,9.87,100% of BCBS fee schedule,9.87,100% of BCBS fee schedule,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,10.55,100% of CIGNA fee schedule,8.08,100% of CMS fee schedule,17.06,100% of CMS fee schedule,8.08,100% of CMS fee schedule,38.5,70% of total billed charges,17.06,100% of CMS fee schedule,10.1,100% of CMS fee schedule,41.25,75% of total billed charges,8.08,100% of CMS fee schedule,46.75,85% of total billed charges,41.25,75% of total billed charges,8.08,100% of CMS fee schedule,14.85,27% of total billed charges,7.19,100% of OK fee schedule,7.53,100% of TX fee schedule,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,33,60% of total billed charges,18.48,33.6% of total billed charges,26.17,227% of AR fee schedule,26.96,233.81% of AR fee schedule,26.17,227% of AR fee schedule,38.5,pays based on per visit rate,42.35,77% of total billed charges,35.75,65% of total billed charges,55,100% of total billed charges,55,100% of total billed charges,41.25,75% of total billed charges,0.94,100% of SHARP fee schedule,27.5,50% of total billed charges,18.45,33.54% of total billed charges,52.25,95% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,16.66,120% of UHC fee schedule,8.08,100% of CMS fee schedule,46.75,85% of total billed charges,8.08,100% of CMS fee schedule,0.94,55,41.25
Outpatient Medical Services,LAB,87088,URINE CULTURE,300,56,14.15,175% of CMS fee schedule,45.92,82% total billed charges,8.09,100% of CMS fee schedule,8.33,103% of CMS fee schedule,11.55,100% of AR fee schedule,18.78,33.54% of total billed charges,9.89,100% of BCBS fee schedule,9.89,100% of BCBS fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,10.57,100% of CIGNA fee schedule,8.09,100% of CMS fee schedule,17.1,100% of CMS fee schedule,8.09,100% of CMS fee schedule,39.2,70% of total billed charges,17.1,100% of CMS fee schedule,10.11,100% of CMS fee schedule,42,75% of total billed charges,8.09,100% of CMS fee schedule,47.6,85% of total billed charges,42,75% of total billed charges,8.09,100% of CMS fee schedule,15.12,27% of total billed charges,7.2,100% of OK fee schedule,7.55,100% of TX fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,33.6,60% of total billed charges,18.82,33.6% of total billed charges,26.22,227% of AR fee schedule,27.01,233.81% of AR fee schedule,26.22,227% of AR fee schedule,39.2,pays based on per visit rate,43.12,77% of total billed charges,36.4,65% of total billed charges,56,100% of total billed charges,56,100% of total billed charges,42,75% of total billed charges,0.94,100% of SHARP fee schedule,28,50% of total billed charges,18.78,33.54% of total billed charges,53.2,95% of total billed charges,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,16.7,120% of UHC fee schedule,8.09,100% of CMS fee schedule,47.6,85% of total billed charges,8.09,100% of CMS fee schedule,0.94,56,42.00
Outpatient Medical Services,LAB,87088,URINE CULTURE,300,56,14.15,175% of CMS fee schedule,45.92,82% total billed charges,8.09,100% of CMS fee schedule,8.33,103% of CMS fee schedule,11.55,100% of AR fee schedule,18.78,33.54% of total billed charges,9.89,100% of BCBS fee schedule,9.89,100% of BCBS fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,10.57,100% of CIGNA fee schedule,8.09,100% of CMS fee schedule,17.1,100% of CMS fee schedule,8.09,100% of CMS fee schedule,39.2,70% of total billed charges,17.1,100% of CMS fee schedule,10.11,100% of CMS fee schedule,42,75% of total billed charges,8.09,100% of CMS fee schedule,47.6,85% of total billed charges,42,75% of total billed charges,8.09,100% of CMS fee schedule,15.12,27% of total billed charges,7.2,100% of OK fee schedule,7.55,100% of TX fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,33.6,60% of total billed charges,18.82,33.6% of total billed charges,26.22,227% of AR fee schedule,27.01,233.81% of AR fee schedule,26.22,227% of AR fee schedule,39.2,pays based on per visit rate,43.12,77% of total billed charges,36.4,65% of total billed charges,56,100% of total billed charges,56,100% of total billed charges,42,75% of total billed charges,0.94,100% of SHARP fee schedule,28,50% of total billed charges,18.78,33.54% of total billed charges,53.2,95% of total billed charges,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,16.7,120% of UHC fee schedule,8.09,100% of CMS fee schedule,47.6,85% of total billed charges,8.09,100% of CMS fee schedule,0.94,56,42.00
Outpatient Medical Services,LAB,87186,ORGANISM SENS,300,58,15.13,175% of CMS fee schedule,47.56,82% total billed charges,8.65,100% of CMS fee schedule,8.9,103% of CMS fee schedule,8.24,100% of AR fee schedule,19.45,33.54% of total billed charges,10.57,100% of BCBS fee schedule,10.57,100% of BCBS fee schedule,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,11.3,100% of CIGNA fee schedule,8.65,100% of CMS fee schedule,12.18,100% of CMS fee schedule,8.65,100% of CMS fee schedule,40.6,70% of total billed charges,12.18,100% of CMS fee schedule,10.81,100% of CMS fee schedule,43.5,75% of total billed charges,8.65,100% of CMS fee schedule,49.3,85% of total billed charges,43.5,75% of total billed charges,8.65,100% of CMS fee schedule,15.66,27% of total billed charges,7.69,100% of OK fee schedule,8.07,100% of TX fee schedule,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,34.8,60% of total billed charges,19.49,33.6% of total billed charges,18.7,227% of AR fee schedule,19.27,233.81% of AR fee schedule,18.7,227% of AR fee schedule,40.6,pays based on per visit rate,44.66,77% of total billed charges,37.7,65% of total billed charges,58,100% of total billed charges,58,100% of total billed charges,43.5,75% of total billed charges,1.01,100% of SHARP fee schedule,29,50% of total billed charges,19.45,33.54% of total billed charges,55.1,95% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,17.83,120% of UHC fee schedule,8.65,100% of CMS fee schedule,49.3,85% of total billed charges,8.65,100% of CMS fee schedule,1.01,58,43.50
Outpatient Medical Services,LAB,87400,INFLUENZAE,300,157,24.72,175% of CMS fee schedule,128.74,82% total billed charges,14.13,100% of CMS fee schedule,14.55,103% of CMS fee schedule,6.43,100% of AR fee schedule,52.66,33.54% of total billed charges,15.17,100% of BCBS fee schedule,15.17,100% of BCBS fee schedule,14.13,100% of CMS fee schedule,14.13,100% of CMS fee schedule,18.45,100% of CIGNA fee schedule,14.13,100% of CMS fee schedule,19.02,100% of CMS fee schedule,14.13,100% of CMS fee schedule,109.9,70% of total billed charges,19.02,100% of CMS fee schedule,17.66,100% of CMS fee schedule,117.75,75% of total billed charges,14.13,100% of CMS fee schedule,133.45,85% of total billed charges,117.75,75% of total billed charges,14.13,100% of CMS fee schedule,42.39,27% of total billed charges,12.57,100% of OK fee schedule,11.87,100% of TX fee schedule,14.13,100% of CMS fee schedule,14.13,100% of CMS fee schedule,14.13,100% of CMS fee schedule,94.2,60% of total billed charges,52.75,33.6% of total billed charges,14.6,227% of AR fee schedule,15.03,233.81% of AR fee schedule,14.6,227% of AR fee schedule,109.9,pays based on per visit rate,120.89,77% of total billed charges,102.05,65% of total billed charges,157,100% of total billed charges,157,100% of total billed charges,117.75,75% of total billed charges,1.48,100% of SHARP fee schedule,78.5,50% of total billed charges,52.66,33.54% of total billed charges,149.15,95% of total billed charges,14.13,100% of CMS fee schedule,14.13,100% of CMS fee schedule,24.74,120% of UHC fee schedule,14.13,100% of CMS fee schedule,133.45,85% of total billed charges,14.13,100% of CMS fee schedule,1.48,157,117.75
Outpatient Medical Services,LAB,87426,COVID ANTIGEN,300,114,61.82,175% of CMS fee schedule,45.23,pays based on per visit rate,35.33,100% of CMS fee schedule,36.38,103% of CMS fee schedule,45.23,100% of AR fee schedule,38.24,33.54% of total billed charges,45.23,100% of BCBS fee schedule,45.23,100% of BCBS fee schedule,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,46.15,100% of CIGNA fee schedule,N/A,not seperately reimbursable,74.1,65% of total billed charges,35.33,100% of CMS fee schedule,79.8,70% of total billed charges,85.5,75% of toal billed charges,45.24,100% of CMS fee schedule,85.5,75% of total billed charges,N/A,not seperately reimbursable,96.9,85% of total billed charges,85.5,75% of total billed charges,35.33,100% of CMS fee schedule,30.78,27% of total billed charges,N/A,not seperately reimbursable,26.22,23% of total billed charges,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,68.4,60% of total billed charges,38.3,33.6% of total billed charges,102.67,227% of AR fee schedule,105.75,233.81% of AR fee schedule,102.67,227% of AR fee schedule,79.8,pays based on per visit rate,87.78,77% of total billed charges,74.1,65% of total billed charges,114,100% of total billed charges,114,100% of total billed charges,85.5,75% of total billed charges,67.26,59% of total billed charges,57,50% of total billed charges,38.24,33.54% of total billed charges,108.3,95% of total billed charges,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,65.33,120% of UHC fee schedule,35.33,100% of CMS fee schedule,96.9,85% of total billed charges,35.33,100% of CMS fee schedule,26.22,114,85.50
Outpatient Medical Services,LAB,87490,GC/CHLAMY G,300,136,39.81,175% of CMS fee schedule,111.52,82% total billed charges,22.75,100% of CMS fee schedule,23.43,103% of CMS fee schedule,28.63,100% of AR fee schedule,45.61,33.54% of total billed charges,25.03,100% of BCBS fee schedule,25.03,100% of BCBS fee schedule,22.75,100% of CMS fee schedule,22.75,100% of CMS fee schedule,29.73,100% of CIGNA fee schedule,22.75,100% of CMS fee schedule,42.33,100% of CMS fee schedule,22.75,100% of CMS fee schedule,95.2,70% of total billed charges,42.33,100% of CMS fee schedule,28.44,100% of CMS fee schedule,102,75% of total billed charges,22.75,100% of CMS fee schedule,115.6,85% of total billed charges,102,75% of total billed charges,22.75,100% of CMS fee schedule,36.72,27% of total billed charges,20.24,100% of OK fee schedule,19.11,100% of TX fee schedule,22.75,100% of CMS fee schedule,22.75,100% of CMS fee schedule,22.75,100% of CMS fee schedule,81.6,60% of total billed charges,45.7,33.6% of total billed charges,64.99,227% of AR fee schedule,66.94,233.81% of AR fee schedule,64.99,227% of AR fee schedule,95.2,pays based on per visit rate,104.72,77% of total billed charges,88.4,65% of total billed charges,136,100% of total billed charges,136,100% of total billed charges,102,75% of total billed charges,2.39,100% of SHARP fee schedule,68,50% of total billed charges,45.61,33.54% of total billed charges,129.2,95% of total billed charges,22.75,100% of CMS fee schedule,22.75,100% of CMS fee schedule,41.35,120% of UHC fee schedule,22.75,100% of CMS fee schedule,115.6,85% of total billed charges,22.75,100% of CMS fee schedule,2.39,136,102.00
Outpatient Medical Services,LAB,87491,CHLAMYDIA/G,300,68,61.4,175% of CMS fee schedule,55.76,82% total billed charges,35.09,100% of CMS fee schedule,36.14,103% of CMS fee schedule,50.12,100% of AR fee schedule,22.81,33.54% of total billed charges,42.89,100% of BCBS fee schedule,42.89,100% of BCBS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,45.85,100% of CIGNA fee schedule,35.09,100% of CMS fee schedule,74.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,47.6,70% of total billed charges,74.09,100% of CMS fee schedule,43.86,100% of CMS fee schedule,51,75% of total billed charges,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,51,75% of total billed charges,35.09,100% of CMS fee schedule,18.36,27% of total billed charges,31.21,100% of OK fee schedule,32.75,100% of TX fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,40.8,60% of total billed charges,22.85,33.6% of total billed charges,113.77,227% of AR fee schedule,117.19,233.81% of AR fee schedule,113.77,227% of AR fee schedule,47.6,pays based on per visit rate,52.36,77% of total billed charges,44.2,65% of total billed charges,68,100% of total billed charges,68,100% of total billed charges,51,75% of total billed charges,3.41,100% of SHARP fee schedule,34,50% of total billed charges,22.81,33.54% of total billed charges,64.6,95% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,72.38,120% of UHC fee schedule,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,35.09,100% of CMS fee schedule,3.41,117.19,51.00
Outpatient Medical Services,LAB,87590,GC/CHLAMY G,300,136,47.04,175% of CMS fee schedule,111.52,82% total billed charges,26.88,100% of CMS fee schedule,27.68,103% of CMS fee schedule,28.63,100% of AR fee schedule,45.61,33.54% of total billed charges,27.55,100% of BCBS fee schedule,27.55,100% of BCBS fee schedule,26.88,100% of CMS fee schedule,26.88,100% of CMS fee schedule,35.11,100% of CIGNA fee schedule,26.88,100% of CMS fee schedule,42.33,100% of CMS fee schedule,26.88,100% of CMS fee schedule,95.2,70% of total billed charges,42.33,100% of CMS fee schedule,33.6,100% of CMS fee schedule,102,75% of total billed charges,26.88,100% of CMS fee schedule,115.6,85% of total billed charges,102,75% of total billed charges,26.88,100% of CMS fee schedule,36.72,27% of total billed charges,23.91,100% of OK fee schedule,22.58,100% of TX fee schedule,26.88,100% of CMS fee schedule,26.88,100% of CMS fee schedule,26.88,100% of CMS fee schedule,81.6,60% of total billed charges,45.7,33.6% of total billed charges,64.99,227% of AR fee schedule,66.94,233.81% of AR fee schedule,64.99,227% of AR fee schedule,95.2,pays based on per visit rate,104.72,77% of total billed charges,88.4,65% of total billed charges,136,100% of total billed charges,136,100% of total billed charges,102,75% of total billed charges,2.82,100% of SHARP fee schedule,68,50% of total billed charges,45.61,33.54% of total billed charges,129.2,95% of total billed charges,26.88,100% of CMS fee schedule,26.88,100% of CMS fee schedule,41.35,120% of UHC fee schedule,26.88,100% of CMS fee schedule,115.6,85% of total billed charges,26.88,100% of CMS fee schedule,2.82,136,102.00
Outpatient Medical Services,LAB,87591,CHLAMYDIA/G,300,68,61.4,175% of CMS fee schedule,55.76,82% total billed charges,35.09,100% of CMS fee schedule,36.14,103% of CMS fee schedule,50.12,100% of AR fee schedule,22.81,33.54% of total billed charges,42.89,100% of BCBS fee schedule,42.89,100% of BCBS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,45.85,100% of CIGNA fee schedule,35.09,100% of CMS fee schedule,74.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,47.6,70% of total billed charges,74.09,100% of CMS fee schedule,43.86,100% of CMS fee schedule,51,75% of total billed charges,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,51,75% of total billed charges,35.09,100% of CMS fee schedule,18.36,27% of total billed charges,31.21,100% of OK fee schedule,32.75,100% of TX fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,40.8,60% of total billed charges,22.85,33.6% of total billed charges,113.77,227% of AR fee schedule,117.19,233.81% of AR fee schedule,113.77,227% of AR fee schedule,47.6,pays based on per visit rate,52.36,77% of total billed charges,44.2,65% of total billed charges,68,100% of total billed charges,68,100% of total billed charges,51,75% of total billed charges,3.41,100% of SHARP fee schedule,34,50% of total billed charges,22.81,33.54% of total billed charges,64.6,95% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,72.38,120% of UHC fee schedule,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,35.09,100% of CMS fee schedule,3.41,117.19,51.00
Outpatient Medical Services,LAB,87661,TRICHOMONAS VAGINALIS,300,68,61.4,175% of CMS fee schedule,55.76,82% total billed charges,35.09,100% of CMS fee schedule,36.14,103% of CMS fee schedule,47.87,100% of AR fee schedule,22.81,33.54% of total billed charges,42.89,100% of BCBS fee schedule,42.89,100% of BCBS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,45.85,100% of CIGNA fee schedule,35.09,100% of CMS fee schedule,44.2,65% of total billed charges,35.09,100% of CMS fee schedule,47.6,70% of total billed charges,51,75% of toal billed charges,43.86,100% of CMS fee schedule,51,75% of total billed charges,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,51,75% of total billed charges,35.09,100% of CMS fee schedule,18.36,27% of total billed charges,31.21,100% of OK fee schedule,32.75,100% of TX fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,40.8,60% of total billed charges,22.85,33.6% of total billed charges,108.66,227% of AR fee schedule,111.92,233.81% of AR fee schedule,108.66,227% of AR fee schedule,47.6,pays based on per visit rate,52.36,77% of total billed charges,44.2,65% of total billed charges,68,100% of total billed charges,68,100% of total billed charges,51,75% of total billed charges,3.41,100% of SHARP fee schedule,34,50% of total billed charges,22.81,33.54% of total billed charges,64.6,95% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,68.93,120% of UHC fee schedule,35.09,100% of CMS fee schedule,57.8,85% of total billed charges,35.09,100% of CMS fee schedule,3.41,111.92,51.00
Outpatient Medical Services,LAB,87880,STREP SCREEN,300,40,28.92,175% of CMS fee schedule,32.8,82% total billed charges,16.53,100% of CMS fee schedule,17.02,103% of CMS fee schedule,12.87,100% of AR fee schedule,13.42,33.54% of total billed charges,16.94,100% of BCBS fee schedule,16.94,100% of BCBS fee schedule,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,21.59,100% of CIGNA fee schedule,16.53,100% of CMS fee schedule,19.02,100% of CMS fee schedule,16.53,100% of CMS fee schedule,28,70% of total billed charges,19.02,100% of CMS fee schedule,20.66,100% of CMS fee schedule,30,75% of total billed charges,16.53,100% of CMS fee schedule,34,85% of total billed charges,30,75% of total billed charges,16.53,100% of CMS fee schedule,10.8,27% of total billed charges,14.7,100% of OK fee schedule,13.89,100% of TX fee schedule,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,24,60% of total billed charges,13.44,33.6% of total billed charges,29.21,227% of AR fee schedule,30.09,233.81% of AR fee schedule,29.21,227% of AR fee schedule,28,pays based on per visit rate,30.8,77% of total billed charges,26,65% of total billed charges,40,100% of total billed charges,40,100% of total billed charges,30,75% of total billed charges,2.02,100% of SHARP fee schedule,20,50% of total billed charges,13.42,33.54% of total billed charges,38,95% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,24.74,120% of UHC fee schedule,16.53,100% of CMS fee schedule,34,85% of total billed charges,16.53,100% of CMS fee schedule,2.02,40,30.00
Outpatient Medical Services,LAB,G0103,PSA SCREENING,300,40,33.79,175% of CMS fee schedule,32.8,82% total billed charges,19.3,100% of CMS fee schedule,19.88,103% of CMS fee schedule,N/A,not seperately reimbursable,13.42,33.54% of total billed charges,22.48,100% of BCBS fee schedule,22.48,100% of BCBS fee schedule,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,25.23,100% of CIGNA fee schedule,19.3,100% of CMS fee schedule,38.84,100% of CMS fee schedule,19.3,100% of CMS fee schedule,28,70% of total billed charges,38.84,100% of CMS fee schedule,24.14,100% of CMS fee schedule,30,75% of total billed charges,19.31,100% of CMS fee schedule,34,85% of total billed charges,30,75% of total billed charges,19.3,100% of CMS fee schedule,10.8,27% of total billed charges,N/A,not seperately reimbursable,9.2,23% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,24,60% of total billed charges,13.44,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28,pays based on per visit rate,30.8,77% of total billed charges,26,65% of total billed charges,40,100% of total billed charges,40,100% of total billed charges,30,75% of total billed charges,2.15,100% of SHARP fee schedule,20,50% of total billed charges,13.42,33.54% of total billed charges,38,95% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,37.93,120% of UHC fee schedule,19.3,100% of CMS fee schedule,34,85% of total billed charges,19.3,100% of CMS fee schedule,2.15,40,30.00
Outpatient Medical Services,LAB,94640,JET NEB SUBSEQUENT,410,169,330.64,175% of CMS APC rate,135.2,pays based on per visit rate,188.94,100% of CMS APC rate,194.6,103% of CMS APC rate,6,100% of AR fee schedule,56.68,33.54% of total billed charges,169.81,100% of BCBS fee schedule,169.81,100% of BCBS fee schedule,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,149.74,pays based on per visit rate,15.37,100% of CMS fee schedule,109.85,65% of total billed charges,188.94,100% of CMS APC rate,118.3,70% of total billed charges,126.75,75% of toal billed charges,355.64,100% of CMS fee schedule,126.75,75% of total billed charges,126.75,75% of total billed charges,143.65,85% of total billed charges,126.75,75% of total billed charges,188.94,100% of CMS APC rate,45.63,27% of total billed charges,N/A,not seperately reimbursable,38.87,23% of total billed charges,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,101.4,60% of total billed charges,56.78,33.6% of total billed charges,13.62,227% of AR fee schedule,14.03,233.81% of AR fee schedule,13.62,227% of AR fee schedule,118.3,70% of total billed charges,130.13,77% of total billed charges,109.85,65% of total billed charges,169,100% of total billed charges,169,100% of total billed charges,126.75,75% of total billed charges,12.35,100% of SHARP fee schedule,84.5,50% of total billed charges,56.68,33.54% of total billed charges,160.55,95% of total billed charges,188.94,100% of CMS APC rate,188.94,100% of CMS APC rate,163,pays based on per day visit,188.94,100% of CMS APC rate,143.65,85% of total billed charges,188.94,100% of CMS apc rate,6,355.64,126.75
Outpatient Medical Services,LAB,94760,O2 SAT CHECK,460,14,N/A,not seperately reimbursable,11.2,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.7,33.54% of total billed charges,2.05,pays based on per visit rate,2.05,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.4,60% of total billed charges,2.04,100% of CMS fee schedule,9.1,65% of total billed charges,N/A,not seperately reimbursable,9.8,70% of total billed charges,10.5,75% of toal billed charges,3.64,100% of CMS fee schedule,10.5,75% of total billed charges,10.5,75% of total billed charges,11.9,85% of total billed charges,10.5,75% of total billed charges,N/A,not seperately reimbursable,3.78,27% of total billed charges,N/A,not seperately reimbursable,3.22,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.4,60% of total billed charges,4.7,33.6% of total billed charges,63.56,227% of AR fee schedule,65.47,233.81% of AR fee schedule,63.56,227% of AR fee schedule,9.8,70% of total billed charges,10.78,77% of total billed charges,9.1,65% of total billed charges,14,100% of total billed charges,14,100% of total billed charges,10.5,75% of total billed charges,N/A,not seperately reimbursable,7,50% of total billed charges,4.7,33.54% of total billed charges,13.3,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,197,pays based on per day visit,N/A,not seperately reimbursable,11.9,85% of total billed charges,N/A,not seperately reimbursable,2.04,197,10.50
Outpatient Medical Services,LAB,J2270,MORPHINE 2 MG INJECTION,636,7,N/A,not seperately reimbursable,5.44,122% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.12,100% of AR fee schedule,2.35,33.54% of total billed charges,5.23,100% of BCBS fee schedule,5.23,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.6,100% of CIGNA fee schedule,N/A,not seperately reimbursable,4.55,65% of total billed charges,N/A,not seperately reimbursable,4.9,70% of total billed charges,3.12,106% of CMS fee schedule,5.52,100% of CMS fee schedule,5.25,75% of total billed charges,5.25,75% of total billed charges,5.95,85% of total billed charges,5.25,75% of total billed charges,N/A,not seperately reimbursable,1.89,27% of total billed charges,N/A,not seperately reimbursable,1.61,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.53,60% of total billed charges,2.35,33.6% of total billed charges,4.81,227% of AR fee schedule,4.96,233.81% of AR fee schedule,4.81,227% of AR fee schedule,4.9,70% of total billed charges,5.39,77% of total billed charges,4.55,65% of total billed charges,7,100% of total billed charges,7,100% of total billed charges,5.25,75% of total billed charges,N/A,not seperately reimbursable,3.5,50% of total billed charges,2.35,33.54% of total billed charges,6.65,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.95,85% of total billed charges,N/A,not seperately reimbursable,0.53,7,5.25
Outpatient Medical Services,LAB,J2765,METOCLOPRAMIDE (REGLAN) 10MG/2ML VlAL,636,5,N/A,not seperately reimbursable,2.59,122% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.95,100% of AR fee schedule,1.68,33.54% of total billed charges,1.18,100% of BCBS fee schedule,1.18,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.32,100% of CIGNA fee schedule,N/A,not seperately reimbursable,3.25,65% of total billed charges,N/A,not seperately reimbursable,3.5,70% of total billed charges,1.1,106% of CMS fee schedule,1.13,100% of CMS fee schedule,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.38,60% of total billed charges,1.68,33.6% of total billed charges,8.97,227% of AR fee schedule,9.24,233.81% of AR fee schedule,8.97,227% of AR fee schedule,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.25,85% of total billed charges,N/A,not seperately reimbursable,0.38,9.24,3.75
Outpatient Medical Services,LAB,Q9967,CONTRAST OPTI 350,636,2,N/A,not seperately reimbursable,0.15,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.67,33.54% of total billed charges,0.17,100% of BCBS fee schedule,0.17,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.3,65% of total billed charges,N/A,not seperately reimbursable,1.4,70% of total billed charges,0.13,106% of CMS fee schedule,0.16,100% of CMS fee schedule,1.5,75% of total billed charges,1.5,75% of total billed charges,1.7,85% of total billed charges,1.5,75% of total billed charges,N/A,not seperately reimbursable,0.54,27% of total billed charges,N/A,not seperately reimbursable,0.46,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.15,60% of total billed charges,0.67,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.4,70% of total billed charges,1.54,77% of total billed charges,1.3,65% of total billed charges,2,100% of total billed charges,2,100% of total billed charges,1.5,75% of total billed charges,N/A,not seperately reimbursable,1,50% of total billed charges,0.67,33.54% of total billed charges,1.9,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.7,85% of total billed charges,N/A,not seperately reimbursable,0.13,2,1.50
Outpatient Medical Services,LAB,63304,ATORVASTATIN (LIPITOR) 20 MG TABLET,637,5,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,4,pays based on per visit rate,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,N/A,not seperately reimbursable,1.68,33.54% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,3,60% of total billed charges,5,100% of CMS fee schedule,3.25,65% of total billed charges,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,3.5,70% of total billed charges,3.75,75% of toal billed charges,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,3,60% of total billed charges,1.68,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,N/A,not seperately reimbursable,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,4.25,85% of total billed charges,5,Pays at line item charges due to Status Indicator C on the CMS APC fee schedule,1.15,5,3.75
Outpatient Medical Services,LAB,80369,CYCLOBENZAPRINE (FLEXERIL) 10 MG TABLET,637,5,N/A,not seperately reimbursable,4,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.78,100% of AR fee schedule,1.68,33.54% of total billed charges,37.72,100% of BCBS fee schedule,37.72,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3,60% of total billed charges,N/A,not seperately reimbursable,3.25,65% of total billed charges,N/A,not seperately reimbursable,3.5,70% of total billed charges,3.75,75% of toal billed charges,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,1.35,27% of total billed charges,N/A,not seperately reimbursable,11.21,100% of TX fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3,60% of total billed charges,1.68,33.6% of total billed charges,65.33,227% of AR fee schedule,67.29,233.81% of AR fee schedule,65.33,227% of AR fee schedule,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,2.52,100% of SHARP fee schedule,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,34.54,120% of UHC fee schedule,N/A,not seperately reimbursable,4.25,85% of total billed charges,N/A,not seperately reimbursable,1.35,67.29,3.75
Outpatient Medical Services,LAB,J7614,LEVALBUTEROL(XOPENEX) 1.25mg/3mL SOLN,637,5,N/A,not seperately reimbursable,4.06,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.68,33.54% of total billed charges,0.1,100% of BCBS fee schedule,0.1,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.07,100% of CIGNA fee schedule,N/A,not seperately reimbursable,3.25,65% of total billed charges,N/A,not seperately reimbursable,3.5,70% of total billed charges,0.06,106% of CMS fee schedule,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3,60% of total billed charges,0.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.25,85% of total billed charges,N/A,not seperately reimbursable,0.06,5,3.75
Outpatient Medical Services,LAB,J1815,HUMULIN R INSULIN,637,5,N/A,not seperately reimbursable,4,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.23,100% of AR fee schedule,1.68,33.54% of total billed charges,1.09,100% of BCBS fee schedule,1.09,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.33,100% of CIGNA fee schedule,N/A,not seperately reimbursable,3.25,65% of total billed charges,N/A,not seperately reimbursable,3.5,70% of total billed charges,3.75,75% of toal billed charges,N/A,not seperately reimbursable,3.75,75% of total billed charges,3.75,75% of total billed charges,4.25,85% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,1.35,27% of total billed charges,N/A,not seperately reimbursable,1.15,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3,60% of total billed charges,1.68,33.6% of total billed charges,7.33,227% of AR fee schedule,7.55,233.81% of AR fee schedule,7.33,227% of AR fee schedule,3.5,70% of total billed charges,3.85,77% of total billed charges,3.25,65% of total billed charges,5,100% of total billed charges,5,100% of total billed charges,3.75,75% of total billed charges,N/A,not seperately reimbursable,2.5,50% of total billed charges,1.68,33.54% of total billed charges,4.75,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.25,85% of total billed charges,N/A,not seperately reimbursable,0.33,7.55,3.75
Outpatient Medical Services,RADIOLOGY,70540,"MRI ORBIT,HEAD NECK W/O CONTRA",610,722,392.96,175% of CMS APC rate,1373.15,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,242.16,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,433.2,60% of total billed charges,168.4,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,505.4,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,168.4,100% of CMS fee schedule,613.7,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,194.94,27% of total billed charges,224.9,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,242.59,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,505.4,70% of total billed charges,555.94,77% of CMS fee schedule,469.3,65% of total billed charges,722,100% of total billed charges,722,100% of total billed charges,541.5,75% of total billed charges,91.67,100% of SHARP fee schedule,361,50% of total billed charges,242.16,33.54% of total billed charges,685.9,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,613.7,85% of total billed charges,224.54,100% of CMS apc rate,91.67,2100,541.50
Outpatient Medical Services,RADIOLOGY,72195,MRI PELVIS W/O CONTRAST,610,1910,392.96,175% of CMS APC rate,1369.36,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,640.61,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1146,60% of total billed charges,167.47,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,1337,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,167.47,100% of CMS fee schedule,1623.5,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,515.7,27% of total billed charges,229.8,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,641.76,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1337,70% of total billed charges,1470.7,77% of CMS fee schedule,1241.5,65% of total billed charges,1910,100% of total billed charges,1910,100% of total billed charges,1432.5,75% of total billed charges,99.4,100% of SHARP fee schedule,955,50% of total billed charges,640.61,33.54% of total billed charges,1814.5,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,1623.5,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2100,1432.50
Outpatient Medical Services,RADIOLOGY,72197,MRI PELVIS W&WO CONTRAST,610,4476,580.57,175% of CMS APC rate,1481.31,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,1501.25,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2685.6,60% of total billed charges,244.35,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,3133.2,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,244.35,100% of CMS fee schedule,3804.6,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,1208.52,27% of total billed charges,337.43,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,1503.94,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,3133.2,70% of total billed charges,3446.52,77% of CMS fee schedule,2909.4,65% of total billed charges,4476,100% of total billed charges,4476,100% of total billed charges,3357,75% of total billed charges,149.45,100% of SHARP fee schedule,2238,50% of total billed charges,1501.25,33.54% of total billed charges,4252.2,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,3804.6,85% of total billed charges,331.76,100% of CMS apc rate,149.45,4476,3357.00
Outpatient Medical Services,RADIOLOGY,73218,MRI UP EXT NONJOINT W/O CONT R,610,870,392.96,175% of CMS APC rate,1488.9,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,291.8,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,522,60% of total billed charges,248.07,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,609,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,248.07,100% of CMS fee schedule,739.5,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,234.9,27% of total billed charges,256.04,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,292.32,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,609,70% of total billed charges,669.9,77% of CMS fee schedule,565.5,65% of total billed charges,870,100% of total billed charges,870,100% of total billed charges,652.5,75% of total billed charges,92.12,100% of SHARP fee schedule,435,50% of total billed charges,291.8,33.54% of total billed charges,826.5,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,739.5,85% of total billed charges,224.54,100% of CMS apc rate,92.12,2100,652.50
Outpatient Medical Services,RADIOLOGY,73218,MRI UP EXT NONJOINT W/O CONT L,610,870,392.96,175% of CMS APC rate,1488.9,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,291.8,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,522,60% of total billed charges,248.07,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,609,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,248.07,100% of CMS fee schedule,739.5,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,234.9,27% of total billed charges,256.04,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,292.32,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,609,70% of total billed charges,669.9,77% of CMS fee schedule,565.5,65% of total billed charges,870,100% of total billed charges,870,100% of total billed charges,652.5,75% of total billed charges,92.12,100% of SHARP fee schedule,435,50% of total billed charges,291.8,33.54% of total billed charges,826.5,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,739.5,85% of total billed charges,224.54,100% of CMS apc rate,92.12,2100,652.50
Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER JOINT W/O CONT LEFT,610,2938,392.96,175% of CMS APC rate,1335.71,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,985.41,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1762.8,60% of total billed charges,139.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,2056.6,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,139.88,100% of CMS fee schedule,2497.3,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,793.26,27% of total billed charges,198.84,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,987.17,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,2056.6,70% of total billed charges,2262.26,77% of CMS fee schedule,1909.7,65% of total billed charges,2938,100% of total billed charges,2938,100% of total billed charges,2203.5,75% of total billed charges,92.55,100% of SHARP fee schedule,1469,50% of total billed charges,985.41,33.54% of total billed charges,2791.1,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2497.3,85% of total billed charges,224.54,100% of CMS apc rate,92.55,2938,2203.50
Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER JOINT W/O CONT RIGHT,610,2676,392.96,175% of CMS APC rate,1335.71,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,897.53,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1605.6,60% of total billed charges,139.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,1873.2,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,139.88,100% of CMS fee schedule,2274.6,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,722.52,27% of total billed charges,198.84,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,899.14,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1873.2,70% of total billed charges,2060.52,77% of CMS fee schedule,1739.4,65% of total billed charges,2676,100% of total billed charges,2676,100% of total billed charges,2007,75% of total billed charges,92.55,100% of SHARP fee schedule,1338,50% of total billed charges,897.53,33.54% of total billed charges,2542.2,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2274.6,85% of total billed charges,224.54,100% of CMS apc rate,92.55,2676,2007.00
Outpatient Medical Services,RADIOLOGY,73223,MRI UPPER EXT JOINT W&WO CONT,610,1123,580.57,175% of CMS APC rate,1559.53,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,376.65,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,673.8,60% of total billed charges,299.84,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,786.1,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,299.84,100% of CMS fee schedule,954.55,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,303.21,27% of total billed charges,389.03,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,377.33,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,786.1,70% of total billed charges,864.71,77% of CMS fee schedule,729.95,65% of total billed charges,1123,100% of total billed charges,1123,100% of total billed charges,842.25,75% of total billed charges,146.2,100% of SHARP fee schedule,561.5,50% of total billed charges,376.65,33.54% of total billed charges,1066.85,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,954.55,85% of total billed charges,331.76,100% of CMS apc rate,146.2,2100,842.25
Outpatient Medical Services,RADIOLOGY,73718,MRI LOW EXT NONJOINT W/O CONT,610,2676,392.96,175% of CMS APC rate,1368.88,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,897.53,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1605.6,60% of total billed charges,165.3,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,1873.2,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,165.3,100% of CMS fee schedule,2274.6,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,722.52,27% of total billed charges,222.21,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,899.14,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1873.2,70% of total billed charges,2060.52,77% of CMS fee schedule,1739.4,65% of total billed charges,2676,100% of total billed charges,2676,100% of total billed charges,2007,75% of total billed charges,91.67,100% of SHARP fee schedule,1338,50% of total billed charges,897.53,33.54% of total billed charges,2542.2,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2274.6,85% of total billed charges,224.54,100% of CMS apc rate,91.67,2676,2007.00
Outpatient Medical Services,RADIOLOGY,73718,MRI LOW EXT NONJOINT W/O CONT,610,2676,392.96,175% of CMS APC rate,1368.88,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,897.53,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1605.6,60% of total billed charges,165.3,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,1873.2,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,165.3,100% of CMS fee schedule,2274.6,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,722.52,27% of total billed charges,222.21,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,899.14,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1873.2,70% of total billed charges,2060.52,77% of CMS fee schedule,1739.4,65% of total billed charges,2676,100% of total billed charges,2676,100% of total billed charges,2007,75% of total billed charges,91.67,100% of SHARP fee schedule,1338,50% of total billed charges,897.53,33.54% of total billed charges,2542.2,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2274.6,85% of total billed charges,224.54,100% of CMS apc rate,91.67,2676,2007.00
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT NON-JOINT W&WO C,610,1198,580.57,175% of CMS APC rate,1484.63,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,901,100% of AR fee schedule,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,718.8,60% of total billed charges,246.21,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,838.6,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,246.21,100% of CMS fee schedule,1018.3,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,323.46,27% of total billed charges,336.94,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,402.53,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,838.6,70% of total billed charges,922.46,77% of CMS fee schedule,778.7,65% of total billed charges,1198,100% of total billed charges,1198,100% of total billed charges,898.5,75% of total billed charges,145.76,100% of SHARP fee schedule,599,50% of total billed charges,901,100% of SPREEMO fee schedule,1138.1,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,1018.3,85% of total billed charges,331.76,100% of CMS apc rate,145.76,2100,898.50
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT NON-JOINT W&WO C,610,1198,580.57,175% of CMS APC rate,1484.63,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,901,100% of AR fee schedule,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,718.8,60% of total billed charges,246.21,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,838.6,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,246.21,100% of CMS fee schedule,1018.3,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,323.46,27% of total billed charges,336.94,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,402.53,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,838.6,70% of total billed charges,922.46,77% of CMS fee schedule,778.7,65% of total billed charges,1198,100% of total billed charges,1198,100% of total billed charges,898.5,75% of total billed charges,145.76,100% of SHARP fee schedule,599,50% of total billed charges,901,100% of SPREEMO fee schedule,1138.1,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,1018.3,85% of total billed charges,331.76,100% of CMS apc rate,145.76,2100,898.50
Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT W/O CONT R,610,2868,392.96,175% of CMS APC rate,1335.71,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,961.93,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1720.8,60% of total billed charges,139.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,2007.6,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,139.88,100% of CMS fee schedule,2437.8,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,774.36,27% of total billed charges,197.96,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,963.65,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,2007.6,70% of total billed charges,2208.36,77% of CMS fee schedule,1864.2,65% of total billed charges,2868,100% of total billed charges,2868,100% of total billed charges,2151,75% of total billed charges,92.55,100% of SHARP fee schedule,1434,50% of total billed charges,961.93,33.54% of total billed charges,2724.6,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2437.8,85% of total billed charges,224.54,100% of CMS apc rate,92.55,2868,2151.00
Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT W/O CONT L,610,3084,392.96,175% of CMS APC rate,1335.71,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,1034.37,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1850.4,60% of total billed charges,139.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,2158.8,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,139.88,100% of CMS fee schedule,2621.4,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,832.68,27% of total billed charges,197.96,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,1036.22,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,2158.8,70% of total billed charges,2374.68,77% of CMS fee schedule,2004.6,65% of total billed charges,3084,100% of total billed charges,3084,100% of total billed charges,2313,75% of total billed charges,92.55,100% of SHARP fee schedule,1542,50% of total billed charges,1034.37,33.54% of total billed charges,2929.8,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2621.4,85% of total billed charges,224.54,100% of CMS apc rate,92.55,3084,2313.00
Outpatient Medical Services,RADIOLOGY,73723,MRI LOW EXT JOINT W&WO CONT RI,610,1124,580.57,175% of CMS APC rate,1558.11,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,376.99,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,674.4,60% of total billed charges,299.22,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,786.8,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,299.22,100% of CMS fee schedule,955.4,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,303.48,27% of total billed charges,388.44,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,377.66,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,786.8,70% of total billed charges,865.48,77% of CMS fee schedule,730.6,65% of total billed charges,1124,100% of total billed charges,1124,100% of total billed charges,843,75% of total billed charges,145.76,100% of SHARP fee schedule,562,50% of total billed charges,376.99,33.54% of total billed charges,1067.8,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,955.4,85% of total billed charges,331.76,100% of CMS apc rate,145.76,2100,843.00
Outpatient Medical Services,RADIOLOGY,73723,MRI LOW EXT JOINT W&WO CONT LE,610,1124,580.57,175% of CMS APC rate,1558.11,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,376.99,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,674.4,60% of total billed charges,299.22,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,786.8,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,299.22,100% of CMS fee schedule,955.4,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,303.48,27% of total billed charges,388.44,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,377.66,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,786.8,70% of total billed charges,865.48,77% of CMS fee schedule,730.6,65% of total billed charges,1124,100% of total billed charges,1124,100% of total billed charges,843,75% of total billed charges,145.76,100% of SHARP fee schedule,562,50% of total billed charges,376.99,33.54% of total billed charges,1067.8,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,955.4,85% of total billed charges,331.76,100% of CMS apc rate,145.76,2100,843.00
Outpatient Medical Services,RADIOLOGY,74181,MRI-ABDOMEN W/O CONTRAST,610,910,392.96,175% of CMS APC rate,1320.06,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,305.21,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,546,60% of total billed charges,131.94,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,637,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,131.94,100% of CMS fee schedule,773.5,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,245.7,27% of total billed charges,195.38,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,305.76,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,637,70% of total billed charges,700.7,77% of CMS fee schedule,591.5,65% of total billed charges,910,100% of total billed charges,910,100% of total billed charges,682.5,75% of total billed charges,99.4,100% of SHARP fee schedule,455,50% of total billed charges,305.21,33.54% of total billed charges,864.5,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,773.5,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2100,682.50
Outpatient Medical Services,RADIOLOGY,74183,MRI ABD W/ & W/O CONTRAST,610,1210,580.57,175% of CMS APC rate,1483.21,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,405.83,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,726,60% of total billed charges,244.97,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,847,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,244.97,100% of CMS fee schedule,1028.5,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,326.7,27% of total billed charges,338.03,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,406.56,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,847,70% of total billed charges,931.7,77% of CMS fee schedule,786.5,65% of total billed charges,1210,100% of total billed charges,1210,100% of total billed charges,907.5,75% of total billed charges,149.45,100% of SHARP fee schedule,605,50% of total billed charges,405.83,33.54% of total billed charges,1149.5,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,1028.5,85% of total billed charges,331.76,100% of CMS apc rate,149.45,2100,907.50
Outpatient Medical Services,RADIOLOGY,70544,MRA HEAD W/O CONTRAST,611,2676,392.96,175% of CMS APC rate,1365.57,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,897.53,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1605.6,60% of total billed charges,160.96,100% of CMS fee schedule,676.67,100% of CMS fee schedule,224.54,100% of CMS APC rate,1873.2,70% of total billed charges,676.67,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,160.96,100% of CMS fee schedule,2274.6,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,722.52,27% of total billed charges,211.15,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,899.14,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1873.2,70% of total billed charges,2060.52,77% of total billed charges,1739.4,65% of total billed charges,2676,100% of total billed charges,2676,100% of total billed charges,2007,75% of total billed charges,81.65,100% of SHARP fee schedule,1338,50% of total billed charges,897.53,33.54% of total billed charges,2542.2,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2274.6,85% of total billed charges,224.54,100% of CMS apc rate,81.65,2676,2007.00
Outpatient Medical Services,RADIOLOGY,70551,MRI BRAIN W/O CONTRS,611,1829,392.96,175% of CMS APC rate,1317.68,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,826,100% of AR fee schedule,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1097.4,60% of total billed charges,129.03,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,1280.3,70% of total billed charges,1190,100% of CMS fee schedule,583.68,100% of CMS fee schedule,990,pays based on per visit rate,129.03,100% of CMS fee schedule,1554.65,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,493.83,27% of total billed charges,193.66,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,614.54,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,1280.3,70% of total billed charges,1408.33,77% of CMS fee schedule,1188.85,65% of total billed charges,1829,100% of total billed charges,1829,100% of total billed charges,1371.75,75% of total billed charges,100.83,100% of SHARP fee schedule,914.5,50% of total billed charges,826,100% of SPREEMO fee schedule,1737.55,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,1554.65,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2100,1371.75
Outpatient Medical Services,RADIOLOGY,70553,MRI BRAIN W&W/O CONT,611,4953,580.57,175% of CMS APC rate,1445.75,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,1661.24,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2971.8,60% of total billed charges,217.38,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,3467.1,70% of total billed charges,1190,100% of CMS fee schedule,916.05,100% of CMS fee schedule,990,pays based on per visit rate,217.38,100% of CMS fee schedule,4210.05,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,1337.31,27% of total billed charges,316.21,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,1664.21,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,3467.1,70% of total billed charges,3813.81,77% of CMS fee schedule,3219.45,65% of total billed charges,4953,100% of total billed charges,4953,100% of total billed charges,3714.75,75% of total billed charges,155.28,100% of SHARP fee schedule,2476.5,50% of total billed charges,1661.24,33.54% of total billed charges,4705.35,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,4210.05,85% of total billed charges,331.76,100% of CMS apc rate,155.01,4953,3714.75
Outpatient Medical Services,RADIOLOGY,72141,MRI C-SPINE W/O CONT,612,2917,392.96,175% of CMS APC rate,1309.63,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,901,100% of AR fee schedule,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1750.2,60% of total billed charges,123.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,2041.9,70% of total billed charges,1190,100% of CMS fee schedule,583.68,100% of CMS fee schedule,990,pays based on per visit rate,123.88,100% of CMS fee schedule,2479.45,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,787.59,27% of total billed charges,188.57,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,980.11,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,2041.9,70% of total billed charges,2246.09,77% of CMS fee schedule,1896.05,65% of total billed charges,2917,100% of total billed charges,2917,100% of total billed charges,2187.75,75% of total billed charges,101.12,100% of SHARP fee schedule,1458.5,50% of total billed charges,901,100% of SPREEMO fee schedule,2771.15,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2479.45,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2917,2187.75
Outpatient Medical Services,RADIOLOGY,72146,MRI T-SPINE W/O CONT,612,547,392.96,175% of CMS APC rate,1309.63,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,945,100% of AR fee schedule,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,328.2,60% of total billed charges,123.88,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,382.9,70% of total billed charges,1190,100% of CMS fee schedule,466.94,100% of CMS fee schedule,990,pays based on per visit rate,123.88,100% of CMS fee schedule,464.95,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,147.69,27% of total billed charges,188.57,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,183.79,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,382.9,70% of total billed charges,421.19,77% of CMS fee schedule,355.55,65% of total billed charges,547,100% of total billed charges,547,100% of total billed charges,410.25,75% of total billed charges,101.12,100% of SHARP fee schedule,273.5,50% of total billed charges,945,100% of SPREEMO fee schedule,519.65,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,464.95,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2100,410.25
Outpatient Medical Services,RADIOLOGY,72148,MRI L-SPINE W/O CONT,612,2982,392.96,175% of CMS APC rate,1310.58,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,96.86,100% of AR ASC tier groupings rate,901,100% of AR fee schedule,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,1789.2,60% of total billed charges,124.19,100% of CMS fee schedule,1109,100% of CMS fee schedule,224.54,100% of CMS APC rate,2087.4,70% of total billed charges,1190,100% of CMS fee schedule,583.68,100% of CMS fee schedule,990,pays based on per visit rate,124.19,100% of CMS fee schedule,2534.7,85% of total billed charges,1215,pays based on per visit rate,224.54,100% of CMS APC rate,805.14,27% of total billed charges,188.87,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2100,pays based on per visit rate,1001.95,33.6% of total billed charges,219.87,227% of AR ASC tier groupings rate,226.47,233.81% of AR ASC tier groupings rate,219.87,227% of AR ASC tier groupings rate,2087.4,70% of total billed charges,2296.14,77% of CMS fee schedule,1938.3,65% of total billed charges,2982,100% of total billed charges,2982,100% of total billed charges,2236.5,75% of total billed charges,101.12,100% of SHARP fee schedule,1491,50% of total billed charges,901,100% of SPREEMO fee schedule,2832.9,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,2534.7,85% of total billed charges,224.54,100% of CMS apc rate,96.86,2982,2236.50
Outpatient Medical Services,RADIOLOGY,72156,MRI C-SPINE W&W/O CO,612,3197,580.57,175% of CMS APC rate,1448.13,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,1072.27,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,1918.2,60% of total billed charges,219.86,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,2237.9,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,219.86,100% of CMS fee schedule,2717.45,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,863.19,27% of total billed charges,318.61,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,1074.19,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,2237.9,70% of total billed charges,2461.69,77% of CMS fee schedule,2078.05,65% of total billed charges,3197,100% of total billed charges,3197,100% of total billed charges,2397.75,75% of total billed charges,155.28,100% of SHARP fee schedule,1598.5,50% of total billed charges,1072.27,33.54% of total billed charges,3037.15,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,2717.45,85% of total billed charges,331.76,100% of CMS apc rate,155.01,3197,2397.75
Outpatient Medical Services,RADIOLOGY,72157,MRI T-SPINE W&W/O CO,612,3197,580.57,175% of CMS APC rate,1449.08,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,1072.27,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,1918.2,60% of total billed charges,220.48,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,2237.9,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,220.48,100% of CMS fee schedule,2717.45,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,863.19,27% of total billed charges,319.21,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,1074.19,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,2237.9,70% of total billed charges,2461.69,77% of CMS fee schedule,2078.05,65% of total billed charges,3197,100% of total billed charges,3197,100% of total billed charges,2397.75,75% of total billed charges,155.28,100% of SHARP fee schedule,1598.5,50% of total billed charges,1072.27,33.54% of total billed charges,3037.15,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,2717.45,85% of total billed charges,331.76,100% of CMS apc rate,155.01,3197,2397.75
Outpatient Medical Services,RADIOLOGY,72158,MRI L-SPINE W&W/O CO,612,4476,580.57,175% of CMS APC rate,1447.18,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,1501.25,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2685.6,60% of total billed charges,219.24,100% of CMS fee schedule,1109,100% of CMS fee schedule,331.76,100% of CMS APC rate,3133.2,70% of total billed charges,1190,100% of CMS fee schedule,732.84,100% of CMS fee schedule,990,pays based on per visit rate,219.24,100% of CMS fee schedule,3804.6,85% of total billed charges,1215,pays based on per visit rate,331.76,100% of CMS APC rate,1208.52,27% of total billed charges,318.01,100% of OK fee schedule,292.99,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2100,pays based on per visit rate,1503.94,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,3133.2,70% of total billed charges,3446.52,77% of CMS fee schedule,2909.4,65% of total billed charges,4476,100% of total billed charges,4476,100% of total billed charges,3357,75% of total billed charges,155.28,100% of SHARP fee schedule,2238,50% of total billed charges,1501.25,33.54% of total billed charges,4252.2,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,3804.6,85% of total billed charges,331.76,100% of CMS apc rate,155.01,4476,3357.00
Outpatient Medical Services,RADIOLOGY,78014,NM THYROIS SCAN/UPTAKE,341,1737,653.24,175% of CMS APC rate,1424.34,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,582.59,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,756.72,100% of CIGNA fee schedule,190.66,100% of CMS fee schedule,294.14,100% of CMS fee schedule,373.28,100% of CMS APC rate,1215.9,70% of total billed charges,294.14,100% of CMS fee schedule,785.94,100% of CMS fee schedule,1302.75,75% of total billed charges,190.66,100% of CMS fee schedule,1476.45,85% of total billed charges,1302.75,75% of total billed charges,373.28,100% of CMS APC rate,468.99,27% of total billed charges,207.26,100% of OK fee schedule,224.34,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,1042.2,60% of total billed charges,583.63,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,1215.9,70% of total billed charges,1337.49,77% of total billed charges,1129.05,65% of total billed charges,1737,100% of total billed charges,1737,100% of total billed charges,1302.75,75% of total billed charges,33.45,100% of SHARP fee schedule,868.5,50% of total billed charges,582.59,33.54% of total billed charges,1650.15,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,1476.45,85% of total billed charges,373.28,100% of CMS apc rate,33.45,1737,1302.75
Outpatient Medical Services,RADIOLOGY,78071,NM PARATHYROID PLANAR W/SPECT,341,2086,653.24,175% of CMS APC rate,1710.52,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,699.64,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,756.72,100% of CIGNA fee schedule,261.65,100% of CMS fee schedule,410.59,100% of CMS fee schedule,373.28,100% of CMS APC rate,1460.2,70% of total billed charges,410.59,100% of CMS fee schedule,785.94,100% of CMS fee schedule,1564.5,75% of total billed charges,261.65,100% of CMS fee schedule,1773.1,85% of total billed charges,1564.5,75% of total billed charges,373.28,100% of CMS APC rate,563.22,27% of total billed charges,307.54,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,1251.6,60% of total billed charges,700.9,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,1460.2,70% of total billed charges,1606.22,77% of total billed charges,1355.9,65% of total billed charges,2086,100% of total billed charges,2086,100% of total billed charges,1564.5,75% of total billed charges,80.05,100% of SHARP fee schedule,1043,50% of total billed charges,699.64,33.54% of total billed charges,1981.7,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,1773.1,85% of total billed charges,373.28,100% of CMS apc rate,80.05,2086,1564.50
Outpatient Medical Services,RADIOLOGY,78227,NM HIDA W/EF,341,2254,875.05,175% of CMS APC rate,1848.28,82% total billed charges,500.03,100% of CMS APC rate,515.02,103% of CMS APC rate,206,100% of AR ASC tier groupings rate,755.99,33.54% of total billed charges,435.69,100% of BCBS fee schedule,435.69,100% of BCBS fee schedule,500.03,100% of CMS APC rate,500.03,100% of CMS APC rate,991.68,100% of CIGNA fee schedule,352.67,100% of CMS fee schedule,526.84,100% of CMS fee schedule,500.03,100% of CMS APC rate,1577.8,70% of total billed charges,526.84,100% of CMS fee schedule,1029.98,100% of CMS fee schedule,1690.5,75% of total billed charges,352.67,100% of CMS fee schedule,1915.9,85% of total billed charges,1690.5,75% of total billed charges,500.03,100% of CMS APC rate,608.58,27% of total billed charges,382.72,100% of OK fee schedule,292.44,100% of TX fee schedule,500.03,100% of CMS APC rate,500.03,100% of CMS APC rate,500.03,100% of CMS APC rate,1352.4,60% of total billed charges,757.34,33.6% of total billed charges,467.62,227% of AR ASC tier groupings rate,481.65,233.81% of AR ASC tier groupings rate,467.62,227% of AR ASC tier groupings rate,1577.8,70% of total billed charges,1735.58,77% of total billed charges,1465.1,65% of total billed charges,2254,100% of total billed charges,2254,100% of total billed charges,1690.5,75% of total billed charges,60.72,100% of SHARP fee schedule,1127,50% of total billed charges,755.99,33.54% of total billed charges,2141.3,95% of total billed charges,500.03,100% of CMS APC rate,500.03,100% of CMS APC rate,N/A,not seperately reimbursable,500.03,100% of CMS APC rate,1915.9,85% of total billed charges,500.03,100% of CMS apc rate,60.72,2254,1690.50
Outpatient Medical Services,RADIOLOGY,78264,NM GASTRIC EMPTYING SCA,341,1961,653.24,175% of CMS APC rate,1608.02,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,657.72,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,756.72,100% of CIGNA fee schedule,260.41,100% of CMS fee schedule,341.72,100% of CMS fee schedule,373.28,100% of CMS APC rate,1372.7,70% of total billed charges,341.72,100% of CMS fee schedule,785.94,100% of CMS fee schedule,1470.75,75% of total billed charges,260.41,100% of CMS fee schedule,1666.85,85% of total billed charges,1470.75,75% of total billed charges,373.28,100% of CMS APC rate,529.47,27% of total billed charges,288.01,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,1176.6,60% of total billed charges,658.9,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,1372.7,70% of total billed charges,1509.97,77% of total billed charges,1274.65,65% of total billed charges,1961,100% of total billed charges,1961,100% of total billed charges,1470.75,75% of total billed charges,57.82,100% of SHARP fee schedule,980.5,50% of total billed charges,657.72,33.54% of total billed charges,1862.95,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,1666.85,85% of total billed charges,373.28,100% of CMS apc rate,57.82,1961,1470.75
Outpatient Medical Services,RADIOLOGY,78306,NM BONE WHOLE,341,1401,653.24,175% of CMS APC rate,1148.82,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,469.9,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,756.72,100% of CIGNA fee schedule,229.1,100% of CMS fee schedule,291.39,100% of CMS fee schedule,373.28,100% of CMS APC rate,980.7,70% of total billed charges,291.39,100% of CMS fee schedule,785.94,100% of CMS fee schedule,1050.75,75% of total billed charges,229.1,100% of CMS fee schedule,1190.85,85% of total billed charges,1050.75,75% of total billed charges,373.28,100% of CMS APC rate,378.27,27% of total billed charges,261.32,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,840.6,60% of total billed charges,470.74,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,980.7,70% of total billed charges,1078.77,77% of total billed charges,910.65,65% of total billed charges,1401,100% of total billed charges,1401,100% of total billed charges,1050.75,75% of total billed charges,61.25,100% of SHARP fee schedule,700.5,50% of total billed charges,469.9,33.54% of total billed charges,1330.95,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,1190.85,85% of total billed charges,373.28,100% of CMS apc rate,61.25,1401,1050.75
Outpatient Medical Services,RADIOLOGY,78315,NM BONE 3 PHASE,341,1820,653.24,175% of CMS APC rate,1492.4,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,610.43,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,756.72,100% of CIGNA fee schedule,262.27,100% of CMS fee schedule,407.58,100% of CMS fee schedule,373.28,100% of CMS APC rate,1274,70% of total billed charges,407.58,100% of CMS fee schedule,785.94,100% of CMS fee schedule,1365,75% of total billed charges,262.27,100% of CMS fee schedule,1547,85% of total billed charges,1365,75% of total billed charges,373.28,100% of CMS APC rate,491.4,27% of total billed charges,300.56,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,1092,60% of total billed charges,611.52,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,1274,70% of total billed charges,1401.4,77% of total billed charges,1183,65% of total billed charges,1820,100% of total billed charges,1820,100% of total billed charges,1365,75% of total billed charges,72.47,100% of SHARP fee schedule,910,50% of total billed charges,610.43,33.54% of total billed charges,1729,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,1547,85% of total billed charges,373.28,100% of CMS apc rate,72.47,1820,1365.00
Outpatient Medical Services,RADIOLOGY,78452,NM MYOCARDIAL/HEART WALL MOTION,341,4727,2122.29,175% of CMS APC rate,3876.14,82% total billed charges,1212.73,100% of CMS APC rate,1249.1,103% of CMS APC rate,550.1,100% of AR ASC tier groupings rate,1585.44,33.54% of total billed charges,1174.37,100% of BCBS fee schedule,1174.37,100% of BCBS fee schedule,1212.73,100% of CMS APC rate,1212.73,100% of CMS APC rate,2605.26,100% of CIGNA fee schedule,345.92,100% of CMS fee schedule,552.69,100% of CMS fee schedule,1212.73,100% of CMS APC rate,3308.9,70% of total billed charges,552.69,100% of CMS fee schedule,2705.86,100% of CMS fee schedule,3545.25,75% of total billed charges,345.92,100% of CMS fee schedule,4017.95,85% of total billed charges,3545.25,75% of total billed charges,1212.73,100% of CMS APC rate,1276.29,27% of total billed charges,408.23,100% of OK fee schedule,789.26,100% of TX fee schedule,1212.73,100% of CMS APC rate,1212.73,100% of CMS APC rate,1212.73,100% of CMS APC rate,2836.2,60% of total billed charges,1588.27,33.6% of total billed charges,1248.73,227% of AR ASC tier groupings rate,1286.19,233.81% of AR ASC tier groupings rate,1248.73,227% of AR ASC tier groupings rate,3308.9,70% of total billed charges,3639.79,77% of total billed charges,3072.55,65% of total billed charges,4727,100% of total billed charges,4727,100% of total billed charges,3545.25,75% of total billed charges,107.74,100% of SHARP fee schedule,2363.5,50% of total billed charges,1585.44,33.54% of total billed charges,4490.65,95% of total billed charges,1212.73,100% of CMS APC rate,1212.73,100% of CMS APC rate,N/A,not seperately reimbursable,1212.73,100% of CMS APC rate,4017.95,85% of total billed charges,1212.73,100% of CMS apc rate,107.74,4727,3545.25
Outpatient Medical Services,RADIOLOGY,78580,NM LUNG PERFUSION,341,498,653.24,175% of CMS APC rate,408.36,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,167.03,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,498,100% of CIGNA fee schedule,177.57,100% of CMS fee schedule,243.41,100% of CMS fee schedule,373.28,100% of CMS APC rate,348.6,70% of total billed charges,243.41,100% of CMS fee schedule,785.94,100% of CMS fee schedule,373.5,75% of total billed charges,177.57,100% of CMS fee schedule,423.3,85% of total billed charges,373.5,75% of total billed charges,373.28,100% of CMS APC rate,134.46,27% of total billed charges,205.5,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,298.8,60% of total billed charges,167.33,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,348.6,70% of total billed charges,383.46,77% of total billed charges,323.7,65% of total billed charges,498,100% of total billed charges,498,100% of total billed charges,373.5,75% of total billed charges,52.97,100% of SHARP fee schedule,249,50% of total billed charges,167.03,33.54% of total billed charges,473.1,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,423.3,85% of total billed charges,373.28,100% of CMS apc rate,52.97,785.94,373.50
Outpatient Medical Services,RADIOLOGY,78597,NM QUANTATIVE PUL PERFUSION,341,498,653.24,175% of CMS APC rate,408.36,82% total billed charges,373.28,100% of CMS APC rate,384.47,103% of CMS APC rate,158.69,100% of AR ASC tier groupings rate,167.03,33.54% of total billed charges,339.82,100% of BCBS fee schedule,339.82,100% of BCBS fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,498,100% of CIGNA fee schedule,146.57,100% of CMS fee schedule,209.86,100% of CMS fee schedule,373.28,100% of CMS APC rate,348.6,70% of total billed charges,209.86,100% of CMS fee schedule,785.94,100% of CMS fee schedule,373.5,75% of total billed charges,146.57,100% of CMS fee schedule,423.3,85% of total billed charges,373.5,75% of total billed charges,373.28,100% of CMS APC rate,134.46,27% of total billed charges,174.71,100% of OK fee schedule,226.94,100% of TX fee schedule,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,298.8,60% of total billed charges,167.33,33.6% of total billed charges,360.23,227% of AR ASC tier groupings rate,371.03,233.81% of AR ASC tier groupings rate,360.23,227% of AR ASC tier groupings rate,348.6,70% of total billed charges,383.46,77% of total billed charges,323.7,65% of total billed charges,498,100% of total billed charges,498,100% of total billed charges,373.5,75% of total billed charges,51.8,100% of SHARP fee schedule,249,50% of total billed charges,167.03,33.54% of total billed charges,473.1,95% of total billed charges,373.28,100% of CMS APC rate,373.28,100% of CMS APC rate,N/A,not seperately reimbursable,373.28,100% of CMS APC rate,423.3,85% of total billed charges,373.28,100% of CMS apc rate,51.8,785.94,373.50
Outpatient Medical Services,RADIOLOGY,A9500,NM MYOVIEW,636,176,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,70.66,100% of AR fee schedule,59.03,33.54% of total billed charges,38.72,100% of BCBS fee schedule,103.84,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,114.4,65% of total billed charges,N/A,not seperately reimbursable,123.2,70% of total billed charges,132,75% of toal billed charges,128.1,100% of CMS fee schedule,132,75% of total billed charges,132,75% of total billed charges,149.6,85% of total billed charges,132,75% of total billed charges,N/A,not seperately reimbursable,47.52,27% of total billed charges,N/A,not seperately reimbursable,40.48,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13.2,60% of total billed charges,59.14,33.6% of total billed charges,160.4,227% of AR fee schedule,165.21,233.81% of AR fee schedule,160.4,227% of AR fee schedule,123.2,70% of total billed charges,135.52,77% of total billed charges,114.4,65% of total billed charges,176,100% of total billed charges,176,100% of total billed charges,132,75% of total billed charges,N/A,not seperately reimbursable,88,50% of total billed charges,59.03,33.54% of total billed charges,167.2,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,149.6,85% of total billed charges,N/A,not seperately reimbursable,13.2,176,132.00
Outpatient Medical Services,RADIOLOGY,A9500,NM TC 99M SESTAMIBI/CARDIOLITE UP,636,333,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,70.66,100% of AR fee schedule,111.69,33.54% of total billed charges,73.26,100% of BCBS fee schedule,196.47,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,216.45,65% of total billed charges,N/A,not seperately reimbursable,233.1,70% of total billed charges,249.75,75% of toal billed charges,128.1,100% of CMS fee schedule,249.75,75% of total billed charges,249.75,75% of total billed charges,283.05,85% of total billed charges,249.75,75% of total billed charges,N/A,not seperately reimbursable,89.91,27% of total billed charges,N/A,not seperately reimbursable,76.59,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.98,60% of total billed charges,111.89,33.6% of total billed charges,160.4,227% of AR fee schedule,165.21,233.81% of AR fee schedule,160.4,227% of AR fee schedule,233.1,70% of total billed charges,256.41,77% of total billed charges,216.45,65% of total billed charges,333,100% of total billed charges,333,100% of total billed charges,249.75,75% of total billed charges,N/A,not seperately reimbursable,166.5,50% of total billed charges,111.69,33.54% of total billed charges,316.35,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,283.05,85% of total billed charges,N/A,not seperately reimbursable,24.98,333,249.75
Outpatient Medical Services,RADIOLOGY,A9503,NM TC 99M MDP UP TO 30 MILLICURIE,636,119,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64,100% of AR fee schedule,39.91,33.54% of total billed charges,16.3,100% of BCBS fee schedule,16.3,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77.35,65% of total billed charges,N/A,not seperately reimbursable,83.3,70% of total billed charges,89.25,75% of toal billed charges,13.65,100% of CMS fee schedule,89.25,75% of total billed charges,89.25,75% of total billed charges,101.15,85% of total billed charges,89.25,75% of total billed charges,N/A,not seperately reimbursable,32.13,27% of total billed charges,N/A,not seperately reimbursable,27.37,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.93,60% of total billed charges,39.98,33.6% of total billed charges,145.28,227% of AR fee schedule,149.64,233.81% of AR fee schedule,145.28,227% of AR fee schedule,83.3,70% of total billed charges,91.63,77% of total billed charges,77.35,65% of total billed charges,119,100% of total billed charges,119,100% of total billed charges,89.25,75% of total billed charges,N/A,not seperately reimbursable,59.5,50% of total billed charges,39.91,33.54% of total billed charges,113.05,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,101.15,85% of total billed charges,N/A,not seperately reimbursable,8.93,149.64,89.25
Outpatient Medical Services,RADIOLOGY,A9516,NM N417156020105,636,196,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20.45,100% of AR fee schedule,65.74,33.54% of total billed charges,43.12,100% of BCBS fee schedule,115.64,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,127.4,65% of total billed charges,N/A,not seperately reimbursable,137.2,70% of total billed charges,147,75% of toal billed charges,117.6,pays based on per vsit rate,147,75% of total billed charges,147,75% of total billed charges,166.6,85% of total billed charges,147,75% of total billed charges,N/A,not seperately reimbursable,52.92,27% of total billed charges,N/A,not seperately reimbursable,45.08,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.7,60% of total billed charges,65.86,33.6% of total billed charges,46.42,227% of AR fee schedule,47.81,233.81% of AR fee schedule,46.42,227% of AR fee schedule,137.2,70% of total billed charges,150.92,77% of total billed charges,127.4,65% of total billed charges,196,100% of total billed charges,196,100% of total billed charges,147,75% of total billed charges,N/A,not seperately reimbursable,98,50% of total billed charges,65.74,33.54% of total billed charges,186.2,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,166.6,85% of total billed charges,N/A,not seperately reimbursable,14.7,196,147.00
Outpatient Medical Services,RADIOLOGY,A9537,"NM TC 99M MEBROFENIN/CHOLETEC, UP",636,195,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,38.2,100% of AR fee schedule,65.4,33.54% of total billed charges,69.37,100% of BCBS fee schedule,69.37,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,126.75,65% of total billed charges,N/A,not seperately reimbursable,136.5,70% of total billed charges,146.25,75% of toal billed charges,59.33,100% of CMS fee schedule,146.25,75% of total billed charges,146.25,75% of total billed charges,165.75,85% of total billed charges,146.25,75% of total billed charges,N/A,not seperately reimbursable,52.65,27% of total billed charges,N/A,not seperately reimbursable,44.85,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.63,60% of total billed charges,65.52,33.6% of total billed charges,86.71,227% of AR fee schedule,89.32,233.81% of AR fee schedule,86.71,227% of AR fee schedule,136.5,70% of total billed charges,150.15,77% of total billed charges,126.75,65% of total billed charges,195,100% of total billed charges,195,100% of total billed charges,146.25,75% of total billed charges,N/A,not seperately reimbursable,97.5,50% of total billed charges,65.4,33.54% of total billed charges,185.25,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,165.75,85% of total billed charges,N/A,not seperately reimbursable,14.63,195,146.25
Outpatient Medical Services,RADIOLOGY,A9540,"NM TC 99M ALBUMIN AGGR/MAA, UP TO",636,119,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,39.91,33.54% of total billed charges,37.62,100% of BCBS fee schedule,37.62,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77.35,65% of total billed charges,N/A,not seperately reimbursable,83.3,70% of total billed charges,89.25,75% of toal billed charges,31.5,100% of CMS fee schedule,89.25,75% of total billed charges,89.25,75% of total billed charges,101.15,85% of total billed charges,89.25,75% of total billed charges,N/A,not seperately reimbursable,32.13,27% of total billed charges,N/A,not seperately reimbursable,27.37,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.93,60% of total billed charges,39.98,33.6% of total billed charges,41.18,227% of AR fee schedule,42.41,233.81% of AR fee schedule,41.18,227% of AR fee schedule,83.3,70% of total billed charges,91.63,77% of total billed charges,77.35,65% of total billed charges,119,100% of total billed charges,119,100% of total billed charges,89.25,75% of total billed charges,N/A,not seperately reimbursable,59.5,50% of total billed charges,39.91,33.54% of total billed charges,113.05,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,101.15,85% of total billed charges,N/A,not seperately reimbursable,8.93,119,89.25
Outpatient Medical Services,RADIOLOGY,A9541,"NM TC 99M SULFUR COLLOID, UP TO 2",636,156,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,52.32,33.54% of total billed charges,335.28,100% of BCBS fee schedule,335.28,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,101.4,65% of total billed charges,N/A,not seperately reimbursable,109.2,70% of total billed charges,117,75% of toal billed charges,280.74,100% of CMS fee schedule,117,75% of total billed charges,117,75% of total billed charges,132.6,85% of total billed charges,117,75% of total billed charges,N/A,not seperately reimbursable,42.12,27% of total billed charges,N/A,not seperately reimbursable,35.88,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.7,60% of total billed charges,52.42,33.6% of total billed charges,120.04,227% of AR fee schedule,123.64,233.81% of AR fee schedule,120.04,227% of AR fee schedule,109.2,70% of total billed charges,120.12,77% of total billed charges,101.4,65% of total billed charges,156,100% of total billed charges,156,100% of total billed charges,117,75% of total billed charges,N/A,not seperately reimbursable,78,50% of total billed charges,52.32,33.54% of total billed charges,148.2,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,132.6,85% of total billed charges,N/A,not seperately reimbursable,11.7,335.28,117.00
Outpatient Medical Services,RADIOLOGY,71045,XR CHEST PA,320,64,143.13,175% of CMS APC rate,52.48,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,13.65,100% of AR ASC tier groupings rate,21.47,33.54% of total billed charges,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,64,100% of CIGNA fee schedule,14.13,100% of CMS fee schedule,41.6,65% of total billed charges,81.79,100% of CMS APC rate,44.8,70% of total billed charges,48,75% of toal billed charges,173.16,100% of CMS fee schedule,48,75% of total billed charges,14.13,100% of CMS fee schedule,54.4,85% of total billed charges,48,75% of total billed charges,81.79,100% of CMS APC rate,17.28,27% of total billed charges,22.24,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,38.4,60% of total billed charges,21.5,33.6% of total billed charges,30.99,227% of AR ASC tier groupings rate,31.92,233.81% of AR ASC tier groupings rate,30.99,227% of AR ASC tier groupings rate,44.8,pays based on per visit rate,49.28,77% of total billed charges,41.6,65% of total billed charges,64,100% of total billed charges,64,100% of total billed charges,48,75% of total billed charges,12.4,100% of SHARP fee schedule,32,50% of total billed charges,21.47,33.54% of total billed charges,60.8,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,54.4,85% of total billed charges,81.79,100% of CMS apc rate,12.4,173.16,48.00
Outpatient Medical Services,RADIOLOGY,71046,XR CHEST PA & LATERAL,320,328,143.13,175% of CMS APC rate,268.96,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,18.57,100% of AR ASC tier groupings rate,110.01,33.54% of total billed charges,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,18.78,100% of CMS fee schedule,213.2,65% of total billed charges,81.79,100% of CMS APC rate,229.6,70% of total billed charges,246,75% of toal billed charges,173.16,100% of CMS fee schedule,246,75% of total billed charges,18.78,100% of CMS fee schedule,278.8,85% of total billed charges,246,75% of total billed charges,81.79,100% of CMS APC rate,88.56,27% of total billed charges,28.38,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,196.8,60% of total billed charges,110.21,33.6% of total billed charges,42.15,227% of AR ASC tier groupings rate,43.42,233.81% of AR ASC tier groupings rate,42.15,227% of AR ASC tier groupings rate,229.6,pays based on per visit rate,252.56,77% of total billed charges,213.2,65% of total billed charges,328,100% of total billed charges,328,100% of total billed charges,246,75% of total billed charges,14.86,100% of SHARP fee schedule,164,50% of total billed charges,110.01,33.54% of total billed charges,311.6,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,278.8,85% of total billed charges,81.79,100% of CMS apc rate,14.86,328,246.00
Outpatient Medical Services,RADIOLOGY,71275,CT CHEST/PE PROTOCOL,320,3035,289.39,175% of CMS APC rate,2488.7,82% total billed charges,165.37,100% of CMS APC rate,170.33,103% of CMS APC rate,75.19,100% of AR ASC tier groupings rate,1017.94,33.54% of total billed charges,168.21,100% of BCBS fee schedule,168.21,100% of BCBS fee schedule,165.37,100% of CMS APC rate,165.37,100% of CMS APC rate,337.1,100% of CIGNA fee schedule,184.21,100% of CMS fee schedule,527.08,100% of CMS fee schedule,165.37,100% of CMS APC rate,2124.5,70% of total billed charges,527.08,100% of CMS fee schedule,350.12,100% of CMS fee schedule,2276.25,75% of total billed charges,184.21,100% of CMS fee schedule,2579.75,85% of total billed charges,2276.25,75% of total billed charges,165.37,100% of CMS APC rate,819.45,27% of total billed charges,235.38,100% of OK fee schedule,162.26,100% of TX fee schedule,165.37,100% of CMS APC rate,165.37,100% of CMS APC rate,165.37,100% of CMS APC rate,1821,60% of total billed charges,1019.76,33.6% of total billed charges,170.68,227% of AR ASC tier groupings rate,175.8,233.81% of AR ASC tier groupings rate,170.68,227% of AR ASC tier groupings rate,2124.5,pays based on per visit rate,2336.95,77% of CMS fee schedule,1972.75,65% of total billed charges,3035,100% of total billed charges,3035,100% of total billed charges,2276.25,75% of total billed charges,131.75,100% of SHARP fee schedule,1517.5,50% of total billed charges,1017.94,33.54% of total billed charges,2883.25,95% of total billed charges,165.37,100% of CMS APC rate,165.37,100% of CMS APC rate,N/A,not seperately reimbursable,165.37,100% of CMS APC rate,2579.75,85% of total billed charges,165.37,100% of CMS apc rate,75.19,3035,2276.25
Outpatient Medical Services,RADIOLOGY,72050,XR CERVICAL SP/OBL,320,588,172.87,175% of CMS APC rate,482.16,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,58.3,100% of AR fee schedule,104,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,31.8,100% of CMS fee schedule,51.5,100% of CMS fee schedule,98.78,100% of CMS APC rate,411.6,70% of total billed charges,51.5,100% of CMS fee schedule,209.5,100% of CMS fee schedule,441,75% of total billed charges,31.8,100% of CMS fee schedule,499.8,85% of total billed charges,441,75% of total billed charges,98.78,100% of CMS APC rate,158.76,27% of total billed charges,43.54,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,352.8,60% of total billed charges,197.57,33.6% of total billed charges,132.34,227% of AR fee schedule,136.31,233.81% of AR fee schedule,132.34,227% of AR fee schedule,411.6,pays based on per visit rate,452.76,77% of total billed charges,382.2,65% of total billed charges,588,100% of total billed charges,588,100% of total billed charges,441,75% of total billed charges,22.81,100% of SHARP fee schedule,294,50% of total billed charges,104,100% of SPREEMO fee schedule,558.6,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,499.8,85% of total billed charges,98.78,100% of CMS apc rate,22.81,588,441.00
Outpatient Medical Services,RADIOLOGY,72072,XR THORACIC SPINE,320,602,172.87,175% of CMS APC rate,493.64,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,50.6,100% of AR fee schedule,201.91,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,23.12,100% of CMS fee schedule,37.39,100% of CMS fee schedule,98.78,100% of CMS APC rate,421.4,70% of total billed charges,37.39,100% of CMS fee schedule,209.5,100% of CMS fee schedule,451.5,75% of total billed charges,23.12,100% of CMS fee schedule,511.7,85% of total billed charges,451.5,75% of total billed charges,98.78,100% of CMS APC rate,162.54,27% of total billed charges,33.21,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,361.2,60% of total billed charges,202.27,33.6% of total billed charges,114.86,227% of AR fee schedule,118.31,233.81% of AR fee schedule,114.86,227% of AR fee schedule,421.4,pays based on per visit rate,463.54,77% of total billed charges,391.3,65% of total billed charges,602,100% of total billed charges,602,100% of total billed charges,451.5,75% of total billed charges,15.81,100% of SHARP fee schedule,301,50% of total billed charges,201.91,33.54% of total billed charges,571.9,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,511.7,85% of total billed charges,98.78,100% of CMS apc rate,15.81,602,451.50
Outpatient Medical Services,RADIOLOGY,72100,XR LUMBOSACRAL SPINE,320,497,172.87,175% of CMS APC rate,407.54,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,46.2,100% of AR fee schedule,83,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,23.12,100% of CMS fee schedule,40.21,100% of CMS fee schedule,98.78,100% of CMS APC rate,347.9,70% of total billed charges,40.21,100% of CMS fee schedule,209.5,100% of CMS fee schedule,372.75,75% of total billed charges,23.12,100% of CMS fee schedule,422.45,85% of total billed charges,372.75,75% of total billed charges,98.78,100% of CMS APC rate,134.19,27% of total billed charges,32.87,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,298.2,60% of total billed charges,166.99,33.6% of total billed charges,104.87,227% of AR fee schedule,108.02,233.81% of AR fee schedule,104.87,227% of AR fee schedule,347.9,pays based on per visit rate,382.69,77% of total billed charges,323.05,65% of total billed charges,497,100% of total billed charges,497,100% of total billed charges,372.75,75% of total billed charges,16.27,100% of SHARP fee schedule,248.5,50% of total billed charges,83,100% of SPREEMO fee schedule,472.15,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,422.45,85% of total billed charges,98.78,100% of CMS apc rate,16.27,497,372.75
Outpatient Medical Services,RADIOLOGY,72110,XR LUMBOSACRAL SPINE W/ OBLIQUE,320,614,172.87,175% of CMS APC rate,503.48,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,66,100% of AR fee schedule,119,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,30.56,100% of CMS fee schedule,55.26,100% of CMS fee schedule,98.78,100% of CMS APC rate,429.8,70% of total billed charges,55.26,100% of CMS fee schedule,209.5,100% of CMS fee schedule,460.5,75% of total billed charges,30.56,100% of CMS fee schedule,521.9,85% of total billed charges,460.5,75% of total billed charges,98.78,100% of CMS APC rate,165.78,27% of total billed charges,41.71,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,368.4,60% of total billed charges,206.3,33.6% of total billed charges,149.82,227% of AR fee schedule,154.31,233.81% of AR fee schedule,149.82,227% of AR fee schedule,429.8,pays based on per visit rate,472.78,77% of total billed charges,399.1,65% of total billed charges,614,100% of total billed charges,614,100% of total billed charges,460.5,75% of total billed charges,22.81,100% of SHARP fee schedule,307,50% of total billed charges,119,100% of SPREEMO fee schedule,583.3,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,521.9,85% of total billed charges,98.78,100% of CMS apc rate,22.81,614,460.50
Outpatient Medical Services,RADIOLOGY,73030,XR SHOULDER INT-EXT LEFT,320,381,143.14,175% of CMS APC rate,312.42,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,38.5,100% of AR fee schedule,75.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,20.33,100% of CMS fee schedule,28.92,100% of CMS fee schedule,81.79,100% of CMS APC rate,266.7,70% of total billed charges,28.92,100% of CMS fee schedule,173.16,100% of CMS fee schedule,285.75,75% of total billed charges,20.33,100% of CMS fee schedule,323.85,85% of total billed charges,285.75,75% of total billed charges,81.79,100% of CMS APC rate,102.87,27% of total billed charges,28.52,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,228.6,60% of total billed charges,128.02,33.6% of total billed charges,87.4,227% of AR fee schedule,90.02,233.81% of AR fee schedule,87.4,227% of AR fee schedule,266.7,pays based on per visit rate,293.37,77% of total billed charges,247.65,65% of total billed charges,381,100% of total billed charges,381,100% of total billed charges,285.75,75% of total billed charges,13.68,100% of SHARP fee schedule,190.5,50% of total billed charges,75.5,100% of SPREEMO fee schedule,361.95,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,323.85,85% of total billed charges,81.79,100% of CMS apc rate,13.68,381,285.75
Outpatient Medical Services,RADIOLOGY,73030,XR SHOULDER INT-EXT RIGHT,320,383,143.14,175% of CMS APC rate,314.06,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,38.5,100% of AR fee schedule,75.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,20.33,100% of CMS fee schedule,28.92,100% of CMS fee schedule,81.79,100% of CMS APC rate,268.1,70% of total billed charges,28.92,100% of CMS fee schedule,173.16,100% of CMS fee schedule,287.25,75% of total billed charges,20.33,100% of CMS fee schedule,325.55,85% of total billed charges,287.25,75% of total billed charges,81.79,100% of CMS APC rate,103.41,27% of total billed charges,28.52,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,229.8,60% of total billed charges,128.69,33.6% of total billed charges,87.4,227% of AR fee schedule,90.02,233.81% of AR fee schedule,87.4,227% of AR fee schedule,268.1,pays based on per visit rate,294.91,77% of total billed charges,248.95,65% of total billed charges,383,100% of total billed charges,383,100% of total billed charges,287.25,75% of total billed charges,13.68,100% of SHARP fee schedule,191.5,50% of total billed charges,75.5,100% of SPREEMO fee schedule,363.85,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,325.55,85% of total billed charges,81.79,100% of CMS apc rate,13.68,383,287.25
Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW 3 VIEWS RIGHT,320,373,143.14,175% of CMS APC rate,305.86,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,35.2,100% of AR fee schedule,68.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,19.09,100% of CMS fee schedule,35.51,100% of CMS fee schedule,81.79,100% of CMS APC rate,261.1,70% of total billed charges,35.51,100% of CMS fee schedule,173.16,100% of CMS fee schedule,279.75,75% of total billed charges,19.09,100% of CMS fee schedule,317.05,85% of total billed charges,279.75,75% of total billed charges,81.79,100% of CMS APC rate,100.71,27% of total billed charges,26.69,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,223.8,60% of total billed charges,125.33,33.6% of total billed charges,79.9,227% of AR fee schedule,82.3,233.81% of AR fee schedule,79.9,227% of AR fee schedule,261.1,pays based on per visit rate,287.21,77% of total billed charges,242.45,65% of total billed charges,373,100% of total billed charges,373,100% of total billed charges,279.75,75% of total billed charges,12.66,100% of SHARP fee schedule,186.5,50% of total billed charges,68.5,100% of SPREEMO fee schedule,354.35,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,317.05,85% of total billed charges,81.79,100% of CMS apc rate,12.66,373,279.75
Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW 3 VIEWS LEFT,320,336,143.14,175% of CMS APC rate,275.52,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,35.2,100% of AR fee schedule,68.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,19.09,100% of CMS fee schedule,35.51,100% of CMS fee schedule,81.79,100% of CMS APC rate,235.2,70% of total billed charges,35.51,100% of CMS fee schedule,173.16,100% of CMS fee schedule,252,75% of total billed charges,19.09,100% of CMS fee schedule,285.6,85% of total billed charges,252,75% of total billed charges,81.79,100% of CMS APC rate,90.72,27% of total billed charges,26.69,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,201.6,60% of total billed charges,112.9,33.6% of total billed charges,79.9,227% of AR fee schedule,82.3,233.81% of AR fee schedule,79.9,227% of AR fee schedule,235.2,pays based on per visit rate,258.72,77% of total billed charges,218.4,65% of total billed charges,336,100% of total billed charges,336,100% of total billed charges,252,75% of total billed charges,12.66,100% of SHARP fee schedule,168,50% of total billed charges,68.5,100% of SPREEMO fee schedule,319.2,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,285.6,85% of total billed charges,81.79,100% of CMS apc rate,12.66,336,252.00
Outpatient Medical Services,RADIOLOGY,73110,XR WRIST W OBLIQUES RIGHT,320,381,143.14,175% of CMS APC rate,312.42,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,37.77,100% of AR fee schedule,67,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,25.91,100% of CMS fee schedule,38.33,100% of CMS fee schedule,81.79,100% of CMS APC rate,266.7,70% of total billed charges,38.33,100% of CMS fee schedule,173.16,100% of CMS fee schedule,285.75,75% of total billed charges,25.91,100% of CMS fee schedule,323.85,85% of total billed charges,285.75,75% of total billed charges,81.79,100% of CMS APC rate,102.87,27% of total billed charges,33.28,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,228.6,60% of total billed charges,128.02,33.6% of total billed charges,85.74,227% of AR fee schedule,88.31,233.81% of AR fee schedule,85.74,227% of AR fee schedule,266.7,pays based on per visit rate,293.37,77% of total billed charges,247.65,65% of total billed charges,381,100% of total billed charges,381,100% of total billed charges,285.75,75% of total billed charges,12.66,100% of SHARP fee schedule,190.5,50% of total billed charges,67,100% of SPREEMO fee schedule,361.95,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,323.85,85% of total billed charges,81.79,100% of CMS apc rate,12.66,381,285.75
Outpatient Medical Services,RADIOLOGY,73110,XR WRIST W OBLIQUES LEFT,320,392,143.14,175% of CMS APC rate,321.44,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,37.77,100% of AR fee schedule,67,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,25.91,100% of CMS fee schedule,38.33,100% of CMS fee schedule,81.79,100% of CMS APC rate,274.4,70% of total billed charges,38.33,100% of CMS fee schedule,173.16,100% of CMS fee schedule,294,75% of total billed charges,25.91,100% of CMS fee schedule,333.2,85% of total billed charges,294,75% of total billed charges,81.79,100% of CMS APC rate,105.84,27% of total billed charges,33.28,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,235.2,60% of total billed charges,131.71,33.6% of total billed charges,85.74,227% of AR fee schedule,88.31,233.81% of AR fee schedule,85.74,227% of AR fee schedule,274.4,pays based on per visit rate,301.84,77% of total billed charges,254.8,65% of total billed charges,392,100% of total billed charges,392,100% of total billed charges,294,75% of total billed charges,12.66,100% of SHARP fee schedule,196,50% of total billed charges,67,100% of SPREEMO fee schedule,372.4,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,333.2,85% of total billed charges,81.79,100% of CMS apc rate,12.66,392,294.00
Outpatient Medical Services,RADIOLOGY,73130,XR HAND RIGHT,320,380,143.14,175% of CMS APC rate,311.6,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,40,100% of AR fee schedule,76,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,22.5,100% of CMS fee schedule,32.68,100% of CMS fee schedule,81.79,100% of CMS APC rate,266,70% of total billed charges,32.68,100% of CMS fee schedule,173.16,100% of CMS fee schedule,285,75% of total billed charges,22.5,100% of CMS fee schedule,323,85% of total billed charges,285,75% of total billed charges,81.79,100% of CMS APC rate,102.6,27% of total billed charges,29.98,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,228,60% of total billed charges,127.68,33.6% of total billed charges,90.8,227% of AR fee schedule,93.52,233.81% of AR fee schedule,90.8,227% of AR fee schedule,266,pays based on per visit rate,292.6,77% of total billed charges,247,65% of total billed charges,380,100% of total billed charges,380,100% of total billed charges,285,75% of total billed charges,12.66,100% of SHARP fee schedule,190,50% of total billed charges,76,100% of SPREEMO fee schedule,361,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,323,85% of total billed charges,81.79,100% of CMS apc rate,12.66,380,285.00
Outpatient Medical Services,RADIOLOGY,73130,XR HAND LEFT,320,332,143.14,175% of CMS APC rate,272.24,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,40,100% of AR fee schedule,76,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,22.5,100% of CMS fee schedule,32.68,100% of CMS fee schedule,81.79,100% of CMS APC rate,232.4,70% of total billed charges,32.68,100% of CMS fee schedule,173.16,100% of CMS fee schedule,249,75% of total billed charges,22.5,100% of CMS fee schedule,282.2,85% of total billed charges,249,75% of total billed charges,81.79,100% of CMS APC rate,89.64,27% of total billed charges,29.98,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,199.2,60% of total billed charges,111.55,33.6% of total billed charges,90.8,227% of AR fee schedule,93.52,233.81% of AR fee schedule,90.8,227% of AR fee schedule,232.4,pays based on per visit rate,255.64,77% of total billed charges,215.8,65% of total billed charges,332,100% of total billed charges,332,100% of total billed charges,249,75% of total billed charges,12.66,100% of SHARP fee schedule,166,50% of total billed charges,76,100% of SPREEMO fee schedule,315.4,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,282.2,85% of total billed charges,81.79,100% of CMS apc rate,12.66,332,249.00
Outpatient Medical Services,RADIOLOGY,73502,XR HIP AP UNILATERAL RIGHT,320,310,143.14,175% of CMS APC rate,254.2,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,39.49,100% of AR fee schedule,103.97,33.54% of total billed charges,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,29.32,100% of CMS fee schedule,201.5,65% of total billed charges,81.79,100% of CMS APC rate,217,70% of total billed charges,232.5,75% of toal billed charges,173.16,100% of CMS fee schedule,232.5,75% of total billed charges,29.32,100% of CMS fee schedule,263.5,85% of total billed charges,232.5,75% of total billed charges,81.79,100% of CMS APC rate,83.7,27% of total billed charges,38.86,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,186,60% of total billed charges,104.16,33.6% of total billed charges,89.64,227% of AR fee schedule,92.33,233.81% of AR fee schedule,89.64,227% of AR fee schedule,217,pays based on per visit rate,238.7,77% of total billed charges,201.5,65% of total billed charges,310,100% of total billed charges,310,100% of total billed charges,232.5,75% of total billed charges,14.8,100% of SHARP fee schedule,155,50% of total billed charges,103.97,33.54% of total billed charges,294.5,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,263.5,85% of total billed charges,81.79,100% of CMS apc rate,14.8,310,232.50
Outpatient Medical Services,RADIOLOGY,73502,XR HIP AP UNILATERAL LEFT,320,313,143.14,175% of CMS APC rate,256.66,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,39.49,100% of AR fee schedule,104.98,33.54% of total billed charges,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,29.32,100% of CMS fee schedule,203.45,65% of total billed charges,81.79,100% of CMS APC rate,219.1,70% of total billed charges,234.75,75% of toal billed charges,173.16,100% of CMS fee schedule,234.75,75% of total billed charges,29.32,100% of CMS fee schedule,266.05,85% of total billed charges,234.75,75% of total billed charges,81.79,100% of CMS APC rate,84.51,27% of total billed charges,38.86,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,187.8,60% of total billed charges,105.17,33.6% of total billed charges,89.64,227% of AR fee schedule,92.33,233.81% of AR fee schedule,89.64,227% of AR fee schedule,219.1,pays based on per visit rate,241.01,77% of total billed charges,203.45,65% of total billed charges,313,100% of total billed charges,313,100% of total billed charges,234.75,75% of total billed charges,14.8,100% of SHARP fee schedule,156.5,50% of total billed charges,104.98,33.54% of total billed charges,297.35,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,266.05,85% of total billed charges,81.79,100% of CMS apc rate,14.8,313,234.75
Outpatient Medical Services,RADIOLOGY,73523,XR HIP AP LAT & PELVIS BILATERAL,320,833,172.87,175% of CMS APC rate,683.06,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,54.14,100% of AR fee schedule,279.39,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,37.38,100% of CMS fee schedule,541.45,65% of total billed charges,98.78,100% of CMS APC rate,583.1,70% of total billed charges,624.75,75% of toal billed charges,209.5,100% of CMS fee schedule,624.75,75% of total billed charges,37.38,100% of CMS fee schedule,708.05,85% of total billed charges,624.75,75% of total billed charges,98.78,100% of CMS APC rate,224.91,27% of total billed charges,50.88,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,499.8,60% of total billed charges,279.89,33.6% of total billed charges,122.9,227% of AR fee schedule,126.58,233.81% of AR fee schedule,122.9,227% of AR fee schedule,583.1,pays based on per visit rate,641.41,77% of total billed charges,541.45,65% of total billed charges,833,100% of total billed charges,833,100% of total billed charges,624.75,75% of total billed charges,21.16,100% of SHARP fee schedule,416.5,50% of total billed charges,279.39,33.54% of total billed charges,791.35,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,708.05,85% of total billed charges,98.78,100% of CMS apc rate,21.16,833,624.75
Outpatient Medical Services,RADIOLOGY,73562,XR KNEE 3 VIEWS RIGHT,320,385,143.14,175% of CMS APC rate,315.7,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,48,100% of AR fee schedule,85,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,25.6,100% of CMS fee schedule,36.92,100% of CMS fee schedule,81.79,100% of CMS APC rate,269.5,70% of total billed charges,36.92,100% of CMS fee schedule,173.16,100% of CMS fee schedule,288.75,75% of total billed charges,25.6,100% of CMS fee schedule,327.25,85% of total billed charges,288.75,75% of total billed charges,81.79,100% of CMS APC rate,103.95,27% of total billed charges,33.61,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,231,60% of total billed charges,129.36,33.6% of total billed charges,108.96,227% of AR fee schedule,112.23,233.81% of AR fee schedule,108.96,227% of AR fee schedule,269.5,pays based on per visit rate,296.45,77% of total billed charges,250.25,65% of total billed charges,385,100% of total billed charges,385,100% of total billed charges,288.75,75% of total billed charges,13.68,100% of SHARP fee schedule,192.5,50% of total billed charges,85,100% of SPREEMO fee schedule,365.75,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,327.25,85% of total billed charges,81.79,100% of CMS apc rate,13.68,385,288.75
Outpatient Medical Services,RADIOLOGY,73562,XR KNEE 3 VIEWS LEFT,320,378,143.14,175% of CMS APC rate,309.96,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,48,100% of AR fee schedule,85,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,25.6,100% of CMS fee schedule,36.92,100% of CMS fee schedule,81.79,100% of CMS APC rate,264.6,70% of total billed charges,36.92,100% of CMS fee schedule,173.16,100% of CMS fee schedule,283.5,75% of total billed charges,25.6,100% of CMS fee schedule,321.3,85% of total billed charges,283.5,75% of total billed charges,81.79,100% of CMS APC rate,102.06,27% of total billed charges,33.61,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,226.8,60% of total billed charges,127.01,33.6% of total billed charges,108.96,227% of AR fee schedule,112.23,233.81% of AR fee schedule,108.96,227% of AR fee schedule,264.6,pays based on per visit rate,291.06,77% of total billed charges,245.7,65% of total billed charges,378,100% of total billed charges,378,100% of total billed charges,283.5,75% of total billed charges,13.68,100% of SHARP fee schedule,189,50% of total billed charges,85,100% of SPREEMO fee schedule,359.1,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,321.3,85% of total billed charges,81.79,100% of CMS apc rate,13.68,378,283.50
Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE 3 VIEWS RIGHT,320,383,143.14,175% of CMS APC rate,314.06,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,37.4,100% of AR fee schedule,62.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,22.5,100% of CMS fee schedule,33.15,100% of CMS fee schedule,81.79,100% of CMS APC rate,268.1,70% of total billed charges,33.15,100% of CMS fee schedule,173.16,100% of CMS fee schedule,287.25,75% of total billed charges,22.5,100% of CMS fee schedule,325.55,85% of total billed charges,287.25,75% of total billed charges,81.79,100% of CMS APC rate,103.41,27% of total billed charges,29.98,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,229.8,60% of total billed charges,128.69,33.6% of total billed charges,84.9,227% of AR fee schedule,87.44,233.81% of AR fee schedule,84.9,227% of AR fee schedule,268.1,pays based on per visit rate,294.91,77% of total billed charges,248.95,65% of total billed charges,383,100% of total billed charges,383,100% of total billed charges,287.25,75% of total billed charges,12.66,100% of SHARP fee schedule,191.5,50% of total billed charges,62.5,100% of SPREEMO fee schedule,363.85,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,325.55,85% of total billed charges,81.79,100% of CMS apc rate,12.66,383,287.25
Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE 3 VIEWS LEFT,320,373,143.14,175% of CMS APC rate,305.86,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,37.4,100% of AR fee schedule,62.5,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,22.5,100% of CMS fee schedule,33.15,100% of CMS fee schedule,81.79,100% of CMS APC rate,261.1,70% of total billed charges,33.15,100% of CMS fee schedule,173.16,100% of CMS fee schedule,279.75,75% of total billed charges,22.5,100% of CMS fee schedule,317.05,85% of total billed charges,279.75,75% of total billed charges,81.79,100% of CMS APC rate,100.71,27% of total billed charges,29.98,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,223.8,60% of total billed charges,125.33,33.6% of total billed charges,84.9,227% of AR fee schedule,87.44,233.81% of AR fee schedule,84.9,227% of AR fee schedule,261.1,pays based on per visit rate,287.21,77% of total billed charges,242.45,65% of total billed charges,373,100% of total billed charges,373,100% of total billed charges,279.75,75% of total billed charges,12.66,100% of SHARP fee schedule,186.5,50% of total billed charges,62.5,100% of SPREEMO fee schedule,354.35,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,317.05,85% of total billed charges,81.79,100% of CMS apc rate,12.66,373,279.75
Outpatient Medical Services,RADIOLOGY,73630,XR FOOT RIGHT,320,380,143.14,175% of CMS APC rate,311.6,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,44,100% of AR fee schedule,52,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,20.95,100% of CMS fee schedule,32.21,100% of CMS fee schedule,81.79,100% of CMS APC rate,266,70% of total billed charges,32.21,100% of CMS fee schedule,173.16,100% of CMS fee schedule,285,75% of total billed charges,20.95,100% of CMS fee schedule,323,85% of total billed charges,285,75% of total billed charges,81.79,100% of CMS APC rate,102.6,27% of total billed charges,28.19,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,228,60% of total billed charges,127.68,33.6% of total billed charges,99.88,227% of AR fee schedule,102.88,233.81% of AR fee schedule,99.88,227% of AR fee schedule,266,pays based on per visit rate,292.6,77% of total billed charges,247,65% of total billed charges,380,100% of total billed charges,380,100% of total billed charges,285,75% of total billed charges,12.2,100% of SHARP fee schedule,190,50% of total billed charges,52,100% of SPREEMO fee schedule,361,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,323,85% of total billed charges,81.79,100% of CMS apc rate,12.2,380,285.00
Outpatient Medical Services,RADIOLOGY,73630,XR FOOT LEFT,320,382,143.14,175% of CMS APC rate,313.24,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,44,100% of AR fee schedule,52,100% of AR fee schedule,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,20.95,100% of CMS fee schedule,32.21,100% of CMS fee schedule,81.79,100% of CMS APC rate,267.4,70% of total billed charges,32.21,100% of CMS fee schedule,173.16,100% of CMS fee schedule,286.5,75% of total billed charges,20.95,100% of CMS fee schedule,324.7,85% of total billed charges,286.5,75% of total billed charges,81.79,100% of CMS APC rate,103.14,27% of total billed charges,28.19,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,229.2,60% of total billed charges,128.35,33.6% of total billed charges,99.88,227% of AR fee schedule,102.88,233.81% of AR fee schedule,99.88,227% of AR fee schedule,267.4,pays based on per visit rate,294.14,77% of total billed charges,248.3,65% of total billed charges,382,100% of total billed charges,382,100% of total billed charges,286.5,75% of total billed charges,12.2,100% of SHARP fee schedule,191,50% of total billed charges,52,100% of SPREEMO fee schedule,362.9,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,324.7,85% of total billed charges,81.79,100% of CMS apc rate,12.2,382,286.50
Outpatient Medical Services,RADIOLOGY,74018,XR ABDOMEN FLAT/KUB,320,240,143.14,175% of CMS APC rate,196.8,82% total billed charges,81.79,100% of CMS APC rate,84.24,103% of CMS APC rate,31.34,100% of AR fee schedule,80.5,33.54% of total billed charges,73.67,100% of BCBS fee schedule,73.67,100% of BCBS fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,166.72,100% of CIGNA fee schedule,17.23,100% of CMS fee schedule,156,65% of total billed charges,81.79,100% of CMS APC rate,168,70% of total billed charges,180,75% of toal billed charges,173.16,100% of CMS fee schedule,180,75% of total billed charges,17.23,100% of CMS fee schedule,204,85% of total billed charges,180,75% of total billed charges,81.79,100% of CMS APC rate,64.8,27% of total billed charges,25.23,100% of OK fee schedule,39.88,100% of TX fee schedule,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,144,60% of total billed charges,80.64,33.6% of total billed charges,71.14,227% of AR fee schedule,73.28,233.81% of AR fee schedule,71.14,227% of AR fee schedule,168,pays based on per visit rate,184.8,77% of total billed charges,156,65% of total billed charges,240,100% of total billed charges,240,100% of total billed charges,180,75% of total billed charges,12.4,100% of SHARP fee schedule,120,50% of total billed charges,80.5,33.54% of total billed charges,228,95% of total billed charges,81.79,100% of CMS APC rate,81.79,100% of CMS APC rate,N/A,not seperately reimbursable,81.79,100% of CMS APC rate,204,85% of total billed charges,81.79,100% of CMS apc rate,12.4,240,180.00
Outpatient Medical Services,RADIOLOGY,74019,XR ABD FLAT/UPRIGHT,320,98,172.87,175% of CMS APC rate,80.36,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,38.38,100% of AR fee schedule,32.87,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98,100% of CIGNA fee schedule,20.95,100% of CMS fee schedule,63.7,65% of total billed charges,98.78,100% of CMS APC rate,68.6,70% of total billed charges,73.5,75% of toal billed charges,209.5,100% of CMS fee schedule,73.5,75% of total billed charges,20.95,100% of CMS fee schedule,83.3,85% of total billed charges,73.5,75% of total billed charges,98.78,100% of CMS APC rate,26.46,27% of total billed charges,31.11,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,58.8,60% of total billed charges,32.93,33.6% of total billed charges,87.12,227% of AR fee schedule,89.74,233.81% of AR fee schedule,87.12,227% of AR fee schedule,68.6,pays based on per visit rate,75.46,77% of total billed charges,63.7,65% of total billed charges,98,100% of total billed charges,98,100% of total billed charges,73.5,75% of total billed charges,15.8,100% of SHARP fee schedule,49,50% of total billed charges,32.87,33.54% of total billed charges,93.1,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,83.3,85% of total billed charges,98.78,100% of CMS apc rate,15.8,209.5,73.50
Outpatient Medical Services,RADIOLOGY,76000,RF FLUORO UNDER 1 HOUR,320,1054,392.96,175% of CMS APC rate,864.28,82% total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,22.39,100% of AR ASC tier groupings rate,353.51,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,449.57,100% of CIGNA fee schedule,22.81,100% of CMS fee schedule,95.72,100% of CMS fee schedule,224.54,100% of CMS APC rate,737.8,70% of total billed charges,95.72,100% of CMS fee schedule,466.94,100% of CMS fee schedule,790.5,75% of total billed charges,22.81,100% of CMS fee schedule,895.9,85% of total billed charges,790.5,75% of total billed charges,224.54,100% of CMS APC rate,284.58,27% of total billed charges,36.46,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,632.4,60% of total billed charges,354.14,33.6% of total billed charges,50.83,227% of AR ASC tier groupings rate,52.35,233.81% of AR ASC tier groupings rate,50.83,227% of AR ASC tier groupings rate,737.8,pays based on per visit rate,811.58,77% of total billed charges,685.1,65% of total billed charges,1054,100% of total billed charges,1054,100% of total billed charges,790.5,75% of total billed charges,22.11,100% of SHARP fee schedule,527,50% of total billed charges,353.51,33.54% of total billed charges,1001.3,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,895.9,85% of total billed charges,224.54,100% of CMS apc rate,22.11,1054,790.50
Outpatient Medical Services,RADIOLOGY,77080,DX DUAL BONE DENSITY ST,320,452,172.87,175% of CMS APC rate,370.64,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,22.12,100% of AR ASC tier groupings rate,151.6,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,25.6,100% of CMS fee schedule,116.78,100% of CMS fee schedule,98.78,100% of CMS APC rate,316.4,70% of total billed charges,116.78,100% of CMS fee schedule,209.5,100% of CMS fee schedule,339,75% of total billed charges,25.6,100% of CMS fee schedule,384.2,85% of total billed charges,339,75% of total billed charges,98.78,100% of CMS APC rate,122.04,27% of total billed charges,90.7,100% of OK APC rate,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,271.2,60% of total billed charges,151.87,33.6% of total billed charges,50.21,227% of AR ASC tier groupings rate,51.72,233.81% of AR ASC tier groupings rate,50.21,227% of AR ASC tier groupings rate,316.4,pays based on per visit rate,348.04,77% of total billed charges,293.8,65% of total billed charges,452,100% of total billed charges,452,100% of total billed charges,339,75% of total billed charges,13.42,100% of SHARP fee schedule,226,50% of total billed charges,151.6,33.54% of total billed charges,429.4,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,384.2,85% of total billed charges,98.78,100% of CMS apc rate,13.42,452,339.00
Outpatient Medical Services,RADIOLOGY,74176,CT ABDOMEN/PELVIS W/O CONTRAST,350,3540,392.96,175% of CMS APC rate,951.77,100% of total billed charges,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,87.38,100% of AR ASC tier groupings rate,1187.32,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,645.31,60% of total billed charges,97.84,100% of CMS fee schedule,892,100% of CMS fee schedule,224.54,100% of CMS APC rate,2478,70% of total billed charges,973,100% of CMS fee schedule,466.94,100% of CMS fee schedule,775,pays based on per visit rate,97.84,100% of CMS fee schedule,3009,85% of total billed charges,1039,pays based on per visit rate,224.54,100% of CMS APC rate,955.8,27% of total billed charges,175.2,100% of OK fee schedule,149.14,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,2000,pays based on per visit rate,1189.44,33.6% of total billed charges,198.35,227% of AR ASC tier groupings rate,204.3,233.81% of AR ASC tier groupings rate,198.35,227% of AR ASC tier groupings rate,2478,70% of total billed charges,2725.8,77% of CMS fee schedule,2301,65% of total billed charges,3540,100% of total billed charges,3540,100% of total billed charges,2655,75% of total billed charges,118.44,100% of SHARP fee schedule,1770,50% of total billed charges,1187.32,33.54% of total billed charges,3363,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,N/A,not seperately reimbursable,224.54,100% of CMS APC rate,3009,85% of total billed charges,224.54,100% of CMS apc rate,87.38,3540,2655.00
Outpatient Medical Services,RADIOLOGY,74177,CT ABDOMEN/PELVIS W/CONTRAST,350,6542,580.57,175% of CMS APC rate,1128.59,100% of total billed charges,331.76,100% of CMS APC rate,341.7,103% of CMS APC rate,155.01,100% of AR ASC tier groupings rate,2194.19,33.54% of total billed charges,352.49,100% of BCBS fee schedule,352.49,100% of BCBS fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,645.31,60% of total billed charges,204.98,100% of CMS fee schedule,892,100% of CMS fee schedule,331.76,100% of CMS APC rate,4579.4,70% of total billed charges,973,100% of CMS fee schedule,732.84,100% of CMS fee schedule,775,pays based on per visit rate,204.98,100% of CMS fee schedule,5560.7,85% of total billed charges,1039,pays based on per visit rate,331.76,100% of CMS APC rate,1766.34,27% of total billed charges,282.68,100% of OK fee schedule,162.26,100% of TX fee schedule,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,2000,pays based on per visit rate,2198.11,33.6% of total billed charges,351.87,227% of AR ASC tier groupings rate,362.43,233.81% of AR ASC tier groupings rate,351.87,227% of AR ASC tier groupings rate,4579.4,70% of total billed charges,5037.34,77% of CMS fee schedule,4252.3,65% of total billed charges,6542,100% of total billed charges,6542,100% of total billed charges,4906.5,75% of total billed charges,124.21,100% of SHARP fee schedule,3271,50% of total billed charges,2194.19,33.54% of total billed charges,6214.9,95% of total billed charges,331.76,100% of CMS APC rate,331.76,100% of CMS APC rate,N/A,not seperately reimbursable,331.76,100% of CMS APC rate,5560.7,85% of total billed charges,331.76,100% of CMS apc rate,124.21,6542,4906.50
Outpatient Medical Services,RADIOLOGY,70450,CT BRAIN W/O CONTRAST,351,375,172.87,175% of CMS APC rate,898.88,100% of total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,458,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,645.31,60% of total billed charges,63.11,100% of CMS fee schedule,892,100% of CMS fee schedule,98.78,100% of CMS APC rate,262.5,70% of total billed charges,973,100% of CMS fee schedule,261.88,100% of CMS fee schedule,775,pays based on per visit rate,63.11,100% of CMS fee schedule,318.75,85% of total billed charges,1039,pays based on per visit rate,98.78,100% of CMS APC rate,101.25,27% of total billed charges,100.54,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,2000,pays based on per visit rate,126,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,262.5,70% of total billed charges,288.75,77% of CMS fee schedule,243.75,65% of total billed charges,375,100% of total billed charges,375,100% of total billed charges,281.25,75% of total billed charges,57.77,100% of SHARP fee schedule,187.5,50% of total billed charges,458,100% of SPREEMO fee schedule,356.25,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,318.75,85% of total billed charges,98.78,100% of CMS apc rate,45.83,2000,281.25
Outpatient Medical Services,RADIOLOGY,70486,CT FACIAL W/O CON,351,439,172.87,175% of CMS APC rate,931.1,100% of total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,147.24,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,645.31,60% of total billed charges,83.58,100% of CMS fee schedule,892,100% of CMS fee schedule,98.78,100% of CMS APC rate,307.3,70% of total billed charges,973,100% of CMS fee schedule,261.88,100% of CMS fee schedule,775,pays based on per visit rate,83.58,100% of CMS fee schedule,373.15,85% of total billed charges,1039,pays based on per visit rate,98.78,100% of CMS APC rate,118.53,27% of total billed charges,120.6,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,2000,pays based on per visit rate,147.5,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,307.3,70% of total billed charges,338.03,77% of CMS fee schedule,285.35,65% of total billed charges,439,100% of total billed charges,439,100% of total billed charges,329.25,75% of total billed charges,58.21,100% of SHARP fee schedule,219.5,50% of total billed charges,147.24,33.54% of total billed charges,417.05,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,373.15,85% of total billed charges,98.78,100% of CMS apc rate,45.83,2000,329.25
Outpatient Medical Services,RADIOLOGY,71250,CT CHEST W/O CONTRA,352,418,172.87,175% of CMS APC rate,923.05,100% of total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,630,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,645.31,60% of total billed charges,86.99,100% of CMS fee schedule,892,100% of CMS fee schedule,98.78,100% of CMS APC rate,292.6,70% of total billed charges,973,100% of CMS fee schedule,261.88,100% of CMS fee schedule,775,pays based on per visit rate,86.99,100% of CMS fee schedule,355.3,85% of total billed charges,1039,pays based on per visit rate,98.78,100% of CMS APC rate,112.86,27% of total billed charges,137.66,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,2000,pays based on per visit rate,140.45,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,292.6,70% of total billed charges,321.86,77% of CMS fee schedule,271.7,65% of total billed charges,418,100% of total billed charges,418,100% of total billed charges,313.5,75% of total billed charges,79.19,100% of SHARP fee schedule,209,50% of total billed charges,630,100% of SPREEMO fee schedule,397.1,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,355.3,85% of total billed charges,98.78,100% of CMS apc rate,45.83,2000,313.50
Outpatient Medical Services,RADIOLOGY,72125,CT CERVICAL SP 5-7 W/O CONTRAS,352,506,172.87,175% of CMS APC rate,924,100% of total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,431,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,645.31,60% of total billed charges,91.64,100% of CMS fee schedule,892,100% of CMS fee schedule,98.78,100% of CMS APC rate,354.2,70% of total billed charges,973,100% of CMS fee schedule,209.5,100% of CMS fee schedule,775,pays based on per visit rate,91.64,100% of CMS fee schedule,430.1,85% of total billed charges,1039,pays based on per visit rate,98.78,100% of CMS APC rate,136.62,27% of total billed charges,134.95,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,2000,pays based on per visit rate,170.02,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,354.2,70% of total billed charges,389.62,77% of CMS fee schedule,328.9,65% of total billed charges,506,100% of total billed charges,506,100% of total billed charges,379.5,75% of total billed charges,72.62,100% of SHARP fee schedule,253,50% of total billed charges,431,100% of SPREEMO fee schedule,480.7,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,430.1,85% of total billed charges,98.78,100% of CMS apc rate,45.83,2000,379.50
Outpatient Medical Services,RADIOLOGY,72131,CT LUMBAR SPINE W/O CONTRAST,352,521,172.87,175% of CMS APC rate,923.05,100% of total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,431,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,645.31,60% of total billed charges,91.02,100% of CMS fee schedule,892,100% of CMS fee schedule,98.78,100% of CMS APC rate,364.7,70% of total billed charges,973,100% of CMS fee schedule,209.5,100% of CMS fee schedule,775,pays based on per visit rate,91.02,100% of CMS fee schedule,442.85,85% of total billed charges,1039,pays based on per visit rate,98.78,100% of CMS APC rate,140.67,27% of total billed charges,90.7,100% of OK APC rate,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,2000,pays based on per visit rate,175.06,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,364.7,70% of total billed charges,401.17,77% of CMS fee schedule,338.65,65% of total billed charges,521,100% of total billed charges,521,100% of total billed charges,390.75,75% of total billed charges,68.23,100% of SHARP fee schedule,260.5,50% of total billed charges,431,100% of SPREEMO fee schedule,494.95,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,442.85,85% of total billed charges,98.78,100% of CMS apc rate,45.83,2000,390.75
Outpatient Medical Services,RADIOLOGY,77061,MM TOMO DIAGNOSTIC UNILATERAL MAMMO,401,258,N/A,not seperately reimbursable,211.56,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,109.69,100% of AR fee schedule,86.53,33.54% of total billed charges,84.34,100% of BCBS fee schedule,84.34,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,154.27,100% of CIGNA fee schedule,N/A,not seperately reimbursable,167.7,65% of total billed charges,N/A,not seperately reimbursable,180.6,70% of total billed charges,193.5,75% of toal billed charges,301.7,100% of CMS fee schedule,193.5,75% of total billed charges,N/A,not seperately reimbursable,219.3,85% of total billed charges,193.5,75% of total billed charges,N/A,not seperately reimbursable,69.66,27% of total billed charges,N/A,not seperately reimbursable,59.34,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,154.8,60% of total billed charges,86.69,33.6% of total billed charges,249,227% of AR fee schedule,256.47,233.81% of AR fee schedule,249,227% of AR fee schedule,180.6,70% of total billed charges,198.66,77% of total billed charges,167.7,65% of total billed charges,258,100% of total billed charges,258,100% of total billed charges,193.5,75% of total billed charges,52.05,100% of SHARP fee schedule,129,50% of total billed charges,86.53,33.54% of total billed charges,245.1,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.3,85% of total billed charges,N/A,not seperately reimbursable,52.05,301.7,193.50
Outpatient Medical Services,RADIOLOGY,77062,MM TOMO DIAGNOSTIC BILATERAL MAMMO,401,317,N/A,not seperately reimbursable,259.94,82% total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,140.81,100% of AR fee schedule,106.32,33.54% of total billed charges,107.56,100% of BCBS fee schedule,107.56,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,197.68,100% of CIGNA fee schedule,N/A,not seperately reimbursable,206.05,65% of total billed charges,N/A,not seperately reimbursable,221.9,70% of total billed charges,237.75,75% of toal billed charges,358.72,100% of CMS fee schedule,237.75,75% of total billed charges,N/A,not seperately reimbursable,269.45,85% of total billed charges,237.75,75% of total billed charges,N/A,not seperately reimbursable,85.59,27% of total billed charges,N/A,not seperately reimbursable,72.91,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,190.2,60% of total billed charges,106.51,33.6% of total billed charges,319.64,227% of AR fee schedule,329.23,233.81% of AR fee schedule,319.64,227% of AR fee schedule,221.9,70% of total billed charges,244.09,77% of total billed charges,206.05,65% of total billed charges,317,100% of total billed charges,317,100% of total billed charges,237.75,75% of total billed charges,64.6,100% of SHARP fee schedule,158.5,50% of total billed charges,106.32,33.54% of total billed charges,301.15,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,269.45,85% of total billed charges,N/A,not seperately reimbursable,64.6,358.72,237.75
Outpatient Medical Services,RADIOLOGY,77066,MM DIAGNOSTIC MAMMO/CAD BILATERAL,401,245,162.68,175% of CMS fee schedule,200.9,82% total billed charges,92.96,100% of CMS fee schedule,95.75,103% of CMS fee schedule,182.79,100% of AR fee schedule,82.17,33.54% of total billed charges,107.56,100% of BCBS fee schedule,107.56,100% of BCBS fee schedule,92.96,100% of CMS fee schedule,92.96,100% of CMS fee schedule,197.68,100% of CIGNA fee schedule,103.42,100% of CMS fee schedule,159.25,65% of total billed charges,92.96,100% of CMS fee schedule,171.5,70% of total billed charges,183.75,75% of toal billed charges,260.32,100% of CMS fee schedule,183.75,75% of total billed charges,103.42,100% of CMS fee schedule,208.25,85% of total billed charges,183.75,75% of total billed charges,92.96,100% of CMS fee schedule,66.15,27% of total billed charges,146.32,100% of OK fee schedule,56.35,23% of total billed charges,92.96,100% of CMS fee schedule,92.96,100% of CMS fee schedule,92.96,100% of CMS fee schedule,147,60% of total billed charges,152.55,100% of CMS fee schedule,414.93,227% of AR fee schedule,427.38,233.81% of AR fee schedule,414.93,227% of AR fee schedule,171.5,70% of total billed charges,188.65,77% of total billed charges,159.25,65% of total billed charges,245,100% of total billed charges,245,100% of total billed charges,183.75,75% of total billed charges,66.03,100% of SHARP fee schedule,122.5,50% of total billed charges,82.17,33.54% of total billed charges,232.75,95% of total billed charges,92.96,100% of CMS fee schedule,92.96,100% of CMS fee schedule,N/A,not seperately reimbursable,92.96,100% of CMS fee schedule,208.25,85% of total billed charges,92.96,100% of CMS fee schedule,56.35,427.38,183.75
Outpatient Medical Services,RADIOLOGY,76536,US THYROID,402,311,172.87,175% of CMS APC rate,255.02,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,94.6,100% of AR fee schedule,168,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,76.45,100% of CMS fee schedule,125.82,100% of CMS fee schedule,98.78,100% of CMS APC rate,217.7,70% of total billed charges,125.82,100% of CMS fee schedule,209.5,100% of CMS fee schedule,233.25,75% of total billed charges,76.45,100% of CMS fee schedule,264.35,85% of total billed charges,233.25,75% of total billed charges,98.78,100% of CMS APC rate,83.97,27% of total billed charges,100.03,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,186.6,60% of total billed charges,104.5,33.6% of total billed charges,214.74,227% of AR fee schedule,221.18,233.81% of AR fee schedule,214.74,227% of AR fee schedule,217.7,70% of total billed charges,239.47,77% of total billed charges,202.15,65% of total billed charges,311,100% of total billed charges,311,100% of total billed charges,233.25,75% of total billed charges,38.22,100% of SHARP fee schedule,155.5,50% of total billed charges,168,100% of SPREEMO fee schedule,295.45,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,264.35,85% of total billed charges,98.78,100% of CMS apc rate,38.22,311,233.25
Outpatient Medical Services,RADIOLOGY,76641,US BREAST UNILAT LT,402,601,172.87,175% of CMS APC rate,492.82,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,108.89,100% of AR fee schedule,201.58,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,61.56,100% of CMS fee schedule,390.65,65% of total billed charges,98.78,100% of CMS APC rate,420.7,70% of total billed charges,450.75,75% of toal billed charges,209.5,100% of CMS fee schedule,450.75,75% of total billed charges,61.56,100% of CMS fee schedule,510.85,85% of total billed charges,450.75,75% of total billed charges,98.78,100% of CMS APC rate,162.27,27% of total billed charges,93.2,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,360.6,60% of total billed charges,201.94,33.6% of total billed charges,247.18,227% of AR fee schedule,254.6,233.81% of AR fee schedule,247.18,227% of AR fee schedule,420.7,70% of total billed charges,462.77,77% of total billed charges,390.65,65% of total billed charges,601,100% of total billed charges,601,100% of total billed charges,450.75,75% of total billed charges,49.69,100% of SHARP fee schedule,300.5,50% of total billed charges,201.58,33.54% of total billed charges,570.95,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,510.85,85% of total billed charges,98.78,100% of CMS apc rate,49.69,601,450.75
Outpatient Medical Services,RADIOLOGY,76641,US BREAST UNILAT RT,402,612,172.87,175% of CMS APC rate,501.84,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,108.89,100% of AR fee schedule,205.26,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,61.56,100% of CMS fee schedule,397.8,65% of total billed charges,98.78,100% of CMS APC rate,428.4,70% of total billed charges,459,75% of toal billed charges,209.5,100% of CMS fee schedule,459,75% of total billed charges,61.56,100% of CMS fee schedule,520.2,85% of total billed charges,459,75% of total billed charges,98.78,100% of CMS APC rate,165.24,27% of total billed charges,93.2,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,367.2,60% of total billed charges,205.63,33.6% of total billed charges,247.18,227% of AR fee schedule,254.6,233.81% of AR fee schedule,247.18,227% of AR fee schedule,428.4,70% of total billed charges,471.24,77% of total billed charges,397.8,65% of total billed charges,612,100% of total billed charges,612,100% of total billed charges,459,75% of total billed charges,49.69,100% of SHARP fee schedule,306,50% of total billed charges,205.26,33.54% of total billed charges,581.4,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,520.2,85% of total billed charges,98.78,100% of CMS apc rate,49.69,612,459.00
Outpatient Medical Services,RADIOLOGY,76705,US ABD (SPECIFY OR,402,895,172.87,175% of CMS APC rate,733.9,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,126,100% of AR fee schedule,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,53.81,100% of CMS fee schedule,107.95,100% of CMS fee schedule,98.78,100% of CMS APC rate,626.5,70% of total billed charges,107.95,100% of CMS fee schedule,209.5,100% of CMS fee schedule,671.25,75% of total billed charges,53.81,100% of CMS fee schedule,760.75,85% of total billed charges,671.25,75% of total billed charges,98.78,100% of CMS APC rate,241.65,27% of total billed charges,79.19,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,537,60% of total billed charges,300.72,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,626.5,70% of total billed charges,689.15,77% of CMS fee schedule,581.75,65% of total billed charges,895,100% of total billed charges,895,100% of total billed charges,671.25,75% of total billed charges,39.74,100% of SHARP fee schedule,447.5,50% of total billed charges,126,100% of SPREEMO fee schedule,850.25,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,760.75,85% of total billed charges,98.78,100% of CMS apc rate,39.74,895,671.25
Outpatient Medical Services,RADIOLOGY,76775,US RENAL,402,782,172.87,175% of CMS APC rate,641.24,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,61.63,100% of AR fee schedule,262.28,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,25.91,100% of CMS fee schedule,114.53,100% of CMS fee schedule,98.78,100% of CMS APC rate,547.4,70% of total billed charges,114.53,100% of CMS fee schedule,209.5,100% of CMS fee schedule,586.5,75% of total billed charges,25.91,100% of CMS fee schedule,664.7,85% of total billed charges,586.5,75% of total billed charges,98.78,100% of CMS APC rate,211.14,27% of total billed charges,51.91,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,469.2,60% of total billed charges,262.75,33.6% of total billed charges,139.9,227% of AR fee schedule,144.1,233.81% of AR fee schedule,139.9,227% of AR fee schedule,547.4,70% of total billed charges,602.14,77% of CMS fee schedule,508.3,65% of total billed charges,782,100% of total billed charges,782,100% of total billed charges,586.5,75% of total billed charges,39.23,100% of SHARP fee schedule,391,50% of total billed charges,262.28,33.54% of total billed charges,742.9,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,664.7,85% of total billed charges,98.78,100% of CMS apc rate,25.91,782,586.50
Outpatient Medical Services,RADIOLOGY,76830,US TRANSVAGINAL,402,890,172.87,175% of CMS APC rate,729.8,82% total billed charges,98.78,100% of CMS APC rate,101.74,103% of CMS APC rate,45.83,100% of AR ASC tier groupings rate,298.51,33.54% of total billed charges,103.47,100% of BCBS fee schedule,103.47,100% of BCBS fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,201.72,100% of CIGNA fee schedule,77.07,100% of CMS fee schedule,126.29,100% of CMS fee schedule,98.78,100% of CMS APC rate,623,70% of total billed charges,126.29,100% of CMS fee schedule,209.5,100% of CMS fee schedule,667.5,75% of total billed charges,77.07,100% of CMS fee schedule,756.5,85% of total billed charges,667.5,75% of total billed charges,98.78,100% of CMS APC rate,240.3,27% of total billed charges,106.52,100% of OK fee schedule,73.48,100% of TX fee schedule,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,534,60% of total billed charges,299.04,33.6% of total billed charges,104.03,227% of AR ASC tier groupings rate,107.16,233.81% of AR ASC tier groupings rate,104.03,227% of AR ASC tier groupings rate,623,70% of total billed charges,685.3,77% of total billed charges,578.5,65% of total billed charges,890,100% of total billed charges,890,100% of total billed charges,667.5,75% of total billed charges,47.25,100% of SHARP fee schedule,445,50% of total billed charges,298.51,33.54% of total billed charges,845.5,95% of total billed charges,98.78,100% of CMS APC rate,98.78,100% of CMS APC rate,N/A,not seperately reimbursable,98.78,100% of CMS APC rate,756.5,85% of total billed charges,98.78,100% of CMS apc rate,45.83,890,667.50
Outpatient Medical Services,RADIOLOGY,77063,MM TOMO SCREENING MAMMO BILATERAL,403,84,35.04,175% of CMS fee schedule,68.88,82% total billed charges,20.02,100% of CMS fee schedule,20.62,103% of CMS fee schedule,60.95,100% of AR fee schedule,28.17,33.54% of total billed charges,40.88,100% of BCBS fee schedule,40.88,100% of BCBS fee schedule,20.02,100% of CMS fee schedule,20.02,100% of CMS fee schedule,42.46,100% of CIGNA fee schedule,21.7,100% of CMS fee schedule,54.6,65% of total billed charges,20.02,100% of CMS fee schedule,58.8,70% of total billed charges,63,75% of toal billed charges,87.07,100% of CMS fee schedule,63,75% of total billed charges,21.7,100% of CMS fee schedule,71.4,85% of total billed charges,63,75% of total billed charges,20.02,100% of CMS fee schedule,22.68,27% of total billed charges,N/A,not seperately reimbursable,19.32,23% of total billed charges,20.02,100% of CMS fee schedule,20.02,100% of CMS fee schedule,20.02,100% of CMS fee schedule,50.4,60% of total billed charges,22.31,100% of CMS fee schedule,138.36,227% of AR fee schedule,142.51,233.81% of AR fee schedule,138.36,227% of AR fee schedule,58.8,70% of total billed charges,64.68,77% of total billed charges,54.6,65% of total billed charges,84,100% of total billed charges,84,100% of total billed charges,63,75% of total billed charges,39.37,100% of SHARP fee schedule,42,50% of total billed charges,28.17,33.54% of total billed charges,79.8,95% of total billed charges,20.02,100% of CMS fee schedule,20.02,100% of CMS fee schedule,N/A,not seperately reimbursable,20.02,100% of CMS fee schedule,71.4,85% of total billed charges,20.02,100% of CMS fee schedule,19.32,142.51,63.00
Outpatient Medical Services,RADIOLOGY,77067,MM DIGITAL SCREENING MAMMO/CAD BILATERAL,403,209,134.65,175% of CMS fee schedule,171.38,82% total billed charges,76.94,100% of CMS fee schedule,79.25,103% of CMS fee schedule,144.14,100% of AR fee schedule,70.1,33.54% of total billed charges,89.18,100% of BCBS fee schedule,89.18,100% of BCBS fee schedule,76.94,100% of CMS fee schedule,76.94,100% of CMS fee schedule,163.11,100% of CIGNA fee schedule,85.75,100% of CMS fee schedule,135.85,65% of total billed charges,76.94,100% of CMS fee schedule,146.3,70% of total billed charges,156.75,75% of toal billed charges,209.74,100% of CMS fee schedule,156.75,75% of total billed charges,85.75,100% of CMS fee schedule,177.65,85% of total billed charges,156.75,75% of total billed charges,76.94,100% of CMS fee schedule,56.43,27% of total billed charges,118.45,100% of OK fee schedule,48.07,23% of total billed charges,76.94,100% of CMS fee schedule,76.94,100% of CMS fee schedule,76.94,100% of CMS fee schedule,125.4,60% of total billed charges,122.98,100% of CMS fee schedule,327.2,227% of AR fee schedule,337.01,233.81% of AR fee schedule,327.2,227% of AR fee schedule,146.3,70% of total billed charges,160.93,77% of total billed charges,135.85,65% of total billed charges,209,100% of total billed charges,209,100% of total billed charges,156.75,75% of total billed charges,49.98,100% of SHARP fee schedule,104.5,50% of total billed charges,70.1,33.54% of total billed charges,198.55,95% of total billed charges,76.94,100% of CMS fee schedule,76.94,100% of CMS fee schedule,N/A,not seperately reimbursable,76.94,100% of CMS fee schedule,177.65,85% of total billed charges,76.94,100% of CMS fee schedule,48.07,337.01,156.75
Outpatient Medical Services,RADIOLOGY,Q9967,CONTRAST OPTIRAY 300,636,2,N/A,not seperately reimbursable,0.15,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.67,33.54% of total billed charges,0.17,100% of BCBS fee schedule,0.17,100% of BCBS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.3,65% of total billed charges,N/A,not seperately reimbursable,1.4,70% of total billed charges,0.13,106% of CMS fee schedule,0.16,100% of CMS fee schedule,1.5,75% of total billed charges,N/A,not seperately reimbursable,1.7,85% of total billed charges,1.5,75% of total billed charges,N/A,not seperately reimbursable,0.54,27% of total billed charges,N/A,not seperately reimbursable,0.46,23% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.15,60% of total billed charges,0.67,33.6% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.4,70% of total billed charges,1.54,77% of total billed charges,1.3,65% of total billed charges,2,100% of total billed charges,2,100% of total billed charges,1.5,75% of total billed charges,N/A,not seperately reimbursable,1,50% of total billed charges,0.67,33.54% of total billed charges,1.9,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.7,85% of total billed charges,N/A,not seperately reimbursable,0.13,2,1.50
Outpatient Medical Services,RADIOLOGY,93880,US CAROTID DUPLEX DOPPL,921,467,392.96,175% of CMS APC rate,196.06,148% of CMS fe schedule,224.54,100% of CMS APC rate,231.28,103% of CMS APC rate,70,100% of AR fee schedule,156.63,33.54% of total billed charges,215.12,100% of BCBS fee schedule,215.12,100% of BCBS fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,280.2,60% of total billed charges,139.57,100% of CMS fee schedule,303.55,65% of total billed charges,224.54,100% of CMS APC rate,326.9,70% of total billed charges,350.25,75% of toal billed charges,420.25,100% of CMS fee schedule,350.25,75% of total billed charges,N/A,not seperately reimbursable,396.95,85% of total billed charges,350.25,75% of total billed charges,224.54,100% of CMS APC rate,126.09,27% of total billed charges,188.57,100% of OK APC rate,148.02,100% of TX fee schedule,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,280.2,60% of total billed charges,156.91,33.6% of total billed charges,158.9,227% of AR fee schedule,163.67,233.81% of AR fee schedule,158.9,227% of AR fee schedule,326.9,70% of total billed charges,359.59,77% of total billed charges,303.55,65% of total billed charges,467,100% of total billed charges,467,100% of total billed charges,350.25,75% of total billed charges,57.57,100% of SHARP fee schedule,233.5,50% of total billed charges,156.63,33.54% of total billed charges,443.65,95% of total billed charges,224.54,100% of CMS APC rate,224.54,100% of CMS APC rate,329,pays based on per day visit,224.54,100% of CMS APC rate,396.95,85% of total billed charges,224.54,100% of CMS apc rate,57.57,467,350.25
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,LAB,80069,Kidney function panel tes,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,RADIOLOGY,76805,"Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus",402,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED,SERVICE NOT OFFERED
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