hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Wills Memorial Hospital,1/17/2025,2.0.0,Wills Memorial Hospital,"120 Gordon St, Washington, GA 30673",582036813,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Service,Category,Code,Description,Revenue code,Charges,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AMERIGROUP MEDICAID PLAN,AMERIGROUP MEDICAID REIMBURSEMENT METHOD,ANTHEM BCBS MEDICARE PLAN,ANTHEM BCBS MEDICARE REIMBURSEMENT METHOD,CARESOURCE MEDICAID PLAN,CARESOURCE MEDICAID REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,HUMANA MEDICARE  PLAN,HUMANA MEDICARE  REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,PEACHSTATE MEDICAID PLAN,PEACHSTATE MEDICAID REIMBURSEMENT METHOD,PRUITTHEALTH PREMIER PLAN,PRUITTHEALTH PREMIER REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICARE ADVANTAGE PLAN,UHC MEDICARE ADVANTAGE REIMBURSEMENT METHOD,WELLCARE PLAN,WELLCARE REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,AMBULATORY,99381,99381 Preventive Eval Initial New Pt. < 1 year age,521,200,160,80% of total billed charges,126,63% of total billed charges,188.14,pays based on per visit rate,126,63% of total billed charges,170,85% of total billed charges,160,80% of total billed charges,190.02,pays based on per visit rate,126,63% of total billed charges,188.14,pays based on per visit rate,126,63% of total billed charges,188.14,pays based on per visit rate,160,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,126,190.02,140
Outpatient Medical Services,AMBULATORY,99382,99382 Preventive Eval Initial New Pt. 1-4 year age,521,200,160,80% of total billed charges,126,63% of total billed charges,188.14,pays based on per visit rate,126,63% of total billed charges,170,85% of total billed charges,160,80% of total billed charges,190.02,pays based on per visit rate,126,63% of total billed charges,188.14,pays based on per visit rate,126,63% of total billed charges,188.14,pays based on per visit rate,160,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,126,190.02,140
Outpatient Medical Services,AMBULATORY,93000,93000 EKG w/ 12+ leads; Tracing/Interp/Report,730,40,32,80% of total billed charges,25.2,63% of total billed charges,24.8,62% of total billed charges,25.2,63% of total billed charges,34,85% of total billed charges,32,80% of total billed charges,24.8,62% of total billed charges,25.2,63% of total billed charges,24.8,62% of total billed charges,25.2,63% of total billed charges,24.8,62% of total billed charges,32,80% of total billed charges,24.8,62% of total billed charges,24.8,62% of total billed charges,24.8,34,28
Outpatient Medical Services,AMBULATORY,90832,90832 Psychotherapy Session 30 minutes,521,113,90.4,80% of total billed charges,71.19,63% of total billed charges,188.14,pays based on per visit rate,71.19,63% of total billed charges,96.05,85% of total billed charges,90.4,80% of total billed charges,190.02,pays based on per visit rate,71.19,63% of total billed charges,188.14,pays based on per visit rate,71.19,63% of total billed charges,188.14,pays based on per visit rate,90.4,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,71.19,190.02,79.1
Outpatient Medical Services,AMBULATORY,90834,90834 Psychotherapy Session 45 minutes,521,150,120,80% of total billed charges,94.5,63% of total billed charges,188.14,pays based on per visit rate,94.5,63% of total billed charges,127.5,85% of total billed charges,120,80% of total billed charges,190.02,pays based on per visit rate,94.5,63% of total billed charges,188.14,pays based on per visit rate,94.5,63% of total billed charges,188.14,pays based on per visit rate,120,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,94.5,190.02,105
Outpatient Medical Services,AMBULATORY,90837,90837 Psychotherapy Session 60 minutes,521,222,177.6,80% of total billed charges,139.86,63% of total billed charges,188.14,pays based on per visit rate,139.86,63% of total billed charges,188.7,85% of total billed charges,177.6,80% of total billed charges,190.02,pays based on per visit rate,139.86,63% of total billed charges,188.14,pays based on per visit rate,139.86,63% of total billed charges,188.14,pays based on per visit rate,177.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,139.86,190.02,155.4
Outpatient Medical Services,AMBULATORY,90839,90839 Psychotherapy for crisis; first 60 minutes,521,211,168.8,80% of total billed charges,132.93,63% of total billed charges,188.14,pays based on per visit rate,132.93,63% of total billed charges,179.35,85% of total billed charges,168.8,80% of total billed charges,190.02,pays based on per visit rate,132.93,63% of total billed charges,188.14,pays based on per visit rate,132.93,63% of total billed charges,188.14,pays based on per visit rate,168.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,132.93,190.02,147.7
Outpatient Medical Services,AMBULATORY,90840,90840 Psychotherapy for crisis; each additional 30,521,100,80,80% of total billed charges,63,63% of total billed charges,188.14,pays based on per visit rate,63,63% of total billed charges,85,85% of total billed charges,80,80% of total billed charges,190.02,pays based on per visit rate,63,63% of total billed charges,188.14,pays based on per visit rate,63,63% of total billed charges,188.14,pays based on per visit rate,80,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,63,190.02,70
Outpatient Medical Services,AMBULATORY,90845,90845 Psychoanalysis,521,143,114.4,80% of total billed charges,90.09,63% of total billed charges,188.14,pays based on per visit rate,90.09,63% of total billed charges,121.55,85% of total billed charges,114.4,80% of total billed charges,190.02,pays based on per visit rate,90.09,63% of total billed charges,188.14,pays based on per visit rate,90.09,63% of total billed charges,188.14,pays based on per visit rate,114.4,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,90.09,190.02,100.1
Outpatient Medical Services,AMBULATORY,90846,90846 Family Psychotherapy w/o patient 50 minutes,521,146,116.8,80% of total billed charges,91.98,63% of total billed charges,188.14,pays based on per visit rate,91.98,63% of total billed charges,124.1,85% of total billed charges,116.8,80% of total billed charges,190.02,pays based on per visit rate,91.98,63% of total billed charges,188.14,pays based on per visit rate,91.98,63% of total billed charges,188.14,pays based on per visit rate,116.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,91.98,190.02,102.2
Outpatient Medical Services,AMBULATORY,90847,90847 Family Psychotherapy with patient 50 minutes,521,151,120.8,80% of total billed charges,95.13,63% of total billed charges,188.14,pays based on per visit rate,95.13,63% of total billed charges,128.35,85% of total billed charges,120.8,80% of total billed charges,190.02,pays based on per visit rate,95.13,63% of total billed charges,188.14,pays based on per visit rate,95.13,63% of total billed charges,188.14,pays based on per visit rate,120.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,95.13,190.02,105.7
Outpatient Medical Services,LAB,36415,Venous Draw,300,14,11.2,80% of total billed charges,8.82,63% of total billed charges,9.09,100% of CMS fee schedule,8.82,63% of total billed charges,11.9,85% of total billed charges,11.2,80% of total billed charges,9.18,101% of CMS fee schedule,8.82,63% of total billed charges,9.09,100% of CMS fee schedule,8.82,63% of total billed charges,9.09,100% of CMS fee schedule,11.2,80% of total billed charges,9.09,100% of CMS fee schedule,9.27,100% of CMS fee schedule,8.82,11.9,9.8
Outpatient Medical Services,LAB,36416,Capillary,300,14,11.2,80% of total billed charges,8.82,63% of total billed charges,8.68,62% of total billed charges,8.82,63% of total billed charges,11.9,85% of total billed charges,11.2,80% of total billed charges,8.68,62% of total billed charges,8.82,63% of total billed charges,8.68,62% of total billed charges,8.82,63% of total billed charges,8.68,62% of total billed charges,11.2,80% of total billed charges,8.68,62% of total billed charges,8.68,62% of total billed charges,8.68,11.9,9.8
Outpatient Medical Services,LAB,36600,Arterial Draw,300,479,383.2,80% of total billed charges,301.77,63% of total billed charges,296.98,62% of total billed charges,301.77,63% of total billed charges,407.15,85% of total billed charges,383.2,80% of total billed charges,296.98,62% of total billed charges,301.77,63% of total billed charges,296.98,62% of total billed charges,301.77,63% of total billed charges,296.98,62% of total billed charges,383.2,80% of total billed charges,296.98,62% of total billed charges,296.98,62% of total billed charges,296.98,407.15,335.3
Outpatient Medical Services,LAB,80048,Basic Metabolic Panel,301,47,37.6,80% of total billed charges,10.65,100% GA fee schedule,8.46,100% of CMS fee schedule,10.65,100% of GA fee schedule,39.95,85% of total billed charges,37.6,80% of total billed charges,8.54,101% of CMS fee schedule,10.65,100% of GA fee schedule,8.46,100% of CMS fee schedule,10.86,102% of GA fee schedule,8.46,100% of CMS fee schedule,37.6,80% of total billed charges,8.46,100% of CMS fee schedule,8.63,100% of CMS fee schedule,8.46,39.95,32.9
Outpatient Medical Services,LAB,80051,Electrolyte Panel,301,39,31.2,80% of total billed charges,8.82,100% GA fee schedule,7.01,100% of CMS fee schedule,8.82,100% of GA fee schedule,33.15,85% of total billed charges,31.2,80% of total billed charges,7.08,101% of CMS fee schedule,8.82,100% of GA fee schedule,7.01,100% of CMS fee schedule,9,102% of GA fee schedule,7.01,100% of CMS fee schedule,31.2,80% of total billed charges,7.01,100% of CMS fee schedule,7.15,100% of CMS fee schedule,7.01,33.15,27.3
Outpatient Medical Services,LAB,80053,Comprehensive Metabolic Panel,301,59,47.2,80% of total billed charges,13.29,100% GA fee schedule,10.56,100% of CMS fee schedule,13.29,100% of GA fee schedule,50.15,85% of total billed charges,47.2,80% of total billed charges,10.67,101% of CMS fee schedule,13.29,100% of GA fee schedule,10.56,100% of CMS fee schedule,13.56,102% of GA fee schedule,10.56,100% of CMS fee schedule,47.2,80% of total billed charges,10.56,100% of CMS fee schedule,10.77,100% of CMS fee schedule,10.56,50.15,41.3
Outpatient Medical Services,LAB,80061,Lipid Panel,301,74,59.2,80% of total billed charges,16.85,100% GA fee schedule,13.39,100% of CMS fee schedule,16.85,100% of GA fee schedule,62.9,85% of total billed charges,59.2,80% of total billed charges,13.52,101% of CMS fee schedule,16.85,100% of GA fee schedule,13.39,100% of CMS fee schedule,17.19,102% of GA fee schedule,13.39,100% of CMS fee schedule,59.2,80% of total billed charges,13.39,100% of CMS fee schedule,13.66,100% of CMS fee schedule,13.39,62.9,51.8
Outpatient Medical Services,LAB,80069,Renal Function Panel,301,48,38.4,80% of total billed charges,10.92,100% GA fee schedule,8.68,100% of CMS fee schedule,10.92,100% of GA fee schedule,40.8,85% of total billed charges,38.4,80% of total billed charges,8.77,101% of CMS fee schedule,10.92,100% of GA fee schedule,8.68,100% of CMS fee schedule,11.14,102% of GA fee schedule,8.68,100% of CMS fee schedule,38.4,80% of total billed charges,8.68,100% of CMS fee schedule,8.85,100% of CMS fee schedule,8.68,40.8,33.6
Outpatient Medical Services,LAB,80074,Hep Panel (4) LC,301,265,212,80% of total billed charges,59.89,100% GA fee schedule,47.63,100% of CMS fee schedule,59.89,100% of GA fee schedule,225.25,85% of total billed charges,212,80% of total billed charges,48.11,101% of CMS fee schedule,59.89,100% of GA fee schedule,47.63,100% of CMS fee schedule,61.09,102% of GA fee schedule,47.63,100% of CMS fee schedule,212,80% of total billed charges,47.63,100% of CMS fee schedule,48.58,100% of CMS fee schedule,47.63,225.25,185.5
Outpatient Medical Services,LAB,80076,Hepatic Function Panel,301,45,36,80% of total billed charges,10.28,100% GA fee schedule,8.17,100% of CMS fee schedule,10.28,100% of GA fee schedule,38.25,85% of total billed charges,36,80% of total billed charges,8.25,101% of CMS fee schedule,10.28,100% of GA fee schedule,8.17,100% of CMS fee schedule,10.49,102% of GA fee schedule,8.17,100% of CMS fee schedule,36,80% of total billed charges,8.17,100% of CMS fee schedule,8.33,100% of CMS fee schedule,8.17,38.25,31.5
Outpatient Medical Services,LAB,80156,Carbamazepine (Tegretol) LC,301,81,64.8,80% of total billed charges,18.31,100% GA fee schedule,14.57,100% of CMS fee schedule,18.31,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,14.72,101% of CMS fee schedule,18.31,100% of GA fee schedule,14.57,100% of CMS fee schedule,18.68,102% of GA fee schedule,14.57,100% of CMS fee schedule,64.8,80% of total billed charges,14.57,100% of CMS fee schedule,14.86,100% of CMS fee schedule,14.57,68.85,56.7
Outpatient Medical Services,LAB,80162,Digoxin LvL,301,74,59.2,80% of total billed charges,16.7,100% GA fee schedule,13.28,100% of CMS fee schedule,16.7,100% of GA fee schedule,62.9,85% of total billed charges,59.2,80% of total billed charges,13.41,101% of CMS fee schedule,16.7,100% of GA fee schedule,13.28,100% of CMS fee schedule,17.03,102% of GA fee schedule,13.28,100% of CMS fee schedule,59.2,80% of total billed charges,13.28,100% of CMS fee schedule,13.55,100% of CMS fee schedule,13.28,62.9,51.8
Outpatient Medical Services,LAB,80164,"Valproic Acid (Depakote)(R),S LC",301,75,60,80% of total billed charges,14.27,100% GA fee schedule,13.54,100% of CMS fee schedule,14.27,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,13.68,101% of CMS fee schedule,14.27,100% of GA fee schedule,13.54,100% of CMS fee schedule,14.56,102% of GA fee schedule,13.54,100% of CMS fee schedule,60,80% of total billed charges,13.54,100% of CMS fee schedule,13.81,100% of CMS fee schedule,13.54,63.75,52.5
Outpatient Medical Services,LAB,80170,"Gentamicin Serum, Trough LC",301,91,72.8,80% of total billed charges,20.61,100% GA fee schedule,16.38,100% of CMS fee schedule,20.61,100% of GA fee schedule,77.35,85% of total billed charges,72.8,80% of total billed charges,16.54,101% of CMS fee schedule,20.61,100% of GA fee schedule,16.38,100% of CMS fee schedule,21.02,102% of GA fee schedule,16.38,100% of CMS fee schedule,72.8,80% of total billed charges,16.38,100% of CMS fee schedule,16.71,100% of CMS fee schedule,16.38,77.35,63.7
Outpatient Medical Services,LAB,80175,"Lamotrigine (Lamictal), LC",301,60,48,80% of total billed charges,14.47,100% GA fee schedule,13.25,100% of CMS fee schedule,14.47,100% of GA fee schedule,51,85% of total billed charges,48,80% of total billed charges,13.38,101% of CMS fee schedule,14.47,100% of GA fee schedule,13.25,100% of CMS fee schedule,14.76,102% of GA fee schedule,13.25,100% of CMS fee schedule,48,80% of total billed charges,13.25,100% of CMS fee schedule,13.52,100% of CMS fee schedule,13.25,51,42
Outpatient Medical Services,LAB,80177,"Levetiracetam (Keppra), S LC",301,84,67.2,80% of total billed charges,14.47,100% GA fee schedule,13.25,100% of CMS fee schedule,14.47,100% of GA fee schedule,71.4,85% of total billed charges,67.2,80% of total billed charges,13.38,101% of CMS fee schedule,14.47,100% of GA fee schedule,13.25,100% of CMS fee schedule,14.76,102% of GA fee schedule,13.25,100% of CMS fee schedule,67.2,80% of total billed charges,13.25,100% of CMS fee schedule,13.52,100% of CMS fee schedule,13.25,71.4,58.8
Outpatient Medical Services,LAB,80178,Lithium (Eskalith(R)) LC,301,37,29.6,80% of total billed charges,8.32,100% GA fee schedule,6.61,100% of CMS fee schedule,8.32,100% of GA fee schedule,31.45,85% of total billed charges,29.6,80% of total billed charges,6.68,101% of CMS fee schedule,8.32,100% of GA fee schedule,6.61,100% of CMS fee schedule,8.49,102% of GA fee schedule,6.61,100% of CMS fee schedule,29.6,80% of total billed charges,6.61,100% of CMS fee schedule,6.74,100% of CMS fee schedule,6.61,31.45,25.9
Outpatient Medical Services,LAB,80184,Phenobarbital LC,301,69,55.2,80% of total billed charges,14.41,100% GA fee schedule,15.3,100% of CMS fee schedule,14.41,100% of GA fee schedule,58.65,85% of total billed charges,55.2,80% of total billed charges,15.45,101% of CMS fee schedule,14.41,100% of GA fee schedule,15.3,100% of CMS fee schedule,14.7,102% of GA fee schedule,15.3,100% of CMS fee schedule,55.2,80% of total billed charges,15.3,100% of CMS fee schedule,15.61,100% of CMS fee schedule,14.41,58.65,48.3
Outpatient Medical Services,LAB,80184,Phenytoin LvL Total,301,69,55.2,80% of total billed charges,14.41,100% GA fee schedule,15.3,100% of CMS fee schedule,14.41,100% of GA fee schedule,58.65,85% of total billed charges,55.2,80% of total billed charges,15.45,101% of CMS fee schedule,14.41,100% of GA fee schedule,15.3,100% of CMS fee schedule,14.7,102% of GA fee schedule,15.3,100% of CMS fee schedule,55.2,80% of total billed charges,15.3,100% of CMS fee schedule,15.61,100% of CMS fee schedule,14.41,58.65,48.3
Outpatient Medical Services,LAB,80195,"Sirolimus (Rapamune), Bld LC",301,76,60.8,80% of total billed charges,17.25,100% GA fee schedule,13.73,100% of CMS fee schedule,17.25,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,13.87,101% of CMS fee schedule,17.25,100% of GA fee schedule,13.73,100% of CMS fee schedule,17.6,102% of GA fee schedule,13.73,100% of CMS fee schedule,60.8,80% of total billed charges,13.73,100% of CMS fee schedule,14,100% of CMS fee schedule,13.73,64.6,53.2
Outpatient Medical Services,LAB,80197,"Tacrolimus (FK506), Bld LC",301,76,60.8,80% of total billed charges,17.25,100% GA fee schedule,13.73,100% of CMS fee schedule,17.25,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,13.87,101% of CMS fee schedule,17.25,100% of GA fee schedule,13.73,100% of CMS fee schedule,17.6,102% of GA fee schedule,13.73,100% of CMS fee schedule,60.8,80% of total billed charges,13.73,100% of CMS fee schedule,14,100% of CMS fee schedule,13.73,64.6,53.2
Outpatient Medical Services,LAB,80202,Vancomycin LvL,301,75,60,80% of total billed charges,14.27,100% GA fee schedule,13.54,100% of CMS fee schedule,14.27,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,13.68,101% of CMS fee schedule,14.27,100% of GA fee schedule,13.54,100% of CMS fee schedule,14.56,102% of GA fee schedule,13.54,100% of CMS fee schedule,60,80% of total billed charges,13.54,100% of CMS fee schedule,13.81,100% of CMS fee schedule,13.54,63.75,52.5
Outpatient Medical Services,LAB,80202,Vancomycin Peak LvL,301,75,60,80% of total billed charges,14.27,100% GA fee schedule,13.54,100% of CMS fee schedule,14.27,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,13.68,101% of CMS fee schedule,14.27,100% of GA fee schedule,13.54,100% of CMS fee schedule,14.56,102% of GA fee schedule,13.54,100% of CMS fee schedule,60,80% of total billed charges,13.54,100% of CMS fee schedule,13.81,100% of CMS fee schedule,13.54,63.75,52.5
Outpatient Medical Services,LAB,80202,Vancomycin Trough LvL,301,75,60,80% of total billed charges,14.27,100% GA fee schedule,13.54,100% of CMS fee schedule,14.27,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,13.68,101% of CMS fee schedule,14.27,100% of GA fee schedule,13.54,100% of CMS fee schedule,14.56,102% of GA fee schedule,13.54,100% of CMS fee schedule,60,80% of total billed charges,13.54,100% of CMS fee schedule,13.81,100% of CMS fee schedule,13.54,63.75,52.5
Outpatient Medical Services,LAB,80307,763824 12+Oxy+Crt-Unbund LC,300,396,316.8,80% of total billed charges,61.16,100% GA fee schedule,62.14,100% of CMS fee schedule,61.16,100% of GA fee schedule,336.6,85% of total billed charges,316.8,80% of total billed charges,62.76,101% of CMS fee schedule,61.16,100% of GA fee schedule,62.14,100% of CMS fee schedule,62.38,102% of GA fee schedule,62.14,100% of CMS fee schedule,316.8,80% of total billed charges,62.14,100% of CMS fee schedule,63.38,100% of CMS fee schedule,61.16,336.6,277.2
Outpatient Medical Services,LAB,80320,"Methanol, Whole Blood or Serum LC",301,515,412,80% of total billed charges,13.59,100% GA fee schedule,319.3,62% of total billed charges,13.59,100% of GA fee schedule,437.75,85% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,13.59,100% of GA fee schedule,319.3,62% of total billed charges,13.86,102% of GA fee schedule,319.3,62% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,319.3,62% of total billed charges,13.59,437.75,360.5
Outpatient Medical Services,LAB,80329,Acetaminophen Level,301,323,258.4,80% of total billed charges,25.45,100% GA fee schedule,200.26,62% of total billed charges,25.45,100% of GA fee schedule,274.55,85% of total billed charges,258.4,80% of total billed charges,200.26,62% of total billed charges,25.45,100% of GA fee schedule,200.26,62% of total billed charges,25.96,102% of GA fee schedule,200.26,62% of total billed charges,258.4,80% of total billed charges,200.26,62% of total billed charges,200.26,62% of total billed charges,25.45,274.55,226.1
Outpatient Medical Services,LAB,80329,Salicylate Level,301,323,258.4,80% of total billed charges,25.45,100% GA fee schedule,200.26,62% of total billed charges,25.45,100% of GA fee schedule,274.55,85% of total billed charges,258.4,80% of total billed charges,200.26,62% of total billed charges,25.45,100% of GA fee schedule,200.26,62% of total billed charges,25.96,102% of GA fee schedule,200.26,62% of total billed charges,258.4,80% of total billed charges,200.26,62% of total billed charges,200.26,62% of total billed charges,25.45,274.55,226.1
Outpatient Medical Services,LAB,80345,Barbiturate GCMS Ur 737697 LC,300,515,412,80% of total billed charges,14.41,100% GA fee schedule,319.3,62% of total billed charges,14.41,100% of GA fee schedule,437.75,85% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,14.41,100% of GA fee schedule,319.3,62% of total billed charges,14.7,102% of GA fee schedule,319.3,62% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,319.3,62% of total billed charges,14.41,437.75,360.5
Outpatient Medical Services,LAB,80346,Benzodiazepines Conf Ur 763910 LC,300,515,412,80% of total billed charges,23.26,100% GA fee schedule,319.3,62% of total billed charges,23.26,100% of GA fee schedule,437.75,85% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,23.26,100% of GA fee schedule,319.3,62% of total billed charges,23.73,102% of GA fee schedule,319.3,62% of total billed charges,412,80% of total billed charges,319.3,62% of total billed charges,319.3,62% of total billed charges,23.26,437.75,360.5
Outpatient Medical Services,LAB,81001,81001 Urinalysis w/ Microscopic Exam,307,15,12,80% of total billed charges,3.99,100% GA fee schedule,3.17,100% of CMS fee schedule,3.99,100% of GA fee schedule,12.75,85% of total billed charges,12,80% of total billed charges,3.2,101% of CMS fee schedule,3.99,100% of GA fee schedule,3.17,100% of CMS fee schedule,4.07,102% of GA fee schedule,3.17,100% of CMS fee schedule,12,80% of total billed charges,3.17,100% of CMS fee schedule,3.23,100% of CMS fee schedule,3.17,12.75,10.5
Outpatient Medical Services,LAB,81002,Urinalysis Dipstick POCT,300,16,12.8,80% of total billed charges,3.21,100% GA fee schedule,3.48,100% of CMS fee schedule,3.21,100% of GA fee schedule,13.6,85% of total billed charges,12.8,80% of total billed charges,3.51,101% of CMS fee schedule,3.21,100% of GA fee schedule,3.48,100% of CMS fee schedule,3.27,102% of GA fee schedule,3.48,100% of CMS fee schedule,12.8,80% of total billed charges,3.48,100% of CMS fee schedule,3.55,100% of CMS fee schedule,3.21,13.6,11.2
Outpatient Medical Services,LAB,81003,Urinalysis with Microscopic if Indicated,307,11,8.8,80% of total billed charges,2.83,100% GA fee schedule,2.25,100% of CMS fee schedule,2.83,100% of GA fee schedule,9.35,85% of total billed charges,8.8,80% of total billed charges,2.27,101% of CMS fee schedule,2.83,100% of GA fee schedule,2.25,100% of CMS fee schedule,2.89,102% of GA fee schedule,2.25,100% of CMS fee schedule,8.8,80% of total billed charges,2.25,100% of CMS fee schedule,2.3,100% of CMS fee schedule,2.25,9.35,7.7
Outpatient Medical Services,LAB,81015,Urinalysis Microscopic,307,14,11.2,80% of total billed charges,3.82,100% GA fee schedule,3.05,100% of CMS fee schedule,3.82,100% of GA fee schedule,11.9,85% of total billed charges,11.2,80% of total billed charges,3.08,101% of CMS fee schedule,3.82,100% of GA fee schedule,3.05,100% of CMS fee schedule,3.9,102% of GA fee schedule,3.05,100% of CMS fee schedule,11.2,80% of total billed charges,3.05,100% of CMS fee schedule,3.11,100% of CMS fee schedule,3.05,11.9,9.8
Outpatient Medical Services,LAB,81025,Urine Pregnancy Test POCT,300,13,10.4,80% of total billed charges,7.96,100% GA fee schedule,8.61,100% of CMS fee schedule,7.96,100% of GA fee schedule,11.05,85% of total billed charges,10.4,80% of total billed charges,8.7,101% of CMS fee schedule,7.96,100% of GA fee schedule,8.61,100% of CMS fee schedule,8.12,102% of GA fee schedule,8.61,100% of CMS fee schedule,10.4,80% of total billed charges,8.61,100% of CMS fee schedule,8.78,100% of CMS fee schedule,7.96,11.05,9.1
Outpatient Medical Services,LAB,81050,"Volume measurement, 24 hr urine",307,17,13.6,80% of total billed charges,3.77,100% GA fee schedule,3.64,100% of CMS fee schedule,3.77,100% of GA fee schedule,14.45,85% of total billed charges,13.6,80% of total billed charges,3.68,101% of CMS fee schedule,3.77,100% of GA fee schedule,3.64,100% of CMS fee schedule,3.85,102% of GA fee schedule,3.64,100% of CMS fee schedule,13.6,80% of total billed charges,3.64,100% of CMS fee schedule,3.71,100% of CMS fee schedule,3.64,14.45,11.9
Outpatient Medical Services,LAB,81374,HLA B 27 Disease Association LC,300,335,268,80% of total billed charges,98.4,100% GA fee schedule,74.33,100% of CMS fee schedule,98.4,100% of GA fee schedule,284.75,85% of total billed charges,268,80% of total billed charges,75.07,101% of CMS fee schedule,98.4,100% of GA fee schedule,74.33,100% of CMS fee schedule,100.37,102% of GA fee schedule,74.33,100% of CMS fee schedule,268,80% of total billed charges,74.33,100% of CMS fee schedule,75.82,100% of CMS fee schedule,74.33,284.75,234.5
Outpatient Medical Services,LAB,82009,Acetone,301,25,20,80% of total billed charges,4.13,100% GA fee schedule,4.52,100% of CMS fee schedule,4.13,100% of GA fee schedule,21.25,85% of total billed charges,20,80% of total billed charges,4.57,101% of CMS fee schedule,4.13,100% of GA fee schedule,4.52,100% of CMS fee schedule,4.21,102% of GA fee schedule,4.52,100% of CMS fee schedule,20,80% of total billed charges,4.52,100% of CMS fee schedule,4.61,100% of CMS fee schedule,4.13,21.25,17.5
Outpatient Medical Services,LAB,82010,Beta-Hydroxybutyrate LC,301,37,29.6,80% of total billed charges,10.28,100% GA fee schedule,8.17,100% of CMS fee schedule,10.28,100% of GA fee schedule,31.45,85% of total billed charges,29.6,80% of total billed charges,8.25,101% of CMS fee schedule,10.28,100% of GA fee schedule,8.17,100% of CMS fee schedule,10.49,102% of GA fee schedule,8.17,100% of CMS fee schedule,29.6,80% of total billed charges,8.17,100% of CMS fee schedule,8.33,100% of CMS fee schedule,8.17,31.45,25.9
Outpatient Medical Services,LAB,82024,ACTH LC,301,215,172,80% of total billed charges,48.57,100% GA fee schedule,38.62,100% of CMS fee schedule,48.57,100% of GA fee schedule,182.75,85% of total billed charges,172,80% of total billed charges,39.01,101% of CMS fee schedule,48.57,100% of GA fee schedule,38.62,100% of CMS fee schedule,49.54,102% of GA fee schedule,38.62,100% of CMS fee schedule,172,80% of total billed charges,38.62,100% of CMS fee schedule,39.39,100% of CMS fee schedule,38.62,182.75,150.5
Outpatient Medical Services,LAB,82040,Albumin Level,301,28,22.4,80% of total billed charges,3.62,100% GA fee schedule,4.95,100% of CMS fee schedule,3.62,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5,101% of CMS fee schedule,3.62,100% of GA fee schedule,4.95,100% of CMS fee schedule,3.69,102% of GA fee schedule,4.95,100% of CMS fee schedule,22.4,80% of total billed charges,4.95,100% of CMS fee schedule,5.05,100% of CMS fee schedule,3.62,23.8,19.6
Outpatient Medical Services,LAB,82043,"Albumin, Ur LC",301,28,22.4,80% of total billed charges,7.28,100% GA fee schedule,5.78,100% of CMS fee schedule,7.28,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.84,101% of CMS fee schedule,7.28,100% of GA fee schedule,5.78,100% of CMS fee schedule,7.43,102% of GA fee schedule,5.78,100% of CMS fee schedule,22.4,80% of total billed charges,5.78,100% of CMS fee schedule,5.9,100% of CMS fee schedule,5.78,23.8,19.6
Outpatient Medical Services,LAB,82085,Aldolase LC,301,54,43.2,80% of total billed charges,12.2,100% GA fee schedule,9.71,100% of CMS fee schedule,12.2,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,9.81,101% of CMS fee schedule,12.2,100% of GA fee schedule,9.71,100% of CMS fee schedule,12.44,102% of GA fee schedule,9.71,100% of CMS fee schedule,43.2,80% of total billed charges,9.71,100% of CMS fee schedule,9.9,100% of CMS fee schedule,9.71,45.9,37.8
Outpatient Medical Services,LAB,82088,Aldosterone LC,301,226,180.8,80% of total billed charges,51.25,100% GA fee schedule,40.75,100% of CMS fee schedule,51.25,100% of GA fee schedule,192.1,85% of total billed charges,180.8,80% of total billed charges,41.16,101% of CMS fee schedule,51.25,100% of GA fee schedule,40.75,100% of CMS fee schedule,52.28,102% of GA fee schedule,40.75,100% of CMS fee schedule,180.8,80% of total billed charges,40.75,100% of CMS fee schedule,41.57,100% of CMS fee schedule,40.75,192.1,158.2
Outpatient Medical Services,LAB,82103,A-1-Antitrypsin LC,301,75,60,80% of total billed charges,16.89,100% GA fee schedule,13.44,100% of CMS fee schedule,16.89,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,13.57,101% of CMS fee schedule,16.89,100% of GA fee schedule,13.44,100% of CMS fee schedule,17.23,102% of GA fee schedule,13.44,100% of CMS fee schedule,60,80% of total billed charges,13.44,100% of CMS fee schedule,13.71,100% of CMS fee schedule,13.44,63.75,52.5
Outpatient Medical Services,LAB,82104,Phenotype PI LC,301,90,72,80% of total billed charges,18.18,100% GA fee schedule,14.46,100% of CMS fee schedule,18.18,100% of GA fee schedule,76.5,85% of total billed charges,72,80% of total billed charges,14.6,101% of CMS fee schedule,18.18,100% of GA fee schedule,14.46,100% of CMS fee schedule,18.54,102% of GA fee schedule,14.46,100% of CMS fee schedule,72,80% of total billed charges,14.46,100% of CMS fee schedule,14.75,100% of CMS fee schedule,14.46,76.5,63
Outpatient Medical Services,LAB,82105,AFP Tumor Marker LC,301,93,74.4,80% of total billed charges,21.1,100% GA fee schedule,16.77,100% of CMS fee schedule,21.1,100% of GA fee schedule,79.05,85% of total billed charges,74.4,80% of total billed charges,16.94,101% of CMS fee schedule,21.1,100% of GA fee schedule,16.77,100% of CMS fee schedule,21.52,102% of GA fee schedule,16.77,100% of CMS fee schedule,74.4,80% of total billed charges,16.77,100% of CMS fee schedule,17.11,100% of CMS fee schedule,16.77,79.05,65.1
Outpatient Medical Services,LAB,82140,Ammonia Level,301,81,64.8,80% of total billed charges,12.44,100% GA fee schedule,14.57,100% of CMS fee schedule,12.44,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,14.72,101% of CMS fee schedule,12.44,100% of GA fee schedule,14.57,100% of CMS fee schedule,12.69,102% of GA fee schedule,14.57,100% of CMS fee schedule,64.8,80% of total billed charges,14.57,100% of CMS fee schedule,14.86,100% of CMS fee schedule,12.44,68.85,56.7
Outpatient Medical Services,LAB,82150,Amylase LC,301,36,28.8,80% of total billed charges,8.15,100% GA fee schedule,6.48,100% of CMS fee schedule,8.15,100% of GA fee schedule,30.6,85% of total billed charges,28.8,80% of total billed charges,6.54,101% of CMS fee schedule,8.15,100% of GA fee schedule,6.48,100% of CMS fee schedule,8.31,102% of GA fee schedule,6.48,100% of CMS fee schedule,28.8,80% of total billed charges,6.48,100% of CMS fee schedule,6.61,100% of CMS fee schedule,6.48,30.6,25.2
Outpatient Medical Services,LAB,82164,Angiotensin-Converting Enzyme LC,301,81,64.8,80% of total billed charges,18.35,100% GA fee schedule,14.6,100% of CMS fee schedule,18.35,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,14.75,101% of CMS fee schedule,18.35,100% of GA fee schedule,14.6,100% of CMS fee schedule,18.72,102% of GA fee schedule,14.6,100% of CMS fee schedule,64.8,80% of total billed charges,14.6,100% of CMS fee schedule,14.89,100% of CMS fee schedule,14.6,68.85,56.7
Outpatient Medical Services,LAB,82175,Arsenic Blood LC,301,64,51.2,80% of total billed charges,23.86,100% GA fee schedule,18.97,100% of CMS fee schedule,23.86,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,19.16,101% of CMS fee schedule,23.86,100% of GA fee schedule,18.97,100% of CMS fee schedule,24.34,102% of GA fee schedule,18.97,100% of CMS fee schedule,51.2,80% of total billed charges,18.97,100% of CMS fee schedule,19.35,100% of CMS fee schedule,18.97,54.4,44.8
Outpatient Medical Services,LAB,82232,"Beta-2 Microglobulin, LC",301,90,72,80% of total billed charges,20.35,100% GA fee schedule,16.18,100% of CMS fee schedule,20.35,100% of GA fee schedule,76.5,85% of total billed charges,72,80% of total billed charges,16.34,101% of CMS fee schedule,20.35,100% of GA fee schedule,16.18,100% of CMS fee schedule,20.76,102% of GA fee schedule,16.18,100% of CMS fee schedule,72,80% of total billed charges,16.18,100% of CMS fee schedule,16.5,100% of CMS fee schedule,16.18,76.5,63
Outpatient Medical Services,LAB,82247,Bili Total,301,28,22.4,80% of total billed charges,6.32,100% GA fee schedule,5.02,100% of CMS fee schedule,6.32,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.07,101% of CMS fee schedule,6.32,100% of GA fee schedule,5.02,100% of CMS fee schedule,6.45,102% of GA fee schedule,5.02,100% of CMS fee schedule,22.4,80% of total billed charges,5.02,100% of CMS fee schedule,5.12,100% of CMS fee schedule,5.02,23.8,19.6
Outpatient Medical Services,LAB,82248,Bili Direct,301,28,22.4,80% of total billed charges,6.32,100% GA fee schedule,5.02,100% of CMS fee schedule,6.32,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.07,101% of CMS fee schedule,6.32,100% of GA fee schedule,5.02,100% of CMS fee schedule,6.45,102% of GA fee schedule,5.02,100% of CMS fee schedule,22.4,80% of total billed charges,5.02,100% of CMS fee schedule,5.12,100% of CMS fee schedule,5.02,23.8,19.6
Outpatient Medical Services,LAB,82271,Guaiac Gastric,301,24,19.2,80% of total billed charges,4.04,100% GA fee schedule,5.32,100% of CMS fee schedule,4.04,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,5.37,101% of CMS fee schedule,4.04,100% of GA fee schedule,5.32,100% of CMS fee schedule,4.12,102% of GA fee schedule,5.32,100% of CMS fee schedule,19.2,80% of total billed charges,5.32,100% of CMS fee schedule,5.43,100% of CMS fee schedule,4.04,20.4,16.8
Outpatient Medical Services,LAB,82274,Immunological Fecal Occult Blood,301,80,64,80% of total billed charges,21.69,100% GA fee schedule,15.92,100% of CMS fee schedule,21.69,100% of GA fee schedule,68,85% of total billed charges,64,80% of total billed charges,16.08,101% of CMS fee schedule,21.69,100% of GA fee schedule,15.92,100% of CMS fee schedule,22.12,102% of GA fee schedule,15.92,100% of CMS fee schedule,64,80% of total billed charges,15.92,100% of CMS fee schedule,16.24,100% of CMS fee schedule,15.92,68,56
Outpatient Medical Services,LAB,82274,Occult Blood Stool POCT,521,24,19.2,80% of total billed charges,21.69,100% GA fee schedule,204.06,pays based on per visit rate,21.69,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,206.1,pays based on per visit rate,21.69,100% of GA fee schedule,204.06,pays based on per visit rate,22.12,102% of GA fee schedule,204.06,pays based on per visit rate,19.2,80% of total billed charges,204.06,pays based on per visit rate,204.38,pays based on per visit rate,19.2,206.1,16.8
Outpatient Medical Services,LAB,82300,"Cadmium, Blood LC",300,129,103.2,80% of total billed charges,29.1,100% GA fee schedule,23.64,100% of CMS fee schedule,29.1,100% of GA fee schedule,109.65,85% of total billed charges,103.2,80% of total billed charges,23.88,101% of CMS fee schedule,29.1,100% of GA fee schedule,23.64,100% of CMS fee schedule,29.68,102% of GA fee schedule,23.64,100% of CMS fee schedule,103.2,80% of total billed charges,23.64,100% of CMS fee schedule,24.11,100% of CMS fee schedule,23.64,109.65,90.3
Outpatient Medical Services,LAB,82306,"Vitamin D, 25-Hydroxy LC",301,165,132,80% of total billed charges,37.22,100% GA fee schedule,29.6,100% of CMS fee schedule,37.22,100% of GA fee schedule,140.25,85% of total billed charges,132,80% of total billed charges,29.9,101% of CMS fee schedule,37.22,100% of GA fee schedule,29.6,100% of CMS fee schedule,37.96,102% of GA fee schedule,29.6,100% of CMS fee schedule,132,80% of total billed charges,29.6,100% of CMS fee schedule,30.19,100% of CMS fee schedule,29.6,140.25,115.5
Outpatient Medical Services,LAB,82310,Calcium Level Total,301,29,23.2,80% of total billed charges,6.35,100% GA fee schedule,5.16,100% of CMS fee schedule,6.35,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.21,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.16,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.16,100% of CMS fee schedule,23.2,80% of total billed charges,5.16,100% of CMS fee schedule,5.26,100% of CMS fee schedule,5.16,24.65,20.3
Outpatient Medical Services,LAB,82330,"Calcium, Ionized LC",301,76,60.8,80% of total billed charges,17.18,100% GA fee schedule,13.68,100% of CMS fee schedule,17.18,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,13.82,101% of CMS fee schedule,17.18,100% of GA fee schedule,13.68,100% of CMS fee schedule,17.52,102% of GA fee schedule,13.68,100% of CMS fee schedule,60.8,80% of total billed charges,13.68,100% of CMS fee schedule,13.95,100% of CMS fee schedule,13.68,64.6,53.2
Outpatient Medical Services,LAB,82340,"Calcium, 24Hr Ur LC",301,34,27.2,80% of total billed charges,7.59,100% GA fee schedule,6.03,100% of CMS fee schedule,7.59,100% of GA fee schedule,28.9,85% of total billed charges,27.2,80% of total billed charges,6.09,101% of CMS fee schedule,7.59,100% of GA fee schedule,6.03,100% of CMS fee schedule,7.74,102% of GA fee schedule,6.03,100% of CMS fee schedule,27.2,80% of total billed charges,6.03,100% of CMS fee schedule,6.15,100% of CMS fee schedule,6.03,28.9,23.8
Outpatient Medical Services,LAB,82374,Carbon Dioxide Level,301,27,21.6,80% of total billed charges,6.15,100% GA fee schedule,4.88,100% of CMS fee schedule,6.15,100% of GA fee schedule,22.95,85% of total billed charges,21.6,80% of total billed charges,4.93,101% of CMS fee schedule,6.15,100% of GA fee schedule,4.88,100% of CMS fee schedule,6.27,102% of GA fee schedule,4.88,100% of CMS fee schedule,21.6,80% of total billed charges,4.88,100% of CMS fee schedule,4.98,100% of CMS fee schedule,4.88,22.95,18.9
Outpatient Medical Services,LAB,82378,CEA LC,301,105,84,80% of total billed charges,23.86,100% GA fee schedule,18.96,100% of CMS fee schedule,23.86,100% of GA fee schedule,89.25,85% of total billed charges,84,80% of total billed charges,19.15,101% of CMS fee schedule,23.86,100% of GA fee schedule,18.96,100% of CMS fee schedule,24.34,102% of GA fee schedule,18.96,100% of CMS fee schedule,84,80% of total billed charges,18.96,100% of CMS fee schedule,19.34,100% of CMS fee schedule,18.96,89.25,73.5
Outpatient Medical Services,LAB,82384,Catecholamines LC,301,140,112,80% of total billed charges,31.75,100% GA fee schedule,25.25,100% of CMS fee schedule,31.75,100% of GA fee schedule,119,85% of total billed charges,112,80% of total billed charges,25.5,101% of CMS fee schedule,31.75,100% of GA fee schedule,25.25,100% of CMS fee schedule,32.39,102% of GA fee schedule,25.25,100% of CMS fee schedule,112,80% of total billed charges,25.25,100% of CMS fee schedule,25.76,100% of CMS fee schedule,25.25,119,98
Outpatient Medical Services,LAB,82390,Ceruloplasmin LC,301,60,48,80% of total billed charges,13.51,100% GA fee schedule,10.74,100% of CMS fee schedule,13.51,100% of GA fee schedule,51,85% of total billed charges,48,80% of total billed charges,10.85,101% of CMS fee schedule,13.51,100% of GA fee schedule,10.74,100% of CMS fee schedule,13.78,102% of GA fee schedule,10.74,100% of CMS fee schedule,48,80% of total billed charges,10.74,100% of CMS fee schedule,10.95,100% of CMS fee schedule,10.74,51,42
Outpatient Medical Services,LAB,82397,PTHrP (PTH-Related Peptide) LC,301,64,51.2,80% of total billed charges,17.77,100% GA fee schedule,14.12,100% of CMS fee schedule,17.77,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,14.26,101% of CMS fee schedule,17.77,100% of GA fee schedule,14.12,100% of CMS fee schedule,18.13,102% of GA fee schedule,14.12,100% of CMS fee schedule,51.2,80% of total billed charges,14.12,100% of CMS fee schedule,14.4,100% of CMS fee schedule,14.12,54.4,44.8
Outpatient Medical Services,LAB,82435,Chloride Level,301,26,20.8,80% of total billed charges,5.78,100% GA fee schedule,4.6,100% of CMS fee schedule,5.78,100% of GA fee schedule,22.1,85% of total billed charges,20.8,80% of total billed charges,4.65,101% of CMS fee schedule,5.78,100% of GA fee schedule,4.6,100% of CMS fee schedule,5.9,102% of GA fee schedule,4.6,100% of CMS fee schedule,20.8,80% of total billed charges,4.6,100% of CMS fee schedule,4.69,100% of CMS fee schedule,4.6,22.1,18.2
Outpatient Medical Services,LAB,82465,Cholesterol Total,300,24,19.2,80% of total billed charges,5.47,100% GA fee schedule,4.35,100% of CMS fee schedule,5.47,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,4.39,101% of CMS fee schedule,5.47,100% of GA fee schedule,4.35,100% of CMS fee schedule,5.58,102% of GA fee schedule,4.35,100% of CMS fee schedule,19.2,80% of total billed charges,4.35,100% of CMS fee schedule,4.44,100% of CMS fee schedule,4.35,20.4,16.8
Outpatient Medical Services,LAB,82495,Chromium LC,300,92,73.6,80% of total billed charges,25.51,100% GA fee schedule,20.28,100% of CMS fee schedule,25.51,100% of GA fee schedule,78.2,85% of total billed charges,73.6,80% of total billed charges,20.48,101% of CMS fee schedule,25.51,100% of GA fee schedule,20.28,100% of CMS fee schedule,26.02,102% of GA fee schedule,20.28,100% of CMS fee schedule,73.6,80% of total billed charges,20.28,100% of CMS fee schedule,20.69,100% of CMS fee schedule,20.28,78.2,64.4
Outpatient Medical Services,LAB,82507,"Citric Acid (Citrate), Ur LC",301,155,124,80% of total billed charges,34.97,100% GA fee schedule,27.8,100% of CMS fee schedule,34.97,100% of GA fee schedule,131.75,85% of total billed charges,124,80% of total billed charges,28.08,101% of CMS fee schedule,34.97,100% of GA fee schedule,27.8,100% of CMS fee schedule,35.67,102% of GA fee schedule,27.8,100% of CMS fee schedule,124,80% of total billed charges,27.8,100% of CMS fee schedule,28.36,100% of CMS fee schedule,27.8,131.75,108.5
Outpatient Medical Services,LAB,82525,Copper LC,301,69,55.2,80% of total billed charges,15.61,100% GA fee schedule,12.41,100% of CMS fee schedule,15.61,100% of GA fee schedule,58.65,85% of total billed charges,55.2,80% of total billed charges,12.53,101% of CMS fee schedule,15.61,100% of GA fee schedule,12.41,100% of CMS fee schedule,15.92,102% of GA fee schedule,12.41,100% of CMS fee schedule,55.2,80% of total billed charges,12.41,100% of CMS fee schedule,12.66,100% of CMS fee schedule,12.41,58.65,48.3
Outpatient Medical Services,LAB,82530,"Cortisol, Urinary Free LC",301,101,80.8,80% of total billed charges,21.02,100% GA fee schedule,16.71,100% of CMS fee schedule,21.02,100% of GA fee schedule,85.85,85% of total billed charges,80.8,80% of total billed charges,16.88,101% of CMS fee schedule,21.02,100% of GA fee schedule,16.71,100% of CMS fee schedule,21.44,102% of GA fee schedule,16.71,100% of CMS fee schedule,80.8,80% of total billed charges,16.71,100% of CMS fee schedule,17.04,100% of CMS fee schedule,16.71,85.85,70.7
Outpatient Medical Services,LAB,82533,Cortisol LC,301,91,72.8,80% of total billed charges,20.5,100% GA fee schedule,16.3,100% of CMS fee schedule,20.5,100% of GA fee schedule,77.35,85% of total billed charges,72.8,80% of total billed charges,16.46,101% of CMS fee schedule,20.5,100% of GA fee schedule,16.3,100% of CMS fee schedule,20.91,102% of GA fee schedule,16.3,100% of CMS fee schedule,72.8,80% of total billed charges,16.3,100% of CMS fee schedule,16.63,100% of CMS fee schedule,16.3,77.35,63.7
Outpatient Medical Services,LAB,82550,Creatine Kinase,301,36,28.8,80% of total billed charges,6.35,100% GA fee schedule,6.51,100% of CMS fee schedule,6.35,100% of GA fee schedule,30.6,85% of total billed charges,28.8,80% of total billed charges,6.58,101% of CMS fee schedule,6.35,100% of GA fee schedule,6.51,100% of CMS fee schedule,6.48,102% of GA fee schedule,6.51,100% of CMS fee schedule,28.8,80% of total billed charges,6.51,100% of CMS fee schedule,6.64,100% of CMS fee schedule,6.35,30.6,25.2
Outpatient Medical Services,LAB,82552,CK-BB LC,301,74,59.2,80% of total billed charges,16.84,100% GA fee schedule,13.39,100% of CMS fee schedule,16.84,100% of GA fee schedule,62.9,85% of total billed charges,59.2,80% of total billed charges,13.52,101% of CMS fee schedule,16.84,100% of GA fee schedule,13.39,100% of CMS fee schedule,17.18,102% of GA fee schedule,13.39,100% of CMS fee schedule,59.2,80% of total billed charges,13.39,100% of CMS fee schedule,13.66,100% of CMS fee schedule,13.39,62.9,51.8
Outpatient Medical Services,LAB,82565,Creatinine,301,28,22.4,80% of total billed charges,6.35,100% GA fee schedule,5.12,100% of CMS fee schedule,6.35,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.17,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.12,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.12,100% of CMS fee schedule,22.4,80% of total billed charges,5.12,100% of CMS fee schedule,5.22,100% of CMS fee schedule,5.12,23.8,19.6
Outpatient Medical Services,LAB,82570,Creat Ur LC,301,53,42.4,80% of total billed charges,6.51,100% GA fee schedule,5.18,100% of CMS fee schedule,6.51,100% of GA fee schedule,45.05,85% of total billed charges,42.4,80% of total billed charges,5.23,101% of CMS fee schedule,6.51,100% of GA fee schedule,5.18,100% of CMS fee schedule,6.64,102% of GA fee schedule,5.18,100% of CMS fee schedule,42.4,80% of total billed charges,5.18,100% of CMS fee schedule,5.28,100% of CMS fee schedule,5.18,45.05,37.1
Outpatient Medical Services,LAB,82575,Creatinine Clearance LC,301,53,42.4,80% of total billed charges,11.88,100% GA fee schedule,9.46,100% of CMS fee schedule,11.88,100% of GA fee schedule,45.05,85% of total billed charges,42.4,80% of total billed charges,9.55,101% of CMS fee schedule,11.88,100% of GA fee schedule,9.46,100% of CMS fee schedule,12.12,102% of GA fee schedule,9.46,100% of CMS fee schedule,42.4,80% of total billed charges,9.46,100% of CMS fee schedule,9.65,100% of CMS fee schedule,9.46,45.05,37.1
Outpatient Medical Services,LAB,82595,"Cryoglobulin, Ql, Rflx LC",301,36,28.8,80% of total billed charges,8.14,100% GA fee schedule,6.47,100% of CMS fee schedule,8.14,100% of GA fee schedule,30.6,85% of total billed charges,28.8,80% of total billed charges,6.53,101% of CMS fee schedule,8.14,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.3,102% of GA fee schedule,6.47,100% of CMS fee schedule,28.8,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,30.6,25.2
Outpatient Medical Services,LAB,82607,Vitamin B12 LC,301,94,75.2,80% of total billed charges,18.95,100% GA fee schedule,15.08,100% of CMS fee schedule,18.95,100% of GA fee schedule,79.9,85% of total billed charges,75.2,80% of total billed charges,15.23,101% of CMS fee schedule,18.95,100% of GA fee schedule,15.08,100% of CMS fee schedule,19.33,102% of GA fee schedule,15.08,100% of CMS fee schedule,75.2,80% of total billed charges,15.08,100% of CMS fee schedule,15.38,100% of CMS fee schedule,15.08,79.9,65.8
Outpatient Medical Services,LAB,82610,Cystatin C LC,301,83,66.4,80% of total billed charges,17.1,100% GA fee schedule,18.52,100% of CMS fee schedule,17.1,100% of GA fee schedule,70.55,85% of total billed charges,66.4,80% of total billed charges,18.71,101% of CMS fee schedule,17.1,100% of GA fee schedule,18.52,100% of CMS fee schedule,17.44,102% of GA fee schedule,18.52,100% of CMS fee schedule,66.4,80% of total billed charges,18.52,100% of CMS fee schedule,18.89,100% of CMS fee schedule,17.1,70.55,58.1
Outpatient Medical Services,LAB,82626,"DHEA, Serum LC",301,140,112,80% of total billed charges,31.78,100% GA fee schedule,25.27,100% of CMS fee schedule,31.78,100% of GA fee schedule,119,85% of total billed charges,112,80% of total billed charges,25.52,101% of CMS fee schedule,31.78,100% of GA fee schedule,25.27,100% of CMS fee schedule,32.42,102% of GA fee schedule,25.27,100% of CMS fee schedule,112,80% of total billed charges,25.27,100% of CMS fee schedule,25.78,100% of CMS fee schedule,25.27,119,98
Outpatient Medical Services,LAB,82627,DHEA-Sulfate LC,301,124,99.2,80% of total billed charges,27.96,100% GA fee schedule,22.23,100% of CMS fee schedule,27.96,100% of GA fee schedule,105.4,85% of total billed charges,99.2,80% of total billed charges,22.45,101% of CMS fee schedule,27.96,100% of GA fee schedule,22.23,100% of CMS fee schedule,28.52,102% of GA fee schedule,22.23,100% of CMS fee schedule,99.2,80% of total billed charges,22.23,100% of CMS fee schedule,22.67,100% of CMS fee schedule,22.23,105.4,86.8
Outpatient Medical Services,LAB,82642,Dihydrotestosterone LC,301,75,60,80% of total billed charges,26.02,100% GA fee schedule,29.28,100% of CMS fee schedule,26.02,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,29.57,101% of CMS fee schedule,26.02,100% of GA fee schedule,29.28,100% of CMS fee schedule,26.54,102% of GA fee schedule,29.28,100% of CMS fee schedule,60,80% of total billed charges,29.28,100% of CMS fee schedule,29.87,100% of CMS fee schedule,26.02,63.75,52.5
Outpatient Medical Services,LAB,82652,"Calcitriol (1,25 di-OH Vit D) LC",301,214,171.2,80% of total billed charges,48.4,100% GA fee schedule,38.5,100% of CMS fee schedule,48.4,100% of GA fee schedule,181.9,85% of total billed charges,171.2,80% of total billed charges,38.89,101% of CMS fee schedule,48.4,100% of GA fee schedule,38.5,100% of CMS fee schedule,49.37,102% of GA fee schedule,38.5,100% of CMS fee schedule,171.2,80% of total billed charges,38.5,100% of CMS fee schedule,39.27,100% of CMS fee schedule,38.5,181.9,149.8
Outpatient Medical Services,LAB,82653,"Pancreatic Elastase, Fecal LC",301,104,83.2,80% of total billed charges,18.38,100% GA fee schedule,22.97,100% of CMS fee schedule,18.38,100% of GA fee schedule,88.4,85% of total billed charges,83.2,80% of total billed charges,23.2,101% of CMS fee schedule,18.38,100% of GA fee schedule,22.97,100% of CMS fee schedule,18.75,102% of GA fee schedule,22.97,100% of CMS fee schedule,83.2,80% of total billed charges,22.97,100% of CMS fee schedule,23.43,100% of CMS fee schedule,18.38,88.4,72.8
Outpatient Medical Services,LAB,82668,Erythropoietin (EPO) LC,301,104,83.2,80% of total billed charges,23.63,100% GA fee schedule,18.79,100% of CMS fee schedule,23.63,100% of GA fee schedule,88.4,85% of total billed charges,83.2,80% of total billed charges,18.98,101% of CMS fee schedule,23.63,100% of GA fee schedule,18.79,100% of CMS fee schedule,24.1,102% of GA fee schedule,18.79,100% of CMS fee schedule,83.2,80% of total billed charges,18.79,100% of CMS fee schedule,19.17,100% of CMS fee schedule,18.79,88.4,72.8
Outpatient Medical Services,LAB,82670,Estradiol LC,301,155,124,80% of total billed charges,35.14,100% GA fee schedule,27.94,100% of CMS fee schedule,35.14,100% of GA fee schedule,131.75,85% of total billed charges,124,80% of total billed charges,28.22,101% of CMS fee schedule,35.14,100% of GA fee schedule,27.94,100% of CMS fee schedule,35.84,102% of GA fee schedule,27.94,100% of CMS fee schedule,124,80% of total billed charges,27.94,100% of CMS fee schedule,28.5,100% of CMS fee schedule,27.94,131.75,108.5
Outpatient Medical Services,LAB,82705,"Fecal Fat, Qual LC",301,28,22.4,80% of total billed charges,6.4,100% GA fee schedule,5.1,100% of CMS fee schedule,6.4,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.15,101% of CMS fee schedule,6.4,100% of GA fee schedule,5.1,100% of CMS fee schedule,6.53,102% of GA fee schedule,5.1,100% of CMS fee schedule,22.4,80% of total billed charges,5.1,100% of CMS fee schedule,5.2,100% of CMS fee schedule,5.1,23.8,19.6
Outpatient Medical Services,LAB,82728,"Ferritin, Serum LC",301,76,60.8,80% of total billed charges,17.13,100% GA fee schedule,13.63,100% of CMS fee schedule,17.13,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,13.77,101% of CMS fee schedule,17.13,100% of GA fee schedule,13.63,100% of CMS fee schedule,17.47,102% of GA fee schedule,13.63,100% of CMS fee schedule,60.8,80% of total billed charges,13.63,100% of CMS fee schedule,13.9,100% of CMS fee schedule,13.63,64.6,53.2
Outpatient Medical Services,LAB,82746,Folate LC,301,82,65.6,80% of total billed charges,18.49,100% GA fee schedule,14.7,100% of CMS fee schedule,18.49,100% of GA fee schedule,69.7,85% of total billed charges,65.6,80% of total billed charges,14.85,101% of CMS fee schedule,18.49,100% of GA fee schedule,14.7,100% of CMS fee schedule,18.86,102% of GA fee schedule,14.7,100% of CMS fee schedule,65.6,80% of total billed charges,14.7,100% of CMS fee schedule,14.99,100% of CMS fee schedule,14.7,69.7,57.4
Outpatient Medical Services,LAB,82747,Folate RBC LC,301,96,76.8,80% of total billed charges,21.78,100% GA fee schedule,17.65,100% of CMS fee schedule,21.78,100% of GA fee schedule,81.6,85% of total billed charges,76.8,80% of total billed charges,17.83,101% of CMS fee schedule,21.78,100% of GA fee schedule,17.65,100% of CMS fee schedule,22.22,102% of GA fee schedule,17.65,100% of CMS fee schedule,76.8,80% of total billed charges,17.65,100% of CMS fee schedule,18,100% of CMS fee schedule,17.65,81.6,67.2
Outpatient Medical Services,LAB,82784,"Immunoglobulin A, Qn LC",301,52,41.6,80% of total billed charges,11.69,100% GA fee schedule,9.3,100% of CMS fee schedule,11.69,100% of GA fee schedule,44.2,85% of total billed charges,41.6,80% of total billed charges,9.39,101% of CMS fee schedule,11.69,100% of GA fee schedule,9.3,100% of CMS fee schedule,11.92,102% of GA fee schedule,9.3,100% of CMS fee schedule,41.6,80% of total billed charges,9.3,100% of CMS fee schedule,9.49,100% of CMS fee schedule,9.3,44.2,36.4
Outpatient Medical Services,LAB,82785,"Immunoglobulin E, Total LC",301,91,72.8,80% of total billed charges,20.71,100% GA fee schedule,16.46,100% of CMS fee schedule,20.71,100% of GA fee schedule,77.35,85% of total billed charges,72.8,80% of total billed charges,16.62,101% of CMS fee schedule,20.71,100% of GA fee schedule,16.46,100% of CMS fee schedule,21.12,102% of GA fee schedule,16.46,100% of CMS fee schedule,72.8,80% of total billed charges,16.46,100% of CMS fee schedule,16.79,100% of CMS fee schedule,16.46,77.35,63.7
Outpatient Medical Services,LAB,82803,Blood Gas Venous,301,118,94.4,80% of total billed charges,24.34,100% GA fee schedule,26.07,100% of CMS fee schedule,24.34,100% of GA fee schedule,100.3,85% of total billed charges,94.4,80% of total billed charges,26.33,101% of CMS fee schedule,24.34,100% of GA fee schedule,26.07,100% of CMS fee schedule,24.83,102% of GA fee schedule,26.07,100% of CMS fee schedule,94.4,80% of total billed charges,26.07,100% of CMS fee schedule,26.59,100% of CMS fee schedule,24.34,100.3,82.6
Outpatient Medical Services,LAB,82947,Glucose Level,301,22,17.6,80% of total billed charges,4.93,100% GA fee schedule,3.93,100% of CMS fee schedule,4.93,100% of GA fee schedule,18.7,85% of total billed charges,17.6,80% of total billed charges,3.97,101% of CMS fee schedule,4.93,100% of GA fee schedule,3.93,100% of CMS fee schedule,5.03,102% of GA fee schedule,3.93,100% of CMS fee schedule,17.6,80% of total billed charges,3.93,100% of CMS fee schedule,4.01,100% of CMS fee schedule,3.93,18.7,15.4
Outpatient Medical Services,LAB,82951,Glucose 2 Hour,301,72,57.6,80% of total billed charges,16.19,100% GA fee schedule,12.87,100% of CMS fee schedule,16.19,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,13,101% of CMS fee schedule,16.19,100% of GA fee schedule,12.87,100% of CMS fee schedule,16.51,102% of GA fee schedule,12.87,100% of CMS fee schedule,57.6,80% of total billed charges,12.87,100% of CMS fee schedule,13.13,100% of CMS fee schedule,12.87,61.2,50.4
Outpatient Medical Services,LAB,82952,Glucose 3 Hour Post Prandial,301,22,17.6,80% of total billed charges,4.93,100% GA fee schedule,3.92,100% of CMS fee schedule,4.93,100% of GA fee schedule,18.7,85% of total billed charges,17.6,80% of total billed charges,3.96,101% of CMS fee schedule,4.93,100% of GA fee schedule,3.92,100% of CMS fee schedule,5.03,102% of GA fee schedule,3.92,100% of CMS fee schedule,17.6,80% of total billed charges,3.92,100% of CMS fee schedule,4,100% of CMS fee schedule,3.92,18.7,15.4
Outpatient Medical Services,LAB,82962,Glucose POCT,300,25,20,80% of total billed charges,2.94,100% GA fee schedule,3.28,100% of CMS fee schedule,2.94,100% of GA fee schedule,21.25,85% of total billed charges,20,80% of total billed charges,3.31,101% of CMS fee schedule,2.94,100% of GA fee schedule,3.28,100% of CMS fee schedule,3,102% of GA fee schedule,3.28,100% of CMS fee schedule,20,80% of total billed charges,3.28,100% of CMS fee schedule,3.35,100% of CMS fee schedule,2.94,21.25,17.5
Outpatient Medical Services,LAB,82977,GGT LC,301,40,32,80% of total billed charges,6.35,100% GA fee schedule,7.2,100% of CMS fee schedule,6.35,100% of GA fee schedule,34,85% of total billed charges,32,80% of total billed charges,7.27,101% of CMS fee schedule,6.35,100% of GA fee schedule,7.2,100% of CMS fee schedule,6.48,102% of GA fee schedule,7.2,100% of CMS fee schedule,32,80% of total billed charges,7.2,100% of CMS fee schedule,7.34,100% of CMS fee schedule,6.35,34,28
Outpatient Medical Services,LAB,82985,Fructosamine LC,301,84,67.2,80% of total billed charges,18.95,100% GA fee schedule,16.76,100% of CMS fee schedule,18.95,100% of GA fee schedule,71.4,85% of total billed charges,67.2,80% of total billed charges,16.93,101% of CMS fee schedule,18.95,100% of GA fee schedule,16.76,100% of CMS fee schedule,19.33,102% of GA fee schedule,16.76,100% of CMS fee schedule,67.2,80% of total billed charges,16.76,100% of CMS fee schedule,17.1,100% of CMS fee schedule,16.76,71.4,58.8
Outpatient Medical Services,LAB,83001,FSH LC,301,103,82.4,80% of total billed charges,23.37,100% GA fee schedule,18.58,100% of CMS fee schedule,23.37,100% of GA fee schedule,87.55,85% of total billed charges,82.4,80% of total billed charges,18.77,101% of CMS fee schedule,23.37,100% of GA fee schedule,18.58,100% of CMS fee schedule,23.84,102% of GA fee schedule,18.58,100% of CMS fee schedule,82.4,80% of total billed charges,18.58,100% of CMS fee schedule,18.95,100% of CMS fee schedule,18.58,87.55,72.1
Outpatient Medical Services,LAB,83002,LH LC,301,10,8,80% of total billed charges,23.29,100% GA fee schedule,18.52,100% of CMS fee schedule,23.29,100% of GA fee schedule,8.5,85% of total billed charges,8,80% of total billed charges,18.71,101% of CMS fee schedule,23.29,100% of GA fee schedule,18.52,100% of CMS fee schedule,23.76,102% of GA fee schedule,18.52,100% of CMS fee schedule,8,80% of total billed charges,18.52,100% of CMS fee schedule,18.89,100% of CMS fee schedule,8,23.76,7
Outpatient Medical Services,LAB,83003,Growth Hormone LC,301,89,71.2,80% of total billed charges,17.9,100% GA fee schedule,16.67,100% of CMS fee schedule,17.9,100% of GA fee schedule,75.65,85% of total billed charges,71.2,80% of total billed charges,16.84,101% of CMS fee schedule,17.9,100% of GA fee schedule,16.67,100% of CMS fee schedule,18.26,102% of GA fee schedule,16.67,100% of CMS fee schedule,71.2,80% of total billed charges,16.67,100% of CMS fee schedule,17,100% of CMS fee schedule,16.67,75.65,62.3
Outpatient Medical Services,LAB,83010,Haptoglobin LC,301,70,56,80% of total billed charges,4.69,100% GA fee schedule,12.58,100% of CMS fee schedule,4.69,100% of GA fee schedule,59.5,85% of total billed charges,56,80% of total billed charges,12.71,101% of CMS fee schedule,4.69,100% of GA fee schedule,12.58,100% of CMS fee schedule,4.78,102% of GA fee schedule,12.58,100% of CMS fee schedule,56,80% of total billed charges,12.58,100% of CMS fee schedule,12.83,100% of CMS fee schedule,4.69,59.5,49
Outpatient Medical Services,LAB,83018,Cobalt LC,301,121,96.8,80% of total billed charges,27.61,100% GA fee schedule,21.96,100% of CMS fee schedule,27.61,100% of GA fee schedule,102.85,85% of total billed charges,96.8,80% of total billed charges,22.18,101% of CMS fee schedule,27.61,100% of GA fee schedule,21.96,100% of CMS fee schedule,28.16,102% of GA fee schedule,21.96,100% of CMS fee schedule,96.8,80% of total billed charges,21.96,100% of CMS fee schedule,22.4,100% of CMS fee schedule,21.96,102.85,84.7
Outpatient Medical Services,LAB,83020,Hemoglobinopathy Fractionation Cascade LC,301,72,57.6,80% of total billed charges,12.29,100% GA fee schedule,12.87,100% of CMS fee schedule,12.29,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,13,101% of CMS fee schedule,12.29,100% of GA fee schedule,12.87,100% of CMS fee schedule,12.54,102% of GA fee schedule,12.87,100% of CMS fee schedule,57.6,80% of total billed charges,12.87,100% of CMS fee schedule,13.13,100% of CMS fee schedule,12.29,61.2,50.4
Outpatient Medical Services,LAB,83021,.Hgb Fractionation by HPLC LC,301,82,65.6,80% of total billed charges,7.55,100% GA fee schedule,18.06,100% of CMS fee schedule,7.55,100% of GA fee schedule,69.7,85% of total billed charges,65.6,80% of total billed charges,18.24,101% of CMS fee schedule,7.55,100% of GA fee schedule,18.06,100% of CMS fee schedule,7.7,102% of GA fee schedule,18.06,100% of CMS fee schedule,65.6,80% of total billed charges,18.06,100% of CMS fee schedule,18.42,100% of CMS fee schedule,7.55,69.7,57.4
Outpatient Medical Services,LAB,83036,Hemoglobin A1c with Estimated Avg Glucose,301,54,43.2,80% of total billed charges,12.2,100% GA fee schedule,9.71,100% of CMS fee schedule,12.2,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,9.81,101% of CMS fee schedule,12.2,100% of GA fee schedule,9.71,100% of CMS fee schedule,12.44,102% of GA fee schedule,9.71,100% of CMS fee schedule,43.2,80% of total billed charges,9.71,100% of CMS fee schedule,9.9,100% of CMS fee schedule,9.71,45.9,37.8
Outpatient Medical Services,LAB,83090,Homocyst(e)ine LC,301,81,64.8,80% of total billed charges,21.21,100% GA fee schedule,17.92,100% of CMS fee schedule,21.21,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,18.1,101% of CMS fee schedule,21.21,100% of GA fee schedule,17.92,100% of CMS fee schedule,21.63,102% of GA fee schedule,17.92,100% of CMS fee schedule,64.8,80% of total billed charges,17.92,100% of CMS fee schedule,18.28,100% of CMS fee schedule,17.92,68.85,56.7
Outpatient Medical Services,LAB,83498,17-OH Progesterone LC/MS LC,301,151,120.8,80% of total billed charges,34.16,100% GA fee schedule,27.17,100% of CMS fee schedule,34.16,100% of GA fee schedule,128.35,85% of total billed charges,120.8,80% of total billed charges,27.44,101% of CMS fee schedule,34.16,100% of GA fee schedule,27.17,100% of CMS fee schedule,34.84,102% of GA fee schedule,27.17,100% of CMS fee schedule,120.8,80% of total billed charges,27.17,100% of CMS fee schedule,27.71,100% of CMS fee schedule,27.17,128.35,105.7
Outpatient Medical Services,LAB,83516,Anti-PLA2R LC,301,79,63.2,80% of total billed charges,13.45,100% GA fee schedule,11.53,100% of CMS fee schedule,13.45,100% of GA fee schedule,67.15,85% of total billed charges,63.2,80% of total billed charges,11.65,101% of CMS fee schedule,13.45,100% of GA fee schedule,11.53,100% of CMS fee schedule,13.72,102% of GA fee schedule,11.53,100% of CMS fee schedule,63.2,80% of total billed charges,11.53,100% of CMS fee schedule,11.76,100% of CMS fee schedule,11.53,67.15,55.3
Outpatient Medical Services,LAB,83520,Tryptase LC,302,64,51.2,80% of total billed charges,16.28,100% GA fee schedule,17.27,100% of CMS fee schedule,16.28,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,17.44,101% of CMS fee schedule,16.28,100% of GA fee schedule,17.27,100% of CMS fee schedule,16.61,102% of GA fee schedule,17.27,100% of CMS fee schedule,51.2,80% of total billed charges,17.27,100% of CMS fee schedule,17.62,100% of CMS fee schedule,16.28,54.4,44.8
Outpatient Medical Services,LAB,83521,Fr Lambda Lt Chains LC,300,78,62.4,80% of total billed charges,13.82,100% GA fee schedule,17.27,100% of CMS fee schedule,13.82,100% of GA fee schedule,66.3,85% of total billed charges,62.4,80% of total billed charges,17.44,101% of CMS fee schedule,13.82,100% of GA fee schedule,17.27,100% of CMS fee schedule,14.1,102% of GA fee schedule,17.27,100% of CMS fee schedule,62.4,80% of total billed charges,17.27,100% of CMS fee schedule,17.62,100% of CMS fee schedule,13.82,66.3,54.6
Outpatient Medical Services,LAB,83525,Insulin LC,301,64,51.2,80% of total billed charges,14.38,100% GA fee schedule,11.43,100% of CMS fee schedule,14.38,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,11.54,101% of CMS fee schedule,14.38,100% of GA fee schedule,11.43,100% of CMS fee schedule,14.67,102% of GA fee schedule,11.43,100% of CMS fee schedule,51.2,80% of total billed charges,11.43,100% of CMS fee schedule,11.66,100% of CMS fee schedule,11.43,54.4,44.8
Outpatient Medical Services,LAB,83540,Iron LC,301,36,28.8,80% of total billed charges,8.15,100% GA fee schedule,6.47,100% of CMS fee schedule,8.15,100% of GA fee schedule,30.6,85% of total billed charges,28.8,80% of total billed charges,6.53,101% of CMS fee schedule,8.15,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.31,102% of GA fee schedule,6.47,100% of CMS fee schedule,28.8,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,30.6,25.2
Outpatient Medical Services,LAB,83550,Iron Bind.Cap.(TIBC) LC,301,49,39.2,80% of total billed charges,10.99,100% GA fee schedule,8.74,100% of CMS fee schedule,10.99,100% of GA fee schedule,41.65,85% of total billed charges,39.2,80% of total billed charges,8.83,101% of CMS fee schedule,10.99,100% of GA fee schedule,8.74,100% of CMS fee schedule,11.21,102% of GA fee schedule,8.74,100% of CMS fee schedule,39.2,80% of total billed charges,8.74,100% of CMS fee schedule,8.91,100% of CMS fee schedule,8.74,41.65,34.3
Outpatient Medical Services,LAB,83586,"17-Ketosteroids, Urine LC",300,58,46.4,80% of total billed charges,15.8,100% GA fee schedule,12.8,100% of CMS fee schedule,15.8,100% of GA fee schedule,49.3,85% of total billed charges,46.4,80% of total billed charges,12.93,101% of CMS fee schedule,15.8,100% of GA fee schedule,12.8,100% of CMS fee schedule,16.12,102% of GA fee schedule,12.8,100% of CMS fee schedule,46.4,80% of total billed charges,12.8,100% of CMS fee schedule,13.06,100% of CMS fee schedule,12.8,49.3,40.6
Outpatient Medical Services,LAB,83605,Lactic Acid Level,301,59,47.2,80% of total billed charges,13.43,100% GA fee schedule,11.57,100% of CMS fee schedule,13.43,100% of GA fee schedule,50.15,85% of total billed charges,47.2,80% of total billed charges,11.69,101% of CMS fee schedule,13.43,100% of GA fee schedule,11.57,100% of CMS fee schedule,13.7,102% of GA fee schedule,11.57,100% of CMS fee schedule,47.2,80% of total billed charges,11.57,100% of CMS fee schedule,11.8,100% of CMS fee schedule,11.57,50.15,41.3
Outpatient Medical Services,LAB,83615,Lactate Dehydrogenase,301,34,27.2,80% of total billed charges,6.35,100% GA fee schedule,6.04,100% of CMS fee schedule,6.35,100% of GA fee schedule,28.9,85% of total billed charges,27.2,80% of total billed charges,6.1,101% of CMS fee schedule,6.35,100% of GA fee schedule,6.04,100% of CMS fee schedule,6.48,102% of GA fee schedule,6.04,100% of CMS fee schedule,27.2,80% of total billed charges,6.04,100% of CMS fee schedule,6.16,100% of CMS fee schedule,6.04,28.9,23.8
Outpatient Medical Services,LAB,83631,"Lactoferrin, Fecal, Quant. LC",301,89,71.2,80% of total billed charges,24.68,100% GA fee schedule,19.63,100% of CMS fee schedule,24.68,100% of GA fee schedule,75.65,85% of total billed charges,71.2,80% of total billed charges,19.83,101% of CMS fee schedule,24.68,100% of GA fee schedule,19.63,100% of CMS fee schedule,25.17,102% of GA fee schedule,19.63,100% of CMS fee schedule,71.2,80% of total billed charges,19.63,100% of CMS fee schedule,20.02,100% of CMS fee schedule,19.63,75.65,62.3
Outpatient Medical Services,LAB,83655,Lead Blood LC,301,67,53.6,80% of total billed charges,10,100% GA fee schedule,12.11,100% of CMS fee schedule,10,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.23,101% of CMS fee schedule,10,100% of GA fee schedule,12.11,100% of CMS fee schedule,10.2,102% of GA fee schedule,12.11,100% of CMS fee schedule,53.6,80% of total billed charges,12.11,100% of CMS fee schedule,12.35,100% of CMS fee schedule,10,56.95,46.9
Outpatient Medical Services,LAB,83690,Lipase Level,301,38,30.4,80% of total billed charges,8.66,100% GA fee schedule,6.89,100% of CMS fee schedule,8.66,100% of GA fee schedule,32.3,85% of total billed charges,30.4,80% of total billed charges,6.96,101% of CMS fee schedule,8.66,100% of GA fee schedule,6.89,100% of CMS fee schedule,8.83,102% of GA fee schedule,6.89,100% of CMS fee schedule,30.4,80% of total billed charges,6.89,100% of CMS fee schedule,7.03,100% of CMS fee schedule,6.89,32.3,26.6
Outpatient Medical Services,LAB,83721,LDL Cholesterol (Direct) LC,301,53,42.4,80% of total billed charges,12,100% GA fee schedule,10.5,100% of CMS fee schedule,12,100% of GA fee schedule,45.05,85% of total billed charges,42.4,80% of total billed charges,10.61,101% of CMS fee schedule,12,100% of GA fee schedule,10.5,100% of CMS fee schedule,12.24,102% of GA fee schedule,10.5,100% of CMS fee schedule,42.4,80% of total billed charges,10.5,100% of CMS fee schedule,10.71,100% of CMS fee schedule,10.5,45.05,37.1
Outpatient Medical Services,LAB,83735,"Magnesium, Ur LC",301,37,29.6,80% of total billed charges,8.42,100% GA fee schedule,6.7,100% of CMS fee schedule,8.42,100% of GA fee schedule,31.45,85% of total billed charges,29.6,80% of total billed charges,6.77,101% of CMS fee schedule,8.42,100% of GA fee schedule,6.7,100% of CMS fee schedule,8.59,102% of GA fee schedule,6.7,100% of CMS fee schedule,29.6,80% of total billed charges,6.7,100% of CMS fee schedule,6.83,100% of CMS fee schedule,6.7,31.45,25.9
Outpatient Medical Services,LAB,83825,Mercury Blood LC,301,90,72,80% of total billed charges,20.45,100% GA fee schedule,16.26,100% of CMS fee schedule,20.45,100% of GA fee schedule,76.5,85% of total billed charges,72,80% of total billed charges,16.42,101% of CMS fee schedule,20.45,100% of GA fee schedule,16.26,100% of CMS fee schedule,20.86,102% of GA fee schedule,16.26,100% of CMS fee schedule,72,80% of total billed charges,16.26,100% of CMS fee schedule,16.59,100% of CMS fee schedule,16.26,76.5,63
Outpatient Medical Services,LAB,83835,"Metanephrines, Frac, Qn, 24-Hr LC",301,94,75.2,80% of total billed charges,21.3,100% GA fee schedule,16.94,100% of CMS fee schedule,21.3,100% of GA fee schedule,79.9,85% of total billed charges,75.2,80% of total billed charges,17.11,101% of CMS fee schedule,21.3,100% of GA fee schedule,16.94,100% of CMS fee schedule,21.73,102% of GA fee schedule,16.94,100% of CMS fee schedule,75.2,80% of total billed charges,16.94,100% of CMS fee schedule,17.28,100% of CMS fee schedule,16.94,79.9,65.8
Outpatient Medical Services,LAB,83874,"Myoglobin, Ur LC",301,72,57.6,80% of total billed charges,16.24,100% GA fee schedule,12.92,100% of CMS fee schedule,16.24,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,13.05,101% of CMS fee schedule,16.24,100% of GA fee schedule,12.92,100% of CMS fee schedule,16.56,102% of GA fee schedule,12.92,100% of CMS fee schedule,57.6,80% of total billed charges,12.92,100% of CMS fee schedule,13.18,100% of CMS fee schedule,12.92,61.2,50.4
Outpatient Medical Services,LAB,83880,BNP,301,189,151.2,80% of total billed charges,42.69,100% GA fee schedule,39.26,100% of CMS fee schedule,42.69,100% of GA fee schedule,160.65,85% of total billed charges,151.2,80% of total billed charges,39.65,101% of CMS fee schedule,42.69,100% of GA fee schedule,39.26,100% of CMS fee schedule,43.54,102% of GA fee schedule,39.26,100% of CMS fee schedule,151.2,80% of total billed charges,39.26,100% of CMS fee schedule,40.05,100% of CMS fee schedule,39.26,160.65,132.3
Outpatient Medical Services,LAB,83921,"Methylmalonic Acid, LC",301,95,76,80% of total billed charges,20.7,100% GA fee schedule,21.21,100% of CMS fee schedule,20.7,100% of GA fee schedule,80.75,85% of total billed charges,76,80% of total billed charges,21.42,101% of CMS fee schedule,20.7,100% of GA fee schedule,21.21,100% of CMS fee schedule,21.11,102% of GA fee schedule,21.21,100% of CMS fee schedule,76,80% of total billed charges,21.21,100% of CMS fee schedule,21.63,100% of CMS fee schedule,20.7,80.75,66.5
Outpatient Medical Services,LAB,83930,Osmolality LC,301,37,29.6,80% of total billed charges,8.32,100% GA fee schedule,6.61,100% of CMS fee schedule,8.32,100% of GA fee schedule,31.45,85% of total billed charges,29.6,80% of total billed charges,6.68,101% of CMS fee schedule,8.32,100% of GA fee schedule,6.61,100% of CMS fee schedule,8.49,102% of GA fee schedule,6.61,100% of CMS fee schedule,29.6,80% of total billed charges,6.61,100% of CMS fee schedule,6.74,100% of CMS fee schedule,6.61,31.45,25.9
Outpatient Medical Services,LAB,83935,"Osmolality, Ur LC",301,38,30.4,80% of total billed charges,8.57,100% GA fee schedule,6.82,100% of CMS fee schedule,8.57,100% of GA fee schedule,32.3,85% of total billed charges,30.4,80% of total billed charges,6.89,101% of CMS fee schedule,8.57,100% of GA fee schedule,6.82,100% of CMS fee schedule,8.74,102% of GA fee schedule,6.82,100% of CMS fee schedule,30.4,80% of total billed charges,6.82,100% of CMS fee schedule,6.96,100% of CMS fee schedule,6.82,32.3,26.6
Outpatient Medical Services,LAB,83945,"Oxalate, Quant, 24Hr Ur LC",301,72,57.6,80% of total billed charges,16.19,100% GA fee schedule,14.45,100% of CMS fee schedule,16.19,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,14.59,101% of CMS fee schedule,16.19,100% of GA fee schedule,14.45,100% of CMS fee schedule,16.51,102% of GA fee schedule,14.45,100% of CMS fee schedule,57.6,80% of total billed charges,14.45,100% of CMS fee schedule,14.74,100% of CMS fee schedule,14.45,61.2,50.4
Outpatient Medical Services,LAB,83970,"PTH, Intact LC",301,256,204.8,80% of total billed charges,51.9,100% GA fee schedule,41.28,100% of CMS fee schedule,51.9,100% of GA fee schedule,217.6,85% of total billed charges,204.8,80% of total billed charges,41.69,101% of CMS fee schedule,51.9,100% of GA fee schedule,41.28,100% of CMS fee schedule,52.94,102% of GA fee schedule,41.28,100% of CMS fee schedule,204.8,80% of total billed charges,41.28,100% of CMS fee schedule,42.11,100% of CMS fee schedule,41.28,217.6,179.2
Outpatient Medical Services,LAB,83986,"pH, Stool LC",301,17,13.6,80% of total billed charges,4.5,100% GA fee schedule,3.58,100% of CMS fee schedule,4.5,100% of GA fee schedule,14.45,85% of total billed charges,13.6,80% of total billed charges,3.62,101% of CMS fee schedule,4.5,100% of GA fee schedule,3.58,100% of CMS fee schedule,4.59,102% of GA fee schedule,3.58,100% of CMS fee schedule,13.6,80% of total billed charges,3.58,100% of CMS fee schedule,3.65,100% of CMS fee schedule,3.58,14.45,11.9
Outpatient Medical Services,LAB,83993,"Calprotectin, Fecal LC",301,89,71.2,80% of total billed charges,24.68,100% GA fee schedule,19.63,100% of CMS fee schedule,24.68,100% of GA fee schedule,75.65,85% of total billed charges,71.2,80% of total billed charges,19.83,101% of CMS fee schedule,24.68,100% of GA fee schedule,19.63,100% of CMS fee schedule,25.17,102% of GA fee schedule,19.63,100% of CMS fee schedule,71.2,80% of total billed charges,19.63,100% of CMS fee schedule,20.02,100% of CMS fee schedule,19.63,75.65,62.3
Outpatient Medical Services,LAB,84075,Alkaline Phosphatase,301,29,23.2,80% of total billed charges,6.35,100% GA fee schedule,5.18,100% of CMS fee schedule,6.35,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.23,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.18,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.18,100% of CMS fee schedule,23.2,80% of total billed charges,5.18,100% of CMS fee schedule,5.28,100% of CMS fee schedule,5.18,24.65,20.3
Outpatient Medical Services,LAB,84080,Bone Frac LC,301,82,65.6,80% of total billed charges,18.59,100% GA fee schedule,14.78,100% of CMS fee schedule,18.59,100% of GA fee schedule,69.7,85% of total billed charges,65.6,80% of total billed charges,14.93,101% of CMS fee schedule,18.59,100% of GA fee schedule,14.78,100% of CMS fee schedule,18.96,102% of GA fee schedule,14.78,100% of CMS fee schedule,65.6,80% of total billed charges,14.78,100% of CMS fee schedule,15.08,100% of CMS fee schedule,14.78,69.7,57.4
Outpatient Medical Services,LAB,84100,Phosphorus Level,301,26,20.8,80% of total billed charges,5.97,100% GA fee schedule,4.74,100% of CMS fee schedule,5.97,100% of GA fee schedule,22.1,85% of total billed charges,20.8,80% of total billed charges,4.79,101% of CMS fee schedule,5.97,100% of GA fee schedule,4.74,100% of CMS fee schedule,6.09,102% of GA fee schedule,4.74,100% of CMS fee schedule,20.8,80% of total billed charges,4.74,100% of CMS fee schedule,4.83,100% of CMS fee schedule,4.74,22.1,18.2
Outpatient Medical Services,LAB,84120,"Porphyrines, Qnt, 24-Hr Urine LC",301,82,65.6,80% of total billed charges,18.5,100% GA fee schedule,14.71,100% of CMS fee schedule,18.5,100% of GA fee schedule,69.7,85% of total billed charges,65.6,80% of total billed charges,14.86,101% of CMS fee schedule,18.5,100% of GA fee schedule,14.71,100% of CMS fee schedule,18.87,102% of GA fee schedule,14.71,100% of CMS fee schedule,65.6,80% of total billed charges,14.71,100% of CMS fee schedule,15,100% of CMS fee schedule,14.71,69.7,57.4
Outpatient Medical Services,LAB,84132,Potassium Level,301,26,20.8,80% of total billed charges,5.78,100% GA fee schedule,4.76,100% of CMS fee schedule,5.78,100% of GA fee schedule,22.1,85% of total billed charges,20.8,80% of total billed charges,4.81,101% of CMS fee schedule,5.78,100% of GA fee schedule,4.76,100% of CMS fee schedule,5.9,102% of GA fee schedule,4.76,100% of CMS fee schedule,20.8,80% of total billed charges,4.76,100% of CMS fee schedule,4.86,100% of CMS fee schedule,4.76,22.1,18.2
Outpatient Medical Services,LAB,84133,"Potassium, Ur LC",301,24,19.2,80% of total billed charges,5.41,100% GA fee schedule,4.73,100% of CMS fee schedule,5.41,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,4.78,101% of CMS fee schedule,5.41,100% of GA fee schedule,4.73,100% of CMS fee schedule,5.52,102% of GA fee schedule,4.73,100% of CMS fee schedule,19.2,80% of total billed charges,4.73,100% of CMS fee schedule,4.82,100% of CMS fee schedule,4.73,20.4,16.8
Outpatient Medical Services,LAB,84134,Prealbumin LC,301,81,64.8,80% of total billed charges,18.34,100% GA fee schedule,14.59,100% of CMS fee schedule,18.34,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,14.74,101% of CMS fee schedule,18.34,100% of GA fee schedule,14.59,100% of CMS fee schedule,18.71,102% of GA fee schedule,14.59,100% of CMS fee schedule,64.8,80% of total billed charges,14.59,100% of CMS fee schedule,14.88,100% of CMS fee schedule,14.59,68.85,56.7
Outpatient Medical Services,LAB,84145,Procalcitonin LC,301,123,98.4,80% of total billed charges,24.06,100% GA fee schedule,27.22,100% of CMS fee schedule,24.06,100% of GA fee schedule,104.55,85% of total billed charges,98.4,80% of total billed charges,27.49,101% of CMS fee schedule,24.06,100% of GA fee schedule,27.22,100% of CMS fee schedule,24.54,102% of GA fee schedule,27.22,100% of CMS fee schedule,98.4,80% of total billed charges,27.22,100% of CMS fee schedule,27.76,100% of CMS fee schedule,24.06,104.55,86.1
Outpatient Medical Services,LAB,84146,Prolactin LC,301,108,86.4,80% of total billed charges,24.37,100% GA fee schedule,19.38,100% of CMS fee schedule,24.37,100% of GA fee schedule,91.8,85% of total billed charges,86.4,80% of total billed charges,19.57,101% of CMS fee schedule,24.37,100% of GA fee schedule,19.38,100% of CMS fee schedule,24.86,102% of GA fee schedule,19.38,100% of CMS fee schedule,86.4,80% of total billed charges,19.38,100% of CMS fee schedule,19.77,100% of CMS fee schedule,19.38,91.8,75.6
Outpatient Medical Services,LAB,84153,"Prostate-Specific Ag, Serum LC",301,102,81.6,80% of total billed charges,23.13,100% GA fee schedule,18.39,100% of CMS fee schedule,23.13,100% of GA fee schedule,86.7,85% of total billed charges,81.6,80% of total billed charges,18.57,101% of CMS fee schedule,23.13,100% of GA fee schedule,18.39,100% of CMS fee schedule,23.59,102% of GA fee schedule,18.39,100% of CMS fee schedule,81.6,80% of total billed charges,18.39,100% of CMS fee schedule,18.76,100% of CMS fee schedule,18.39,86.7,71.4
Outpatient Medical Services,LAB,84154,PSA Free LC,301,102,81.6,80% of total billed charges,23.13,100% GA fee schedule,18.39,100% of CMS fee schedule,23.13,100% of GA fee schedule,86.7,85% of total billed charges,81.6,80% of total billed charges,18.57,101% of CMS fee schedule,23.13,100% of GA fee schedule,18.39,100% of CMS fee schedule,23.59,102% of GA fee schedule,18.39,100% of CMS fee schedule,81.6,80% of total billed charges,18.39,100% of CMS fee schedule,18.76,100% of CMS fee schedule,18.39,86.7,71.4
Outpatient Medical Services,LAB,84155,Protein Total,301,20,16,80% of total billed charges,4.61,100% GA fee schedule,3.67,100% of CMS fee schedule,4.61,100% of GA fee schedule,17,85% of total billed charges,16,80% of total billed charges,3.71,101% of CMS fee schedule,4.61,100% of GA fee schedule,3.67,100% of CMS fee schedule,4.7,102% of GA fee schedule,3.67,100% of CMS fee schedule,16,80% of total billed charges,3.67,100% of CMS fee schedule,3.74,100% of CMS fee schedule,3.67,17,14
Outpatient Medical Services,LAB,84156,Protein Total Ur LC,301,10,8,80% of total billed charges,4.61,100% GA fee schedule,3.67,100% of CMS fee schedule,4.61,100% of GA fee schedule,8.5,85% of total billed charges,8,80% of total billed charges,3.71,101% of CMS fee schedule,4.61,100% of GA fee schedule,3.67,100% of CMS fee schedule,4.7,102% of GA fee schedule,3.67,100% of CMS fee schedule,8,80% of total billed charges,3.67,100% of CMS fee schedule,3.74,100% of CMS fee schedule,3.67,8.5,7
Outpatient Medical Services,LAB,84165,Alpha1 Glob LC,301,67,53.6,80% of total billed charges,13.51,100% GA fee schedule,10.74,100% of CMS fee schedule,13.51,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,10.85,101% of CMS fee schedule,13.51,100% of GA fee schedule,10.74,100% of CMS fee schedule,13.78,102% of GA fee schedule,10.74,100% of CMS fee schedule,53.6,80% of total billed charges,10.74,100% of CMS fee schedule,10.95,100% of CMS fee schedule,10.74,56.95,46.9
Outpatient Medical Services,LAB,84166,Alpha-1-Glob Ur LC,301,35,28,80% of total billed charges,22.43,100% GA fee schedule,17.83,100% of CMS fee schedule,22.43,100% of GA fee schedule,29.75,85% of total billed charges,28,80% of total billed charges,18.01,101% of CMS fee schedule,22.43,100% of GA fee schedule,17.83,100% of CMS fee schedule,22.88,102% of GA fee schedule,17.83,100% of CMS fee schedule,28,80% of total billed charges,17.83,100% of CMS fee schedule,18.19,100% of CMS fee schedule,17.83,29.75,24.5
Outpatient Medical Services,LAB,84207,"Vitamin B6, LC",301,156,124.8,80% of total billed charges,35.33,100% GA fee schedule,28.1,100% of CMS fee schedule,35.33,100% of GA fee schedule,132.6,85% of total billed charges,124.8,80% of total billed charges,28.38,101% of CMS fee schedule,35.33,100% of GA fee schedule,28.1,100% of CMS fee schedule,36.04,102% of GA fee schedule,28.1,100% of CMS fee schedule,124.8,80% of total billed charges,28.1,100% of CMS fee schedule,28.66,100% of CMS fee schedule,28.1,132.6,109.2
Outpatient Medical Services,LAB,84238,Soluble Transferrin Receptor LC,301,165,132,80% of total billed charges,45.98,100% GA fee schedule,36.57,100% of CMS fee schedule,45.98,100% of GA fee schedule,140.25,85% of total billed charges,132,80% of total billed charges,36.94,101% of CMS fee schedule,45.98,100% of GA fee schedule,36.57,100% of CMS fee schedule,46.9,102% of GA fee schedule,36.57,100% of CMS fee schedule,132,80% of total billed charges,36.57,100% of CMS fee schedule,37.3,100% of CMS fee schedule,36.57,140.25,115.5
Outpatient Medical Services,LAB,84244,Renin Activity LC,301,122,97.6,80% of total billed charges,27.66,100% GA fee schedule,21.99,100% of CMS fee schedule,27.66,100% of GA fee schedule,103.7,85% of total billed charges,97.6,80% of total billed charges,22.21,101% of CMS fee schedule,27.66,100% of GA fee schedule,21.99,100% of CMS fee schedule,28.21,102% of GA fee schedule,21.99,100% of CMS fee schedule,97.6,80% of total billed charges,21.99,100% of CMS fee schedule,22.43,100% of CMS fee schedule,21.99,103.7,85.4
Outpatient Medical Services,LAB,84270,Sex Horm Binding Glob LC,301,135,108,80% of total billed charges,27.32,100% GA fee schedule,21.73,100% of CMS fee schedule,27.32,100% of GA fee schedule,114.75,85% of total billed charges,108,80% of total billed charges,21.95,101% of CMS fee schedule,27.32,100% of GA fee schedule,21.73,100% of CMS fee schedule,27.87,102% of GA fee schedule,21.73,100% of CMS fee schedule,108,80% of total billed charges,21.73,100% of CMS fee schedule,22.16,100% of CMS fee schedule,21.73,114.75,94.5
Outpatient Medical Services,LAB,84295,Sodium Level,300,27,21.6,80% of total billed charges,6.05,100% GA fee schedule,4.81,100% of CMS fee schedule,6.05,100% of GA fee schedule,22.95,85% of total billed charges,21.6,80% of total billed charges,4.86,101% of CMS fee schedule,6.05,100% of GA fee schedule,4.81,100% of CMS fee schedule,6.17,102% of GA fee schedule,4.81,100% of CMS fee schedule,21.6,80% of total billed charges,4.81,100% of CMS fee schedule,4.91,100% of CMS fee schedule,4.81,22.95,18.9
Outpatient Medical Services,LAB,84300,"Sodium, Ur LC",301,24,19.2,80% of total billed charges,4.35,100% GA fee schedule,5.06,100% of CMS fee schedule,4.35,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,5.11,101% of CMS fee schedule,4.35,100% of GA fee schedule,5.06,100% of CMS fee schedule,4.44,102% of GA fee schedule,5.06,100% of CMS fee schedule,19.2,80% of total billed charges,5.06,100% of CMS fee schedule,5.16,100% of CMS fee schedule,4.35,20.4,16.8
Outpatient Medical Services,LAB,84305,IGF-1 LC,301,96,76.8,80% of total billed charges,26.73,100% GA fee schedule,21.26,100% of CMS fee schedule,26.73,100% of GA fee schedule,81.6,85% of total billed charges,76.8,80% of total billed charges,21.47,101% of CMS fee schedule,26.73,100% of GA fee schedule,21.26,100% of CMS fee schedule,27.26,102% of GA fee schedule,21.26,100% of CMS fee schedule,76.8,80% of total billed charges,21.26,100% of CMS fee schedule,21.69,100% of CMS fee schedule,21.26,81.6,67.2
Outpatient Medical Services,LAB,84376,"Reducing Substances, Fecal LC",301,25,20,80% of total billed charges,6.92,100% GA fee schedule,5.5,100% of CMS fee schedule,6.92,100% of GA fee schedule,21.25,85% of total billed charges,20,80% of total billed charges,5.56,101% of CMS fee schedule,6.92,100% of GA fee schedule,5.5,100% of CMS fee schedule,7.06,102% of GA fee schedule,5.5,100% of CMS fee schedule,20,80% of total billed charges,5.5,100% of CMS fee schedule,5.61,100% of CMS fee schedule,5.5,21.25,17.5
Outpatient Medical Services,LAB,84402,Free Testost Direct LC,301,142,113.6,80% of total billed charges,32.01,100% GA fee schedule,25.47,100% of CMS fee schedule,32.01,100% of GA fee schedule,120.7,85% of total billed charges,113.6,80% of total billed charges,25.72,101% of CMS fee schedule,32.01,100% of GA fee schedule,25.47,100% of CMS fee schedule,32.65,102% of GA fee schedule,25.47,100% of CMS fee schedule,113.6,80% of total billed charges,25.47,100% of CMS fee schedule,25.98,100% of CMS fee schedule,25.47,120.7,99.4
Outpatient Medical Services,LAB,84403,Testosterone LC,301,143,114.4,80% of total billed charges,32.47,100% GA fee schedule,25.81,100% of CMS fee schedule,32.47,100% of GA fee schedule,121.55,85% of total billed charges,114.4,80% of total billed charges,26.07,101% of CMS fee schedule,32.47,100% of GA fee schedule,25.81,100% of CMS fee schedule,33.12,102% of GA fee schedule,25.81,100% of CMS fee schedule,114.4,80% of total billed charges,25.81,100% of CMS fee schedule,26.33,100% of CMS fee schedule,25.81,121.55,100.1
Outpatient Medical Services,LAB,84410,"Testosterone,Free+Weakly Bound LC",301,285,228,80% of total billed charges,179.55,63% of total billed charges,51.28,100% of CMS fee schedule,179.55,63% of total billed charges,242.25,85% of total billed charges,228,80% of total billed charges,51.79,101% of CMS fee schedule,179.55,63% of total billed charges,51.28,100% of CMS fee schedule,179.55,63% of total billed charges,51.28,100% of CMS fee schedule,228,80% of total billed charges,51.28,100% of CMS fee schedule,52.31,100% of CMS fee schedule,51.28,242.25,199.5
Outpatient Medical Services,LAB,84425,"Vitamin B1 (Thiamine), Bld LC",300,118,94.4,80% of total billed charges,26.7,100% GA fee schedule,21.23,100% of CMS fee schedule,26.7,100% of GA fee schedule,100.3,85% of total billed charges,94.4,80% of total billed charges,21.44,101% of CMS fee schedule,26.7,100% of GA fee schedule,21.23,100% of CMS fee schedule,27.23,102% of GA fee schedule,21.23,100% of CMS fee schedule,94.4,80% of total billed charges,21.23,100% of CMS fee schedule,21.65,100% of CMS fee schedule,21.23,100.3,82.6
Outpatient Medical Services,LAB,84433,Thiopurine Methyltransferase LC,301,100,80,80% of total billed charges,17.74,100% GA fee schedule,22.17,100% of CMS fee schedule,17.74,100% of GA fee schedule,85,85% of total billed charges,80,80% of total billed charges,22.39,101% of CMS fee schedule,17.74,100% of GA fee schedule,22.17,100% of CMS fee schedule,18.09,102% of GA fee schedule,22.17,100% of CMS fee schedule,80,80% of total billed charges,22.17,100% of CMS fee schedule,22.61,100% of CMS fee schedule,17.74,85,70
Outpatient Medical Services,LAB,84436,Thyroxine (T4) LC,301,38,30.4,80% of total billed charges,8.65,100% GA fee schedule,6.87,100% of CMS fee schedule,8.65,100% of GA fee schedule,32.3,85% of total billed charges,30.4,80% of total billed charges,6.94,101% of CMS fee schedule,8.65,100% of GA fee schedule,6.87,100% of CMS fee schedule,8.82,102% of GA fee schedule,6.87,100% of CMS fee schedule,30.4,80% of total billed charges,6.87,100% of CMS fee schedule,7.01,100% of CMS fee schedule,6.87,32.3,26.6
Outpatient Medical Services,LAB,84439,Thyroxine (T4) Free Direct LC,301,50,40,80% of total billed charges,11.34,100% GA fee schedule,9.02,100% of CMS fee schedule,11.34,100% of GA fee schedule,42.5,85% of total billed charges,40,80% of total billed charges,9.11,101% of CMS fee schedule,11.34,100% of GA fee schedule,9.02,100% of CMS fee schedule,11.57,102% of GA fee schedule,9.02,100% of CMS fee schedule,40,80% of total billed charges,9.02,100% of CMS fee schedule,9.2,100% of CMS fee schedule,9.02,42.5,35
Outpatient Medical Services,LAB,84443,Thyroid Stimulating Hormone,301,93,74.4,80% of total billed charges,21.12,100% GA fee schedule,16.8,100% of CMS fee schedule,21.12,100% of GA fee schedule,79.05,85% of total billed charges,74.4,80% of total billed charges,16.97,101% of CMS fee schedule,21.12,100% of GA fee schedule,16.8,100% of CMS fee schedule,21.54,102% of GA fee schedule,16.8,100% of CMS fee schedule,74.4,80% of total billed charges,16.8,100% of CMS fee schedule,17.14,100% of CMS fee schedule,16.8,79.05,65.1
Outpatient Medical Services,LAB,84446,Vitamin E LC,301,79,63.2,80% of total billed charges,17.83,100% GA fee schedule,14.18,100% of CMS fee schedule,17.83,100% of GA fee schedule,67.15,85% of total billed charges,63.2,80% of total billed charges,14.32,101% of CMS fee schedule,17.83,100% of GA fee schedule,14.18,100% of CMS fee schedule,18.19,102% of GA fee schedule,14.18,100% of CMS fee schedule,63.2,80% of total billed charges,14.18,100% of CMS fee schedule,14.46,100% of CMS fee schedule,14.18,67.15,55.3
Outpatient Medical Services,LAB,84450,AST,301,29,23.2,80% of total billed charges,6.35,100% GA fee schedule,5.18,100% of CMS fee schedule,6.35,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.23,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.18,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.18,100% of CMS fee schedule,23.2,80% of total billed charges,5.18,100% of CMS fee schedule,5.28,100% of CMS fee schedule,5.18,24.65,20.3
Outpatient Medical Services,LAB,84460,ALT,301,29,23.2,80% of total billed charges,6.35,100% GA fee schedule,5.3,100% of CMS fee schedule,6.35,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.35,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.3,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.3,100% of CMS fee schedule,23.2,80% of total billed charges,5.3,100% of CMS fee schedule,5.41,100% of CMS fee schedule,5.3,24.65,20.3
Outpatient Medical Services,LAB,84466,Transferrin LC,301,71,56.8,80% of total billed charges,16.06,100% GA fee schedule,12.76,100% of CMS fee schedule,16.06,100% of GA fee schedule,60.35,85% of total billed charges,56.8,80% of total billed charges,12.89,101% of CMS fee schedule,16.06,100% of GA fee schedule,12.76,100% of CMS fee schedule,16.38,102% of GA fee schedule,12.76,100% of CMS fee schedule,56.8,80% of total billed charges,12.76,100% of CMS fee schedule,13.02,100% of CMS fee schedule,12.76,60.35,49.7
Outpatient Medical Services,LAB,84478,Triglycerides,301,32,25.6,80% of total billed charges,6.35,100% GA fee schedule,5.74,100% of CMS fee schedule,6.35,100% of GA fee schedule,27.2,85% of total billed charges,25.6,80% of total billed charges,5.8,101% of CMS fee schedule,6.35,100% of GA fee schedule,5.74,100% of CMS fee schedule,6.48,102% of GA fee schedule,5.74,100% of CMS fee schedule,25.6,80% of total billed charges,5.74,100% of CMS fee schedule,5.85,100% of CMS fee schedule,5.74,27.2,22.4
Outpatient Medical Services,LAB,84479,T3 Uptake LC,301,36,28.8,80% of total billed charges,8.14,100% GA fee schedule,6.47,100% of CMS fee schedule,8.14,100% of GA fee schedule,30.6,85% of total billed charges,28.8,80% of total billed charges,6.53,101% of CMS fee schedule,8.14,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.3,102% of GA fee schedule,6.47,100% of CMS fee schedule,28.8,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,30.6,25.2
Outpatient Medical Services,LAB,84480,Triiodothyronine (T3) LC,301,79,63.2,80% of total billed charges,16.03,100% GA fee schedule,14.18,100% of CMS fee schedule,16.03,100% of GA fee schedule,67.15,85% of total billed charges,63.2,80% of total billed charges,14.32,101% of CMS fee schedule,16.03,100% of GA fee schedule,14.18,100% of CMS fee schedule,16.35,102% of GA fee schedule,14.18,100% of CMS fee schedule,63.2,80% of total billed charges,14.18,100% of CMS fee schedule,14.46,100% of CMS fee schedule,14.18,67.15,55.3
Outpatient Medical Services,LAB,84481,"Triiodothyronine (T3), Free LC",301,94,75.2,80% of total billed charges,21.3,100% GA fee schedule,16.94,100% of CMS fee schedule,21.3,100% of GA fee schedule,79.9,85% of total billed charges,75.2,80% of total billed charges,17.11,101% of CMS fee schedule,21.3,100% of GA fee schedule,16.94,100% of CMS fee schedule,21.73,102% of GA fee schedule,16.94,100% of CMS fee schedule,75.2,80% of total billed charges,16.94,100% of CMS fee schedule,17.28,100% of CMS fee schedule,16.94,79.9,65.8
Outpatient Medical Services,LAB,84484,hs Troponin-I,301,46,36.8,80% of total billed charges,12.38,100% GA fee schedule,12.47,100% of CMS fee schedule,12.38,100% of GA fee schedule,39.1,85% of total billed charges,36.8,80% of total billed charges,12.59,101% of CMS fee schedule,12.38,100% of GA fee schedule,12.47,100% of CMS fee schedule,12.63,102% of GA fee schedule,12.47,100% of CMS fee schedule,36.8,80% of total billed charges,12.47,100% of CMS fee schedule,12.72,100% of CMS fee schedule,12.38,39.1,32.2
Outpatient Medical Services,LAB,84520,BUN,301,22,17.6,80% of total billed charges,4.96,100% GA fee schedule,3.95,100% of CMS fee schedule,4.96,100% of GA fee schedule,18.7,85% of total billed charges,17.6,80% of total billed charges,3.99,101% of CMS fee schedule,4.96,100% of GA fee schedule,3.95,100% of CMS fee schedule,5.06,102% of GA fee schedule,3.95,100% of CMS fee schedule,17.6,80% of total billed charges,3.95,100% of CMS fee schedule,4.03,100% of CMS fee schedule,3.95,18.7,15.4
Outpatient Medical Services,LAB,84550,Uric Acid,301,25,20,80% of total billed charges,5.68,100% GA fee schedule,4.52,100% of CMS fee schedule,5.68,100% of GA fee schedule,21.25,85% of total billed charges,20,80% of total billed charges,4.57,101% of CMS fee schedule,5.68,100% of GA fee schedule,4.52,100% of CMS fee schedule,5.79,102% of GA fee schedule,4.52,100% of CMS fee schedule,20,80% of total billed charges,4.52,100% of CMS fee schedule,4.61,100% of CMS fee schedule,4.52,21.25,17.5
Outpatient Medical Services,LAB,84560,Uric Acid 24h Ur LC,301,26,20.8,80% of total billed charges,5.98,100% GA fee schedule,5.08,100% of CMS fee schedule,5.98,100% of GA fee schedule,22.1,85% of total billed charges,20.8,80% of total billed charges,5.13,101% of CMS fee schedule,5.98,100% of GA fee schedule,5.08,100% of CMS fee schedule,6.1,102% of GA fee schedule,5.08,100% of CMS fee schedule,20.8,80% of total billed charges,5.08,100% of CMS fee schedule,5.18,100% of CMS fee schedule,5.08,22.1,18.2
Outpatient Medical Services,LAB,84588,ADH LC,301,210,168,80% of total billed charges,42.69,100% GA fee schedule,33.94,100% of CMS fee schedule,42.69,100% of GA fee schedule,178.5,85% of total billed charges,168,80% of total billed charges,34.28,101% of CMS fee schedule,42.69,100% of GA fee schedule,33.94,100% of CMS fee schedule,43.54,102% of GA fee schedule,33.94,100% of CMS fee schedule,168,80% of total billed charges,33.94,100% of CMS fee schedule,34.62,100% of CMS fee schedule,33.94,178.5,147
Outpatient Medical Services,LAB,84590,Vitamin A LC,301,64,51.2,80% of total billed charges,14.58,100% GA fee schedule,11.61,100% of CMS fee schedule,14.58,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,11.73,101% of CMS fee schedule,14.58,100% of GA fee schedule,11.61,100% of CMS fee schedule,14.87,102% of GA fee schedule,11.61,100% of CMS fee schedule,51.2,80% of total billed charges,11.61,100% of CMS fee schedule,11.84,100% of CMS fee schedule,11.61,54.4,44.8
Outpatient Medical Services,LAB,84630,"Zinc, Whole Blood LC",301,63,50.4,80% of total billed charges,14.32,100% GA fee schedule,11.39,100% of CMS fee schedule,14.32,100% of GA fee schedule,53.55,85% of total billed charges,50.4,80% of total billed charges,11.5,101% of CMS fee schedule,14.32,100% of GA fee schedule,11.39,100% of CMS fee schedule,14.61,102% of GA fee schedule,11.39,100% of CMS fee schedule,50.4,80% of total billed charges,11.39,100% of CMS fee schedule,11.62,100% of CMS fee schedule,11.39,53.55,44.1
Outpatient Medical Services,LAB,84630,Zinc WhlBld LC,301,63,50.4,80% of total billed charges,14.32,100% GA fee schedule,11.39,100% of CMS fee schedule,14.32,100% of GA fee schedule,53.55,85% of total billed charges,50.4,80% of total billed charges,11.5,101% of CMS fee schedule,14.32,100% of GA fee schedule,11.39,100% of CMS fee schedule,14.61,102% of GA fee schedule,11.39,100% of CMS fee schedule,50.4,80% of total billed charges,11.39,100% of CMS fee schedule,11.62,100% of CMS fee schedule,11.39,53.55,44.1
Outpatient Medical Services,LAB,84681,C-Peptide LC,301,116,92.8,80% of total billed charges,19.98,100% GA fee schedule,20.81,100% of CMS fee schedule,19.98,100% of GA fee schedule,98.6,85% of total billed charges,92.8,80% of total billed charges,21.02,101% of CMS fee schedule,19.98,100% of GA fee schedule,20.81,100% of CMS fee schedule,20.38,102% of GA fee schedule,20.81,100% of CMS fee schedule,92.8,80% of total billed charges,20.81,100% of CMS fee schedule,21.23,100% of CMS fee schedule,19.98,98.6,81.2
Outpatient Medical Services,LAB,84702,Beta hCG Quantitative,301,84,67.2,80% of total billed charges,8.07,100% GA fee schedule,15.05,100% of CMS fee schedule,8.07,100% of GA fee schedule,71.4,85% of total billed charges,67.2,80% of total billed charges,15.2,101% of CMS fee schedule,8.07,100% of GA fee schedule,15.05,100% of CMS fee schedule,8.23,102% of GA fee schedule,15.05,100% of CMS fee schedule,67.2,80% of total billed charges,15.05,100% of CMS fee schedule,15.35,100% of CMS fee schedule,8.07,71.4,58.8
Outpatient Medical Services,LAB,84703,Beta hCG Qualitative Urine,301,42,33.6,80% of total billed charges,8.07,100% GA fee schedule,7.52,100% of CMS fee schedule,8.07,100% of GA fee schedule,35.7,85% of total billed charges,33.6,80% of total billed charges,7.6,101% of CMS fee schedule,8.07,100% of GA fee schedule,7.52,100% of CMS fee schedule,8.23,102% of GA fee schedule,7.52,100% of CMS fee schedule,33.6,80% of total billed charges,7.52,100% of CMS fee schedule,7.67,100% of CMS fee schedule,7.52,35.7,29.4
Outpatient Medical Services,LAB,85007,.Manual Differential (WLMH),305,18,14.4,80% of total billed charges,4.33,100% GA fee schedule,3.8,100% of CMS fee schedule,4.33,100% of GA fee schedule,15.3,85% of total billed charges,14.4,80% of total billed charges,3.84,101% of CMS fee schedule,4.33,100% of GA fee schedule,3.8,100% of CMS fee schedule,4.42,102% of GA fee schedule,3.8,100% of CMS fee schedule,14.4,80% of total billed charges,3.8,100% of CMS fee schedule,3.88,100% of CMS fee schedule,3.8,15.3,12.6
Outpatient Medical Services,LAB,85014,Hematocrit,305,13,10.4,80% of total billed charges,2.98,100% GA fee schedule,2.37,100% of CMS fee schedule,2.98,100% of GA fee schedule,11.05,85% of total billed charges,10.4,80% of total billed charges,2.39,101% of CMS fee schedule,2.98,100% of GA fee schedule,2.37,100% of CMS fee schedule,3.04,102% of GA fee schedule,2.37,100% of CMS fee schedule,10.4,80% of total billed charges,2.37,100% of CMS fee schedule,2.42,100% of CMS fee schedule,2.37,11.05,9.1
Outpatient Medical Services,LAB,85014,Hct LC,305,13,10.4,80% of total billed charges,2.98,100% GA fee schedule,2.37,100% of CMS fee schedule,2.98,100% of GA fee schedule,11.05,85% of total billed charges,10.4,80% of total billed charges,2.39,101% of CMS fee schedule,2.98,100% of GA fee schedule,2.37,100% of CMS fee schedule,3.04,102% of GA fee schedule,2.37,100% of CMS fee schedule,10.4,80% of total billed charges,2.37,100% of CMS fee schedule,2.42,100% of CMS fee schedule,2.37,11.05,9.1
Outpatient Medical Services,LAB,85018,Hemoglobin,305,13,10.4,80% of total billed charges,2.98,100% GA fee schedule,2.37,100% of CMS fee schedule,2.98,100% of GA fee schedule,11.05,85% of total billed charges,10.4,80% of total billed charges,2.39,101% of CMS fee schedule,2.98,100% of GA fee schedule,2.37,100% of CMS fee schedule,3.04,102% of GA fee schedule,2.37,100% of CMS fee schedule,10.4,80% of total billed charges,2.37,100% of CMS fee schedule,2.42,100% of CMS fee schedule,2.37,11.05,9.1
Outpatient Medical Services,LAB,85025,CBC w/ Diff,305,35,28,80% of total billed charges,9.77,100% GA fee schedule,7.77,100% of CMS fee schedule,9.77,100% of GA fee schedule,29.75,85% of total billed charges,28,80% of total billed charges,7.85,101% of CMS fee schedule,9.77,100% of GA fee schedule,7.77,100% of CMS fee schedule,9.97,102% of GA fee schedule,7.77,100% of CMS fee schedule,28,80% of total billed charges,7.77,100% of CMS fee schedule,7.93,100% of CMS fee schedule,7.77,29.75,24.5
Outpatient Medical Services,LAB,85027,CBC w/o Diff,301,30,24,80% of total billed charges,8.14,100% GA fee schedule,6.47,100% of CMS fee schedule,8.14,100% of GA fee schedule,25.5,85% of total billed charges,24,80% of total billed charges,6.53,101% of CMS fee schedule,8.14,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.3,102% of GA fee schedule,6.47,100% of CMS fee schedule,24,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,25.5,21
Outpatient Medical Services,LAB,85045,Retic Count,305,18,14.4,80% of total billed charges,5.03,100% GA fee schedule,3.99,100% of CMS fee schedule,5.03,100% of GA fee schedule,15.3,85% of total billed charges,14.4,80% of total billed charges,4.03,101% of CMS fee schedule,5.03,100% of GA fee schedule,3.99,100% of CMS fee schedule,5.13,102% of GA fee schedule,3.99,100% of CMS fee schedule,14.4,80% of total billed charges,3.99,100% of CMS fee schedule,4.07,100% of CMS fee schedule,3.99,15.3,12.6
Outpatient Medical Services,LAB,85049,Platelet Count,305,25,20,80% of total billed charges,5.63,100% GA fee schedule,4.48,100% of CMS fee schedule,5.63,100% of GA fee schedule,21.25,85% of total billed charges,20,80% of total billed charges,4.52,101% of CMS fee schedule,5.63,100% of GA fee schedule,4.48,100% of CMS fee schedule,5.74,102% of GA fee schedule,4.48,100% of CMS fee schedule,20,80% of total billed charges,4.48,100% of CMS fee schedule,4.57,100% of CMS fee schedule,4.48,21.25,17.5
Outpatient Medical Services,LAB,85060,"Hematopath Consultation, Smear LC",305,20,16,80% of total billed charges,25.97,100% GA fee schedule,12.4,62% of total billed charges,25.97,100% of GA fee schedule,17,85% of total billed charges,16,80% of total billed charges,12.4,62% of total billed charges,25.97,100% of GA fee schedule,12.4,62% of total billed charges,26.49,102% of GA fee schedule,12.4,62% of total billed charges,16,80% of total billed charges,12.4,62% of total billed charges,12.4,62% of total billed charges,12.4,26.49,14
Outpatient Medical Services,LAB,85302,Protein C Ag LC,305,67,53.6,80% of total billed charges,15.12,100% GA fee schedule,12.01,100% of CMS fee schedule,15.12,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.13,101% of CMS fee schedule,15.12,100% of GA fee schedule,12.01,100% of CMS fee schedule,15.42,102% of GA fee schedule,12.01,100% of CMS fee schedule,53.6,80% of total billed charges,12.01,100% of CMS fee schedule,12.25,100% of CMS fee schedule,12.01,56.95,46.9
Outpatient Medical Services,LAB,85303,Protein C Funct LC,305,77,61.6,80% of total billed charges,17.39,100% GA fee schedule,13.84,100% of CMS fee schedule,17.39,100% of GA fee schedule,65.45,85% of total billed charges,61.6,80% of total billed charges,13.98,101% of CMS fee schedule,17.39,100% of GA fee schedule,13.84,100% of CMS fee schedule,17.74,102% of GA fee schedule,13.84,100% of CMS fee schedule,61.6,80% of total billed charges,13.84,100% of CMS fee schedule,14.12,100% of CMS fee schedule,13.84,65.45,53.9
Outpatient Medical Services,LAB,85305,Protein S Total LC,305,65,52,80% of total billed charges,14.58,100% GA fee schedule,11.61,100% of CMS fee schedule,14.58,100% of GA fee schedule,55.25,85% of total billed charges,52,80% of total billed charges,11.73,101% of CMS fee schedule,14.58,100% of GA fee schedule,11.61,100% of CMS fee schedule,14.87,102% of GA fee schedule,11.61,100% of CMS fee schedule,52,80% of total billed charges,11.61,100% of CMS fee schedule,11.84,100% of CMS fee schedule,11.61,55.25,45.5
Outpatient Medical Services,LAB,85306,Protein S Funct LC,301,85,68,80% of total billed charges,19.27,100% GA fee schedule,15.32,100% of CMS fee schedule,19.27,100% of GA fee schedule,72.25,85% of total billed charges,68,80% of total billed charges,15.47,101% of CMS fee schedule,19.27,100% of GA fee schedule,15.32,100% of CMS fee schedule,19.66,102% of GA fee schedule,15.32,100% of CMS fee schedule,68,80% of total billed charges,15.32,100% of CMS fee schedule,15.63,100% of CMS fee schedule,15.32,72.25,59.5
Outpatient Medical Services,LAB,85379,D-Dimer,305,57,45.6,80% of total billed charges,12.8,100% GA fee schedule,10.18,100% of CMS fee schedule,12.8,100% of GA fee schedule,48.45,85% of total billed charges,45.6,80% of total billed charges,10.28,101% of CMS fee schedule,12.8,100% of GA fee schedule,10.18,100% of CMS fee schedule,13.06,102% of GA fee schedule,10.18,100% of CMS fee schedule,45.6,80% of total billed charges,10.18,100% of CMS fee schedule,10.38,100% of CMS fee schedule,10.18,48.45,39.9
Outpatient Medical Services,LAB,85384,Fibrinogen Activity LC,305,47,37.6,80% of total billed charges,10.68,100% GA fee schedule,9.72,100% of CMS fee schedule,10.68,100% of GA fee schedule,39.95,85% of total billed charges,37.6,80% of total billed charges,9.82,101% of CMS fee schedule,10.68,100% of GA fee schedule,9.72,100% of CMS fee schedule,10.89,102% of GA fee schedule,9.72,100% of CMS fee schedule,37.6,80% of total billed charges,9.72,100% of CMS fee schedule,9.91,100% of CMS fee schedule,9.72,39.95,32.9
Outpatient Medical Services,LAB,85549,"Lysozyme, Serum LC",305,104,83.2,80% of total billed charges,23.59,100% GA fee schedule,18.75,100% of CMS fee schedule,23.59,100% of GA fee schedule,88.4,85% of total billed charges,83.2,80% of total billed charges,18.94,101% of CMS fee schedule,23.59,100% of GA fee schedule,18.75,100% of CMS fee schedule,24.06,102% of GA fee schedule,18.75,100% of CMS fee schedule,83.2,80% of total billed charges,18.75,100% of CMS fee schedule,19.13,100% of CMS fee schedule,18.75,88.4,72.8
Outpatient Medical Services,LAB,85598,.Hex Phase Phospholipid 117020 LC,305,81,64.8,80% of total billed charges,20.24,100% GA fee schedule,17.98,100% of CMS fee schedule,20.24,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,18.16,101% of CMS fee schedule,20.24,100% of GA fee schedule,17.98,100% of CMS fee schedule,20.64,102% of GA fee schedule,17.98,100% of CMS fee schedule,64.8,80% of total billed charges,17.98,100% of CMS fee schedule,18.34,100% of CMS fee schedule,17.98,68.85,56.7
Outpatient Medical Services,LAB,85610,PT,305,22,17.6,80% of total billed charges,4.94,100% GA fee schedule,4.29,100% of CMS fee schedule,4.94,100% of GA fee schedule,18.7,85% of total billed charges,17.6,80% of total billed charges,4.33,101% of CMS fee schedule,4.94,100% of GA fee schedule,4.29,100% of CMS fee schedule,5.04,102% of GA fee schedule,4.29,100% of CMS fee schedule,17.6,80% of total billed charges,4.29,100% of CMS fee schedule,4.38,100% of CMS fee schedule,4.29,18.7,15.4
Outpatient Medical Services,LAB,85613,.dRVVT Mix 117912 LC,305,60,48,80% of total billed charges,12.03,100% GA fee schedule,9.58,100% of CMS fee schedule,12.03,100% of GA fee schedule,51,85% of total billed charges,48,80% of total billed charges,9.68,101% of CMS fee schedule,12.03,100% of GA fee schedule,9.58,100% of CMS fee schedule,12.27,102% of GA fee schedule,9.58,100% of CMS fee schedule,48,80% of total billed charges,9.58,100% of CMS fee schedule,9.77,100% of CMS fee schedule,9.58,51,42
Outpatient Medical Services,LAB,85651,ESR Westergren,305,20,16,80% of total billed charges,4.46,100% GA fee schedule,4.27,100% of CMS fee schedule,4.46,100% of GA fee schedule,17,85% of total billed charges,16,80% of total billed charges,4.31,101% of CMS fee schedule,4.46,100% of GA fee schedule,4.27,100% of CMS fee schedule,4.55,102% of GA fee schedule,4.27,100% of CMS fee schedule,16,80% of total billed charges,4.27,100% of CMS fee schedule,4.36,100% of CMS fee schedule,4.27,17,14
Outpatient Medical Services,LAB,85652,ESR (Erythrocyte Sedimentation Rate),305,13,10.4,80% of total billed charges,3.39,100% GA fee schedule,2.7,100% of CMS fee schedule,3.39,100% of GA fee schedule,11.05,85% of total billed charges,10.4,80% of total billed charges,2.73,101% of CMS fee schedule,3.39,100% of GA fee schedule,2.7,100% of CMS fee schedule,3.46,102% of GA fee schedule,2.7,100% of CMS fee schedule,10.4,80% of total billed charges,2.7,100% of CMS fee schedule,2.75,100% of CMS fee schedule,2.7,11.05,9.1
Outpatient Medical Services,LAB,85660,.Hgb Frac by HPLC+Solubility LC,305,31,24.8,80% of total billed charges,6.94,100% GA fee schedule,5.51,100% of CMS fee schedule,6.94,100% of GA fee schedule,26.35,85% of total billed charges,24.8,80% of total billed charges,5.57,101% of CMS fee schedule,6.94,100% of GA fee schedule,5.51,100% of CMS fee schedule,7.08,102% of GA fee schedule,5.51,100% of CMS fee schedule,24.8,80% of total billed charges,5.51,100% of CMS fee schedule,5.62,100% of CMS fee schedule,5.51,26.35,21.7
Outpatient Medical Services,LAB,85730,PTT,305,38,30.4,80% of total billed charges,7.54,100% GA fee schedule,6.01,100% of CMS fee schedule,7.54,100% of GA fee schedule,32.3,85% of total billed charges,30.4,80% of total billed charges,6.07,101% of CMS fee schedule,7.54,100% of GA fee schedule,6.01,100% of CMS fee schedule,7.69,102% of GA fee schedule,6.01,100% of CMS fee schedule,30.4,80% of total billed charges,6.01,100% of CMS fee schedule,6.13,100% of CMS fee schedule,6.01,32.3,26.6
Outpatient Medical Services,LAB,85732,.PTT-LA Mix 117040 LC,305,40,32,80% of total billed charges,8.14,100% GA fee schedule,6.47,100% of CMS fee schedule,8.14,100% of GA fee schedule,34,85% of total billed charges,32,80% of total billed charges,6.53,101% of CMS fee schedule,8.14,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.3,102% of GA fee schedule,6.47,100% of CMS fee schedule,32,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,34,28
Outpatient Medical Services,LAB,85732,Lupus Anticoagulant Reflex LC,305,40,32,80% of total billed charges,8.14,100% GA fee schedule,6.47,100% of CMS fee schedule,8.14,100% of GA fee schedule,34,85% of total billed charges,32,80% of total billed charges,6.53,101% of CMS fee schedule,8.14,100% of GA fee schedule,6.47,100% of CMS fee schedule,8.3,102% of GA fee schedule,6.47,100% of CMS fee schedule,32,80% of total billed charges,6.47,100% of CMS fee schedule,6.6,100% of CMS fee schedule,6.47,34,28
Outpatient Medical Services,LAB,86008,Alpha Gal IgE LC,302,81,64.8,80% of total billed charges,17.71,100% GA fee schedule,17.93,100% of CMS fee schedule,17.71,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,18.11,101% of CMS fee schedule,17.71,100% of GA fee schedule,17.93,100% of CMS fee schedule,18.06,102% of GA fee schedule,17.93,100% of CMS fee schedule,64.8,80% of total billed charges,17.93,100% of CMS fee schedule,18.29,100% of CMS fee schedule,17.71,68.85,56.7
Outpatient Medical Services,LAB,86015,Actin (Smooth Muscle) Ab LC,302,55,44,80% of total billed charges,9.22,100% GA fee schedule,12.05,100% of CMS fee schedule,9.22,100% of GA fee schedule,46.75,85% of total billed charges,44,80% of total billed charges,12.17,101% of CMS fee schedule,9.22,100% of GA fee schedule,12.05,100% of CMS fee schedule,9.4,102% of GA fee schedule,12.05,100% of CMS fee schedule,44,80% of total billed charges,12.05,100% of CMS fee schedule,12.29,100% of CMS fee schedule,9.22,46.75,38.5
Outpatient Medical Services,LAB,86037,Antineutrophil Cytoplasmic Ab LC,302,55,44,80% of total billed charges,9.64,100% GA fee schedule,12.05,100% of CMS fee schedule,9.64,100% of GA fee schedule,46.75,85% of total billed charges,44,80% of total billed charges,12.17,101% of CMS fee schedule,9.64,100% of GA fee schedule,12.05,100% of CMS fee schedule,9.83,102% of GA fee schedule,12.05,100% of CMS fee schedule,44,80% of total billed charges,12.05,100% of CMS fee schedule,12.29,100% of CMS fee schedule,9.64,46.75,38.5
Outpatient Medical Services,LAB,86038,ANA w/Rflx LC,302,67,53.6,80% of total billed charges,15.2,100% GA fee schedule,12.09,100% of CMS fee schedule,15.2,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.21,101% of CMS fee schedule,15.2,100% of GA fee schedule,12.09,100% of CMS fee schedule,15.5,102% of GA fee schedule,12.09,100% of CMS fee schedule,53.6,80% of total billed charges,12.09,100% of CMS fee schedule,12.33,100% of CMS fee schedule,12.09,56.95,46.9
Outpatient Medical Services,LAB,86060,Antistreptolysin O Ab LC,302,44,35.2,80% of total billed charges,8.79,100% GA fee schedule,7.3,100% of CMS fee schedule,8.79,100% of GA fee schedule,37.4,85% of total billed charges,35.2,80% of total billed charges,7.37,101% of CMS fee schedule,8.79,100% of GA fee schedule,7.3,100% of CMS fee schedule,8.97,102% of GA fee schedule,7.3,100% of CMS fee schedule,35.2,80% of total billed charges,7.3,100% of CMS fee schedule,7.45,100% of CMS fee schedule,7.3,37.4,30.8
Outpatient Medical Services,LAB,86140,"CRP, Quant LC",302,29,23.2,80% of total billed charges,6.51,100% GA fee schedule,5.18,100% of CMS fee schedule,6.51,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.23,101% of CMS fee schedule,6.51,100% of GA fee schedule,5.18,100% of CMS fee schedule,6.64,102% of GA fee schedule,5.18,100% of CMS fee schedule,23.2,80% of total billed charges,5.18,100% of CMS fee schedule,5.28,100% of CMS fee schedule,5.18,24.65,20.3
Outpatient Medical Services,LAB,86141,"C-reactive Protein, Cardiac LC",300,72,57.6,80% of total billed charges,16.28,100% GA fee schedule,12.95,100% of CMS fee schedule,16.28,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,13.08,101% of CMS fee schedule,16.28,100% of GA fee schedule,12.95,100% of CMS fee schedule,16.61,102% of GA fee schedule,12.95,100% of CMS fee schedule,57.6,80% of total billed charges,12.95,100% of CMS fee schedule,13.21,100% of CMS fee schedule,12.95,61.2,50.4
Outpatient Medical Services,LAB,86162,"Complement, Total (CH50) LC",302,113,90.4,80% of total billed charges,25.55,100% GA fee schedule,20.32,100% of CMS fee schedule,25.55,100% of GA fee schedule,96.05,85% of total billed charges,90.4,80% of total billed charges,20.52,101% of CMS fee schedule,25.55,100% of GA fee schedule,20.32,100% of CMS fee schedule,26.06,102% of GA fee schedule,20.32,100% of CMS fee schedule,90.4,80% of total billed charges,20.32,100% of CMS fee schedule,20.73,100% of CMS fee schedule,20.32,96.05,79.1
Outpatient Medical Services,LAB,86200,CCP Antibodies IgG/IgA LC,302,64,51.2,80% of total billed charges,16.28,100% GA fee schedule,12.95,100% of CMS fee schedule,16.28,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,13.08,101% of CMS fee schedule,16.28,100% of GA fee schedule,12.95,100% of CMS fee schedule,16.61,102% of GA fee schedule,12.95,100% of CMS fee schedule,51.2,80% of total billed charges,12.95,100% of CMS fee schedule,13.21,100% of CMS fee schedule,12.95,54.4,44.8
Outpatient Medical Services,LAB,86225,Anti-dsDNA Antibodies LC,302,76,60.8,80% of total billed charges,17.28,100% GA fee schedule,13.74,100% of CMS fee schedule,17.28,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,13.88,101% of CMS fee schedule,17.28,100% of GA fee schedule,13.74,100% of CMS fee schedule,17.63,102% of GA fee schedule,13.74,100% of CMS fee schedule,60.8,80% of total billed charges,13.74,100% of CMS fee schedule,14.01,100% of CMS fee schedule,13.74,64.6,53.2
Outpatient Medical Services,LAB,86256,Anti-Centromere Ab by IFA (RDL),302,67,53.6,80% of total billed charges,15.16,100% GA fee schedule,12.05,100% of CMS fee schedule,15.16,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.17,101% of CMS fee schedule,15.16,100% of GA fee schedule,12.05,100% of CMS fee schedule,15.46,102% of GA fee schedule,12.05,100% of CMS fee schedule,53.6,80% of total billed charges,12.05,100% of CMS fee schedule,12.29,100% of CMS fee schedule,12.05,56.95,46.9
Outpatient Medical Services,LAB,86301,CA 19-9 LC,302,116,92.8,80% of total billed charges,26.16,100% GA fee schedule,20.81,100% of CMS fee schedule,26.16,100% of GA fee schedule,98.6,85% of total billed charges,92.8,80% of total billed charges,21.02,101% of CMS fee schedule,26.16,100% of GA fee schedule,20.81,100% of CMS fee schedule,26.68,102% of GA fee schedule,20.81,100% of CMS fee schedule,92.8,80% of total billed charges,20.81,100% of CMS fee schedule,21.23,100% of CMS fee schedule,20.81,98.6,81.2
Outpatient Medical Services,LAB,86304,Cancer Antigen (CA) 125 LC,302,116,92.8,80% of total billed charges,26.16,100% GA fee schedule,20.81,100% of CMS fee schedule,26.16,100% of GA fee schedule,98.6,85% of total billed charges,92.8,80% of total billed charges,21.02,101% of CMS fee schedule,26.16,100% of GA fee schedule,20.81,100% of CMS fee schedule,26.68,102% of GA fee schedule,20.81,100% of CMS fee schedule,92.8,80% of total billed charges,20.81,100% of CMS fee schedule,21.23,100% of CMS fee schedule,20.81,98.6,81.2
Outpatient Medical Services,LAB,86308,"Mononucleosis Test, Qual LC",302,29,23.2,80% of total billed charges,6.51,100% GA fee schedule,5.18,100% of CMS fee schedule,6.51,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,5.23,101% of CMS fee schedule,6.51,100% of GA fee schedule,5.18,100% of CMS fee schedule,6.64,102% of GA fee schedule,5.18,100% of CMS fee schedule,23.2,80% of total billed charges,5.18,100% of CMS fee schedule,5.28,100% of CMS fee schedule,5.18,24.65,20.3
Outpatient Medical Services,LAB,86334,.Immunofixation Elect 001686 LC,302,124,99.2,80% of total billed charges,28.09,100% GA fee schedule,22.34,100% of CMS fee schedule,28.09,100% of GA fee schedule,105.4,85% of total billed charges,99.2,80% of total billed charges,22.56,101% of CMS fee schedule,28.09,100% of GA fee schedule,22.34,100% of CMS fee schedule,28.65,102% of GA fee schedule,22.34,100% of CMS fee schedule,99.2,80% of total billed charges,22.34,100% of CMS fee schedule,22.79,100% of CMS fee schedule,22.34,105.4,86.8
Outpatient Medical Services,LAB,86335,"Immunofixation, Ur LC",307,49,39.2,80% of total billed charges,36.9,100% GA fee schedule,29.35,100% of CMS fee schedule,36.9,100% of GA fee schedule,41.65,85% of total billed charges,39.2,80% of total billed charges,29.64,101% of CMS fee schedule,36.9,100% of GA fee schedule,29.35,100% of CMS fee schedule,37.64,102% of GA fee schedule,29.35,100% of CMS fee schedule,39.2,80% of total billed charges,29.35,100% of CMS fee schedule,29.94,100% of CMS fee schedule,29.35,41.65,34.3
Outpatient Medical Services,LAB,86337,Insulin Abs LC,302,97,77.6,80% of total billed charges,26.93,100% GA fee schedule,21.41,100% of CMS fee schedule,26.93,100% of GA fee schedule,82.45,85% of total billed charges,77.6,80% of total billed charges,21.62,101% of CMS fee schedule,26.93,100% of GA fee schedule,21.41,100% of CMS fee schedule,27.47,102% of GA fee schedule,21.41,100% of CMS fee schedule,77.6,80% of total billed charges,21.41,100% of CMS fee schedule,21.84,100% of CMS fee schedule,21.41,82.45,67.9
Outpatient Medical Services,LAB,86341,GAD-65 Autoantibody LC,302,95,76,80% of total billed charges,24.89,100% GA fee schedule,23.57,100% of CMS fee schedule,24.89,100% of GA fee schedule,80.75,85% of total billed charges,76,80% of total billed charges,23.81,101% of CMS fee schedule,24.89,100% of GA fee schedule,23.57,100% of CMS fee schedule,25.39,102% of GA fee schedule,23.57,100% of CMS fee schedule,76,80% of total billed charges,23.57,100% of CMS fee schedule,24.04,100% of CMS fee schedule,23.57,80.75,66.5
Outpatient Medical Services,LAB,86360,CD4/CD8 Ratio Profile LC,302,212,169.6,80% of total billed charges,59.09,100% GA fee schedule,46.98,100% of CMS fee schedule,59.09,100% of GA fee schedule,180.2,85% of total billed charges,169.6,80% of total billed charges,47.45,101% of CMS fee schedule,59.09,100% of GA fee schedule,46.98,100% of CMS fee schedule,60.27,102% of GA fee schedule,46.98,100% of CMS fee schedule,169.6,80% of total billed charges,46.98,100% of CMS fee schedule,47.92,100% of CMS fee schedule,46.98,180.2,148.4
Outpatient Medical Services,LAB,86364,t-Transglutaminase (tTG) IgA LC,302,52,41.6,80% of total billed charges,9.22,100% GA fee schedule,11.53,100% of CMS fee schedule,9.22,100% of GA fee schedule,44.2,85% of total billed charges,41.6,80% of total billed charges,11.65,101% of CMS fee schedule,9.22,100% of GA fee schedule,11.53,100% of CMS fee schedule,9.4,102% of GA fee schedule,11.53,100% of CMS fee schedule,41.6,80% of total billed charges,11.53,100% of CMS fee schedule,11.76,100% of CMS fee schedule,9.22,44.2,36.4
Outpatient Medical Services,LAB,86376,Thyroid Peroxidase (TPO) Ab LC,302,90,72,80% of total billed charges,18.3,100% GA fee schedule,14.55,100% of CMS fee schedule,18.3,100% of GA fee schedule,76.5,85% of total billed charges,72,80% of total billed charges,14.7,101% of CMS fee schedule,18.3,100% of GA fee schedule,14.55,100% of CMS fee schedule,18.67,102% of GA fee schedule,14.55,100% of CMS fee schedule,72,80% of total billed charges,14.55,100% of CMS fee schedule,14.84,100% of CMS fee schedule,14.55,76.5,63
Outpatient Medical Services,LAB,86376,TPO Ab LC,302,90,72,80% of total billed charges,18.3,100% GA fee schedule,14.55,100% of CMS fee schedule,18.3,100% of GA fee schedule,76.5,85% of total billed charges,72,80% of total billed charges,14.7,101% of CMS fee schedule,18.3,100% of GA fee schedule,14.55,100% of CMS fee schedule,18.67,102% of GA fee schedule,14.55,100% of CMS fee schedule,72,80% of total billed charges,14.55,100% of CMS fee schedule,14.84,100% of CMS fee schedule,14.55,76.5,63
Outpatient Medical Services,LAB,86381,Mitochondrial (M2) Ab LC,302,115,92,80% of total billed charges,20.36,100% GA fee schedule,25.45,100% of CMS fee schedule,20.36,100% of GA fee schedule,97.75,85% of total billed charges,92,80% of total billed charges,25.7,101% of CMS fee schedule,20.36,100% of GA fee schedule,25.45,100% of CMS fee schedule,20.77,102% of GA fee schedule,25.45,100% of CMS fee schedule,92,80% of total billed charges,25.45,100% of CMS fee schedule,25.96,100% of CMS fee schedule,20.36,97.75,80.5
Outpatient Medical Services,LAB,86431,Rheumatoid Arthritis Factor LC,302,26,20.8,80% of total billed charges,7.14,100% GA fee schedule,5.67,100% of CMS fee schedule,7.14,100% of GA fee schedule,22.1,85% of total billed charges,20.8,80% of total billed charges,5.73,101% of CMS fee schedule,7.14,100% of GA fee schedule,5.67,100% of CMS fee schedule,7.28,102% of GA fee schedule,5.67,100% of CMS fee schedule,20.8,80% of total billed charges,5.67,100% of CMS fee schedule,5.78,100% of CMS fee schedule,5.67,22.1,18.2
Outpatient Medical Services,LAB,86480,QuantiFERON-TB Gold Plus LC,302,344,275.2,80% of total billed charges,77.93,100% GA fee schedule,61.98,100% of CMS fee schedule,77.93,100% of GA fee schedule,292.4,85% of total billed charges,275.2,80% of total billed charges,62.6,101% of CMS fee schedule,77.93,100% of GA fee schedule,61.98,100% of CMS fee schedule,79.49,102% of GA fee schedule,61.98,100% of CMS fee schedule,275.2,80% of total billed charges,61.98,100% of CMS fee schedule,63.22,100% of CMS fee schedule,61.98,292.4,240.8
Outpatient Medical Services,LAB,86592,RPR LC,302,24,19.2,80% of total billed charges,4.65,100% GA fee schedule,4.27,100% of CMS fee schedule,4.65,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,4.31,101% of CMS fee schedule,4.65,100% of GA fee schedule,4.27,100% of CMS fee schedule,4.74,102% of GA fee schedule,4.27,100% of CMS fee schedule,19.2,80% of total billed charges,4.27,100% of CMS fee schedule,4.36,100% of CMS fee schedule,4.27,20.4,16.8
Outpatient Medical Services,LAB,86618,Lyme Disease Total Antibody with reflex LC,302,99,79.2,80% of total billed charges,21.42,100% GA fee schedule,17.03,100% of CMS fee schedule,21.42,100% of GA fee schedule,84.15,85% of total billed charges,79.2,80% of total billed charges,17.2,101% of CMS fee schedule,21.42,100% of GA fee schedule,17.03,100% of CMS fee schedule,21.85,102% of GA fee schedule,17.03,100% of CMS fee schedule,79.2,80% of total billed charges,17.03,100% of CMS fee schedule,17.37,100% of CMS fee schedule,17.03,84.15,69.3
Outpatient Medical Services,LAB,86663,EBV Ab to Early Ag Diffuse [EA(D)] IgG LC,302,59,47.2,80% of total billed charges,16.5,100% GA fee schedule,13.12,100% of CMS fee schedule,16.5,100% of GA fee schedule,50.15,85% of total billed charges,47.2,80% of total billed charges,13.25,101% of CMS fee schedule,16.5,100% of GA fee schedule,13.12,100% of CMS fee schedule,16.83,102% of GA fee schedule,13.12,100% of CMS fee schedule,47.2,80% of total billed charges,13.12,100% of CMS fee schedule,13.38,100% of CMS fee schedule,13.12,50.15,41.3
Outpatient Medical Services,LAB,86671,Saccharomyces cerevisiae Profile LC,302,56,44.8,80% of total billed charges,15.42,100% GA fee schedule,12.25,100% of CMS fee schedule,15.42,100% of GA fee schedule,47.6,85% of total billed charges,44.8,80% of total billed charges,12.37,101% of CMS fee schedule,15.42,100% of GA fee schedule,12.25,100% of CMS fee schedule,15.73,102% of GA fee schedule,12.25,100% of CMS fee schedule,44.8,80% of total billed charges,12.25,100% of CMS fee schedule,12.5,100% of CMS fee schedule,12.25,47.6,39.2
Outpatient Medical Services,LAB,86695,HSV 1 IgG Type Spec LC,300,82,65.6,80% of total billed charges,16.59,100% GA fee schedule,13.19,100% of CMS fee schedule,16.59,100% of GA fee schedule,69.7,85% of total billed charges,65.6,80% of total billed charges,13.32,101% of CMS fee schedule,16.59,100% of GA fee schedule,13.19,100% of CMS fee schedule,16.92,102% of GA fee schedule,13.19,100% of CMS fee schedule,65.6,80% of total billed charges,13.19,100% of CMS fee schedule,13.45,100% of CMS fee schedule,13.19,69.7,57.4
Outpatient Medical Services,LAB,86701,HIV-1 Ab LC,302,40,32,80% of total billed charges,9.7,100% GA fee schedule,8.89,100% of CMS fee schedule,9.7,100% of GA fee schedule,34,85% of total billed charges,32,80% of total billed charges,8.98,101% of CMS fee schedule,9.7,100% of GA fee schedule,8.89,100% of CMS fee schedule,9.89,102% of GA fee schedule,8.89,100% of CMS fee schedule,32,80% of total billed charges,8.89,100% of CMS fee schedule,9.07,100% of CMS fee schedule,8.89,34,28
Outpatient Medical Services,LAB,86702,HIV-2 Ab LC,302,61,48.8,80% of total billed charges,14.75,100% GA fee schedule,13.52,100% of CMS fee schedule,14.75,100% of GA fee schedule,51.85,85% of total billed charges,48.8,80% of total billed charges,13.66,101% of CMS fee schedule,14.75,100% of GA fee schedule,13.52,100% of CMS fee schedule,15.05,102% of GA fee schedule,13.52,100% of CMS fee schedule,48.8,80% of total billed charges,13.52,100% of CMS fee schedule,13.79,100% of CMS fee schedule,13.52,51.85,42.7
Outpatient Medical Services,LAB,86704,"Hep B Core Ab, Tot LC",302,67,53.6,80% of total billed charges,15.16,100% GA fee schedule,12.05,100% of CMS fee schedule,15.16,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.17,101% of CMS fee schedule,15.16,100% of GA fee schedule,12.05,100% of CMS fee schedule,15.46,102% of GA fee schedule,12.05,100% of CMS fee schedule,53.6,80% of total billed charges,12.05,100% of CMS fee schedule,12.29,100% of CMS fee schedule,12.05,56.95,46.9
Outpatient Medical Services,LAB,86705,"Hep B Core Ab, IgM LC",302,65,52,80% of total billed charges,14.8,100% GA fee schedule,11.77,100% of CMS fee schedule,14.8,100% of GA fee schedule,55.25,85% of total billed charges,52,80% of total billed charges,11.89,101% of CMS fee schedule,14.8,100% of GA fee schedule,11.77,100% of CMS fee schedule,15.1,102% of GA fee schedule,11.77,100% of CMS fee schedule,52,80% of total billed charges,11.77,100% of CMS fee schedule,12.01,100% of CMS fee schedule,11.77,55.25,45.5
Outpatient Medical Services,LAB,86706,Hep B Surf Ab LC,302,60,48,80% of total billed charges,13.51,100% GA fee schedule,10.74,100% of CMS fee schedule,13.51,100% of GA fee schedule,51,85% of total billed charges,48,80% of total billed charges,10.85,101% of CMS fee schedule,13.51,100% of GA fee schedule,10.74,100% of CMS fee schedule,13.78,102% of GA fee schedule,10.74,100% of CMS fee schedule,48,80% of total billed charges,10.74,100% of CMS fee schedule,10.95,100% of CMS fee schedule,10.74,51,42
Outpatient Medical Services,LAB,86709,"Hep A Ab, IgM LC",302,15,12,80% of total billed charges,14.16,100% GA fee schedule,11.26,100% of CMS fee schedule,14.16,100% of GA fee schedule,12.75,85% of total billed charges,12,80% of total billed charges,11.37,101% of CMS fee schedule,14.16,100% of GA fee schedule,11.26,100% of CMS fee schedule,14.44,102% of GA fee schedule,11.26,100% of CMS fee schedule,12,80% of total billed charges,11.26,100% of CMS fee schedule,11.49,100% of CMS fee schedule,11.26,14.44,10.5
Outpatient Medical Services,LAB,86762,Rubella IgG Abs LC,302,80,64,80% of total billed charges,14.63,100% GA fee schedule,14.39,100% of CMS fee schedule,14.63,100% of GA fee schedule,68,85% of total billed charges,64,80% of total billed charges,14.53,101% of CMS fee schedule,14.63,100% of GA fee schedule,14.39,100% of CMS fee schedule,14.92,102% of GA fee schedule,14.39,100% of CMS fee schedule,64,80% of total billed charges,14.39,100% of CMS fee schedule,14.68,100% of CMS fee schedule,14.39,68,56
Outpatient Medical Services,LAB,86765,Rubeola IgG Ab LC,302,72,57.6,80% of total billed charges,16.2,100% GA fee schedule,12.88,100% of CMS fee schedule,16.2,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,13.01,101% of CMS fee schedule,16.2,100% of GA fee schedule,12.88,100% of CMS fee schedule,16.52,102% of GA fee schedule,12.88,100% of CMS fee schedule,57.6,80% of total billed charges,12.88,100% of CMS fee schedule,13.14,100% of CMS fee schedule,12.88,61.2,50.4
Outpatient Medical Services,LAB,86769,"SARS-CoV-2 Antibody, IgG LC",302,76,60.8,80% of total billed charges,51.31,100% GA fee schedule,42.13,100% of CMS fee schedule,51.31,100% of GA fee schedule,64.6,85% of total billed charges,60.8,80% of total billed charges,42.55,101% of CMS fee schedule,51.31,100% of GA fee schedule,42.13,100% of CMS fee schedule,52.34,102% of GA fee schedule,42.13,100% of CMS fee schedule,60.8,80% of total billed charges,42.13,100% of CMS fee schedule,42.97,100% of CMS fee schedule,42.13,64.6,53.2
Outpatient Medical Services,LAB,86777,"Toxo gondii Ab, IgG LC",300,72,57.6,80% of total billed charges,14.63,100% GA fee schedule,14.39,100% of CMS fee schedule,14.63,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,14.53,101% of CMS fee schedule,14.63,100% of GA fee schedule,14.39,100% of CMS fee schedule,14.92,102% of GA fee schedule,14.39,100% of CMS fee schedule,57.6,80% of total billed charges,14.39,100% of CMS fee schedule,14.68,100% of CMS fee schedule,14.39,61.2,50.4
Outpatient Medical Services,LAB,86778,"Toxo gondii Ab,IgM LC",302,72,57.6,80% of total billed charges,18.11,100% GA fee schedule,14.41,100% of CMS fee schedule,18.11,100% of GA fee schedule,61.2,85% of total billed charges,57.6,80% of total billed charges,14.55,101% of CMS fee schedule,18.11,100% of GA fee schedule,14.41,100% of CMS fee schedule,18.47,102% of GA fee schedule,14.41,100% of CMS fee schedule,57.6,80% of total billed charges,14.41,100% of CMS fee schedule,14.7,100% of CMS fee schedule,14.41,61.2,50.4
Outpatient Medical Services,LAB,86780,Treponema pallidum Antibodies LC,302,82,65.6,80% of total billed charges,51.66,63% of total billed charges,13.24,100% of CMS fee schedule,51.66,63% of total billed charges,69.7,85% of total billed charges,65.6,80% of total billed charges,13.37,101% of CMS fee schedule,51.66,63% of total billed charges,13.24,100% of CMS fee schedule,51.66,63% of total billed charges,13.24,100% of CMS fee schedule,65.6,80% of total billed charges,13.24,100% of CMS fee schedule,13.5,100% of CMS fee schedule,13.24,69.7,57.4
Outpatient Medical Services,LAB,86800,Thyroglob Ab LC,302,88,70.4,80% of total billed charges,20,100% GA fee schedule,15.91,100% of CMS fee schedule,20,100% of GA fee schedule,74.8,85% of total billed charges,70.4,80% of total billed charges,16.07,101% of CMS fee schedule,20,100% of GA fee schedule,15.91,100% of CMS fee schedule,20.4,102% of GA fee schedule,15.91,100% of CMS fee schedule,70.4,80% of total billed charges,15.91,100% of CMS fee schedule,16.23,100% of CMS fee schedule,15.91,74.8,61.6
Outpatient Medical Services,LAB,86803,HCV Antibody RFX to Quant PCR LC,302,89,71.2,80% of total billed charges,10,100% GA fee schedule,14.27,100% of CMS fee schedule,10,100% of GA fee schedule,75.65,85% of total billed charges,71.2,80% of total billed charges,14.41,101% of CMS fee schedule,10,100% of GA fee schedule,14.27,100% of CMS fee schedule,10.2,102% of GA fee schedule,14.27,100% of CMS fee schedule,71.2,80% of total billed charges,14.27,100% of CMS fee schedule,14.56,100% of CMS fee schedule,10,75.65,62.3
Outpatient Medical Services,LAB,87045,Salmonella/Shigella Scr LC,306,52,41.6,80% of total billed charges,32.76,63% of total billed charges,9.44,100% of CMS fee schedule,32.76,63% of total billed charges,44.2,85% of total billed charges,41.6,80% of total billed charges,9.53,101% of CMS fee schedule,32.76,63% of total billed charges,9.44,100% of CMS fee schedule,32.76,63% of total billed charges,9.44,100% of CMS fee schedule,41.6,80% of total billed charges,9.44,100% of CMS fee schedule,9.63,100% of CMS fee schedule,9.44,44.2,36.4
Outpatient Medical Services,LAB,87046,Campylobacter Cult Status LC,306,52,41.6,80% of total billed charges,2.97,100% GA fee schedule,9.44,100% of CMS fee schedule,2.97,100% of GA fee schedule,44.2,85% of total billed charges,41.6,80% of total billed charges,9.53,101% of CMS fee schedule,2.97,100% of GA fee schedule,9.44,100% of CMS fee schedule,3.03,102% of GA fee schedule,9.44,100% of CMS fee schedule,41.6,80% of total billed charges,9.44,100% of CMS fee schedule,9.63,100% of CMS fee schedule,2.97,44.2,36.4
Outpatient Medical Services,LAB,87070,Aerobic Bacterial Culture LC,306,48,38.4,80% of total billed charges,10.83,100% GA fee schedule,8.62,100% of CMS fee schedule,10.83,100% of GA fee schedule,40.8,85% of total billed charges,38.4,80% of total billed charges,8.71,101% of CMS fee schedule,10.83,100% of GA fee schedule,8.62,100% of CMS fee schedule,11.05,102% of GA fee schedule,8.62,100% of CMS fee schedule,38.4,80% of total billed charges,8.62,100% of CMS fee schedule,8.79,100% of CMS fee schedule,8.62,40.8,33.6
Outpatient Medical Services,LAB,87075,Anaerobic Cult Status: LC,306,34,27.2,80% of total billed charges,11.9,100% GA fee schedule,9.47,100% of CMS fee schedule,11.9,100% of GA fee schedule,28.9,85% of total billed charges,27.2,80% of total billed charges,9.56,101% of CMS fee schedule,11.9,100% of GA fee schedule,9.47,100% of CMS fee schedule,12.14,102% of GA fee schedule,9.47,100% of CMS fee schedule,27.2,80% of total billed charges,9.47,100% of CMS fee schedule,9.66,100% of CMS fee schedule,9.47,28.9,23.8
Outpatient Medical Services,LAB,87076,Anaerobe Identification Only LC,306,45,36,80% of total billed charges,10.16,100% GA fee schedule,8.08,100% of CMS fee schedule,10.16,100% of GA fee schedule,38.25,85% of total billed charges,36,80% of total billed charges,8.16,101% of CMS fee schedule,10.16,100% of GA fee schedule,8.08,100% of CMS fee schedule,10.36,102% of GA fee schedule,8.08,100% of CMS fee schedule,36,80% of total billed charges,8.08,100% of CMS fee schedule,8.24,100% of CMS fee schedule,8.08,38.25,31.5
Outpatient Medical Services,LAB,87077,"Organism ID, Bacteria LC",306,50,40,80% of total billed charges,10.16,100% GA fee schedule,8.08,100% of CMS fee schedule,10.16,100% of GA fee schedule,42.5,85% of total billed charges,40,80% of total billed charges,8.16,101% of CMS fee schedule,10.16,100% of GA fee schedule,8.08,100% of CMS fee schedule,10.36,102% of GA fee schedule,8.08,100% of CMS fee schedule,40,80% of total billed charges,8.08,100% of CMS fee schedule,8.24,100% of CMS fee schedule,8.08,42.5,35
Outpatient Medical Services,LAB,87081,MRSA Screening Culture LC,306,37,29.6,80% of total billed charges,8.33,100% GA fee schedule,6.63,100% of CMS fee schedule,8.33,100% of GA fee schedule,31.45,85% of total billed charges,29.6,80% of total billed charges,6.7,101% of CMS fee schedule,8.33,100% of GA fee schedule,6.63,100% of CMS fee schedule,8.5,102% of GA fee schedule,6.63,100% of CMS fee schedule,29.6,80% of total billed charges,6.63,100% of CMS fee schedule,6.76,100% of CMS fee schedule,6.63,31.45,25.9
Outpatient Medical Services,LAB,87101,Fungus (Mycology) Culture LC,306,29,23.2,80% of total billed charges,9.69,100% GA fee schedule,7.71,100% of CMS fee schedule,9.69,100% of GA fee schedule,24.65,85% of total billed charges,23.2,80% of total billed charges,7.79,101% of CMS fee schedule,9.69,100% of GA fee schedule,7.71,100% of CMS fee schedule,9.88,102% of GA fee schedule,7.71,100% of CMS fee schedule,23.2,80% of total billed charges,7.71,100% of CMS fee schedule,7.86,100% of CMS fee schedule,7.71,24.65,20.3
Outpatient Medical Services,LAB,87116,Acid Fast Smear+Culture W/Rflx LC,306,49,39.2,80% of total billed charges,30.87,63% of total billed charges,10.8,100% of CMS fee schedule,30.87,63% of total billed charges,41.65,85% of total billed charges,39.2,80% of total billed charges,10.91,101% of CMS fee schedule,30.87,63% of total billed charges,10.8,100% of CMS fee schedule,30.87,63% of total billed charges,10.8,100% of CMS fee schedule,39.2,80% of total billed charges,10.8,100% of CMS fee schedule,11.02,100% of CMS fee schedule,10.8,41.65,34.3
Outpatient Medical Services,LAB,87153,.Organism ID by Sequencing LC,306,195,156,80% of total billed charges,122.85,63% of total billed charges,115.36,100% of CMS fee schedule,122.85,63% of total billed charges,165.75,85% of total billed charges,156,80% of total billed charges,116.51,101% of CMS fee schedule,122.85,63% of total billed charges,115.36,100% of CMS fee schedule,122.85,63% of total billed charges,115.36,100% of CMS fee schedule,156,80% of total billed charges,115.36,100% of CMS fee schedule,117.67,100% of CMS fee schedule,115.36,165.75,136.5
Outpatient Medical Services,LAB,87158,.Aerobic Bact ID by Seq 183269 LC,306,35,28,80% of total billed charges,6.58,100% GA fee schedule,7.74,100% of CMS fee schedule,6.58,100% of GA fee schedule,29.75,85% of total billed charges,28,80% of total billed charges,7.82,101% of CMS fee schedule,6.58,100% of GA fee schedule,7.74,100% of CMS fee schedule,6.71,102% of GA fee schedule,7.74,100% of CMS fee schedule,28,80% of total billed charges,7.74,100% of CMS fee schedule,7.89,100% of CMS fee schedule,6.58,29.75,24.5
Outpatient Medical Services,LAB,87177,Ova + Parasite Status LC,306,49,39.2,80% of total billed charges,11.19,100% GA fee schedule,8.9,100% of CMS fee schedule,11.19,100% of GA fee schedule,41.65,85% of total billed charges,39.2,80% of total billed charges,8.99,101% of CMS fee schedule,11.19,100% of GA fee schedule,8.9,100% of CMS fee schedule,11.41,102% of GA fee schedule,8.9,100% of CMS fee schedule,39.2,80% of total billed charges,8.9,100% of CMS fee schedule,9.08,100% of CMS fee schedule,8.9,41.65,34.3
Outpatient Medical Services,LAB,87186,"Susceptibility, Gram Pos Rods LC",306,54,43.2,80% of total billed charges,10.87,100% GA fee schedule,8.65,100% of CMS fee schedule,10.87,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,8.74,101% of CMS fee schedule,10.87,100% of GA fee schedule,8.65,100% of CMS fee schedule,11.09,102% of GA fee schedule,8.65,100% of CMS fee schedule,43.2,80% of total billed charges,8.65,100% of CMS fee schedule,8.82,100% of CMS fee schedule,8.65,45.9,37.8
Outpatient Medical Services,LAB,87205,Sputum Cult w/ Gram Stain LC,306,24,19.2,80% of total billed charges,2.95,100% GA fee schedule,4.27,100% of CMS fee schedule,2.95,100% of GA fee schedule,20.4,85% of total billed charges,19.2,80% of total billed charges,4.31,101% of CMS fee schedule,2.95,100% of GA fee schedule,4.27,100% of CMS fee schedule,3.01,102% of GA fee schedule,4.27,100% of CMS fee schedule,19.2,80% of total billed charges,4.27,100% of CMS fee schedule,4.36,100% of CMS fee schedule,2.95,20.4,16.8
Outpatient Medical Services,LAB,87209,Ova + Parasite Status-Prelim LC,306,81,64.8,80% of total billed charges,22.6,100% GA fee schedule,17.98,100% of CMS fee schedule,22.6,100% of GA fee schedule,68.85,85% of total billed charges,64.8,80% of total billed charges,18.16,101% of CMS fee schedule,22.6,100% of GA fee schedule,17.98,100% of CMS fee schedule,23.05,102% of GA fee schedule,17.98,100% of CMS fee schedule,64.8,80% of total billed charges,17.98,100% of CMS fee schedule,18.34,100% of CMS fee schedule,17.98,68.85,56.7
Outpatient Medical Services,LAB,87210,Fern Test,306,44,35.2,80% of total billed charges,5.36,100% GA fee schedule,5.82,100% of CMS fee schedule,5.36,100% of GA fee schedule,37.4,85% of total billed charges,35.2,80% of total billed charges,5.88,101% of CMS fee schedule,5.36,100% of GA fee schedule,5.82,100% of CMS fee schedule,5.47,102% of GA fee schedule,5.82,100% of CMS fee schedule,35.2,80% of total billed charges,5.82,100% of CMS fee schedule,5.94,100% of CMS fee schedule,5.36,37.4,30.8
Outpatient Medical Services,LAB,87301,Adenovirus(40/41)/Rotavirus EIA LC,306,54,43.2,80% of total billed charges,15.08,100% GA fee schedule,11.98,100% of CMS fee schedule,15.08,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,12.1,101% of CMS fee schedule,15.08,100% of GA fee schedule,11.98,100% of CMS fee schedule,15.38,102% of GA fee schedule,11.98,100% of CMS fee schedule,43.2,80% of total billed charges,11.98,100% of CMS fee schedule,12.22,100% of CMS fee schedule,11.98,45.9,37.8
Outpatient Medical Services,LAB,87324,Clostridium Difficile,306,67,53.6,80% of total billed charges,15.08,100% GA fee schedule,11.98,100% of CMS fee schedule,15.08,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,12.1,101% of CMS fee schedule,15.08,100% of GA fee schedule,11.98,100% of CMS fee schedule,15.38,102% of GA fee schedule,11.98,100% of CMS fee schedule,53.6,80% of total billed charges,11.98,100% of CMS fee schedule,12.22,100% of CMS fee schedule,11.98,56.95,46.9
Outpatient Medical Services,LAB,87328,Cryptosporidium EIA LC,306,63,50.4,80% of total billed charges,15.08,100% GA fee schedule,13.82,100% of CMS fee schedule,15.08,100% of GA fee schedule,53.55,85% of total billed charges,50.4,80% of total billed charges,13.96,101% of CMS fee schedule,15.08,100% of GA fee schedule,13.82,100% of CMS fee schedule,15.38,102% of GA fee schedule,13.82,100% of CMS fee schedule,50.4,80% of total billed charges,13.82,100% of CMS fee schedule,14.1,100% of CMS fee schedule,13.82,53.55,44.1
Outpatient Medical Services,LAB,87329,"Giardia lamblia Ag, EIA LC",306,50,40,80% of total billed charges,15.08,100% GA fee schedule,11.98,100% of CMS fee schedule,15.08,100% of GA fee schedule,42.5,85% of total billed charges,40,80% of total billed charges,12.1,101% of CMS fee schedule,15.08,100% of GA fee schedule,11.98,100% of CMS fee schedule,15.38,102% of GA fee schedule,11.98,100% of CMS fee schedule,40,80% of total billed charges,11.98,100% of CMS fee schedule,12.22,100% of CMS fee schedule,11.98,42.5,35
Outpatient Medical Services,LAB,87338,"Helicobacter pylori Stool Ag, EIA LC",306,80,64,80% of total billed charges,18.09,100% GA fee schedule,14.38,100% of CMS fee schedule,18.09,100% of GA fee schedule,68,85% of total billed charges,64,80% of total billed charges,14.52,101% of CMS fee schedule,18.09,100% of GA fee schedule,14.38,100% of CMS fee schedule,18.45,102% of GA fee schedule,14.38,100% of CMS fee schedule,64,80% of total billed charges,14.38,100% of CMS fee schedule,14.67,100% of CMS fee schedule,14.38,68,56
Outpatient Medical Services,LAB,87340,Hep B Surf Antigen Scr LC,306,57,45.6,80% of total billed charges,12.99,100% GA fee schedule,10.33,100% of CMS fee schedule,12.99,100% of GA fee schedule,48.45,85% of total billed charges,45.6,80% of total billed charges,10.43,101% of CMS fee schedule,12.99,100% of GA fee schedule,10.33,100% of CMS fee schedule,13.25,102% of GA fee schedule,10.33,100% of CMS fee schedule,45.6,80% of total billed charges,10.33,100% of CMS fee schedule,10.54,100% of CMS fee schedule,10.33,48.45,39.9
Outpatient Medical Services,LAB,87350,Hep Be Ag LC,306,64,51.2,80% of total billed charges,14.49,100% GA fee schedule,11.53,100% of CMS fee schedule,14.49,100% of GA fee schedule,54.4,85% of total billed charges,51.2,80% of total billed charges,11.65,101% of CMS fee schedule,14.49,100% of GA fee schedule,11.53,100% of CMS fee schedule,14.78,102% of GA fee schedule,11.53,100% of CMS fee schedule,51.2,80% of total billed charges,11.53,100% of CMS fee schedule,11.76,100% of CMS fee schedule,11.53,54.4,44.8
Outpatient Medical Services,LAB,87389,"HIV-1/O/2, 4th Generation LC",306,134,107.2,80% of total billed charges,27.3,100% GA fee schedule,24.08,100% of CMS fee schedule,27.3,100% of GA fee schedule,113.9,85% of total billed charges,107.2,80% of total billed charges,24.32,101% of CMS fee schedule,27.3,100% of GA fee schedule,24.08,100% of CMS fee schedule,27.85,102% of GA fee schedule,24.08,100% of CMS fee schedule,107.2,80% of total billed charges,24.08,100% of CMS fee schedule,24.56,100% of CMS fee schedule,24.08,113.9,93.8
Outpatient Medical Services,LAB,87420,RSV POCT,521,21,16.8,80% of total billed charges,15.08,100% GA fee schedule,202.05,pays based on per visit rate,15.08,100% of GA fee schedule,17.85,85% of total billed charges,16.8,80% of total billed charges,204.07,pays based on per visit rate,15.08,100% of GA fee schedule,202.05,pays based on per visit rate,15.38,102% of GA fee schedule,202.05,pays based on per visit rate,16.8,80% of total billed charges,202.05,pays based on per visit rate,202.33,pays based on per visit rate,15.08,204.07,14.7
Outpatient Medical Services,LAB,87427,E coli Shiga Toxin EIA LC,306,54,43.2,80% of total billed charges,15.08,100% GA fee schedule,11.98,100% of CMS fee schedule,15.08,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,12.1,101% of CMS fee schedule,15.08,100% of GA fee schedule,11.98,100% of CMS fee schedule,15.38,102% of GA fee schedule,11.98,100% of CMS fee schedule,43.2,80% of total billed charges,11.98,100% of CMS fee schedule,12.22,100% of CMS fee schedule,11.98,45.9,37.8
Outpatient Medical Services,LAB,87428,Coronavirus SARS/Flu Ag (Sofia),306,140,112,80% of total billed charges,67.08,100% GA fee schedule,70.29,100% of CMS fee schedule,67.08,100% of GA fee schedule,119,85% of total billed charges,112,80% of total billed charges,70.99,101% of CMS fee schedule,67.08,100% of GA fee schedule,70.29,100% of CMS fee schedule,68.42,102% of GA fee schedule,70.29,100% of CMS fee schedule,112,80% of total billed charges,70.29,100% of CMS fee schedule,71.7,100% of CMS fee schedule,67.08,119,98
Outpatient Medical Services,LAB,87449,L. pneumophila Serogp 1 Ur Ag LC,306,54,43.2,80% of total billed charges,15.08,100% GA fee schedule,11.98,100% of CMS fee schedule,15.08,100% of GA fee schedule,45.9,85% of total billed charges,43.2,80% of total billed charges,12.1,101% of CMS fee schedule,15.08,100% of GA fee schedule,11.98,100% of CMS fee schedule,15.38,102% of GA fee schedule,11.98,100% of CMS fee schedule,43.2,80% of total billed charges,11.98,100% of CMS fee schedule,12.22,100% of CMS fee schedule,11.98,45.9,37.8
Outpatient Medical Services,LAB,87491,C trach NAA LC,306,195,156,80% of total billed charges,24.67,100% GA fee schedule,35.09,100% of CMS fee schedule,24.67,100% of GA fee schedule,165.75,85% of total billed charges,156,80% of total billed charges,35.44,101% of CMS fee schedule,24.67,100% of GA fee schedule,35.09,100% of CMS fee schedule,25.16,102% of GA fee schedule,35.09,100% of CMS fee schedule,156,80% of total billed charges,35.09,100% of CMS fee schedule,35.79,100% of CMS fee schedule,24.67,165.75,136.5
Outpatient Medical Services,LAB,87497,CMV Quant DNA PCR LC,306,238,190.4,80% of total billed charges,53.87,100% GA fee schedule,42.84,100% of CMS fee schedule,53.87,100% of GA fee schedule,202.3,85% of total billed charges,190.4,80% of total billed charges,43.27,101% of CMS fee schedule,53.87,100% of GA fee schedule,42.84,100% of CMS fee schedule,54.95,102% of GA fee schedule,42.84,100% of CMS fee schedule,190.4,80% of total billed charges,42.84,100% of CMS fee schedule,43.7,100% of CMS fee schedule,42.84,202.3,166.6
Outpatient Medical Services,LAB,87507,"GI Profile, Stool, PCR LC",306,1876,1500.8,80% of total billed charges,333.42,100% GA fee schedule,416.78,100% of CMS fee schedule,333.42,100% of GA fee schedule,1594.6,85% of total billed charges,1500.8,80% of total billed charges,420.95,101% of CMS fee schedule,333.42,100% of GA fee schedule,416.78,100% of CMS fee schedule,340.09,102% of GA fee schedule,416.78,100% of CMS fee schedule,1500.8,80% of total billed charges,416.78,100% of CMS fee schedule,425.12,100% of CMS fee schedule,333.42,1594.6,1313.2
Outpatient Medical Services,LAB,87517,"HBV RT PCR, Quant LC",310,238,190.4,80% of total billed charges,53.87,100% GA fee schedule,42.84,100% of CMS fee schedule,53.87,100% of GA fee schedule,202.3,85% of total billed charges,190.4,80% of total billed charges,43.27,101% of CMS fee schedule,53.87,100% of GA fee schedule,42.84,100% of CMS fee schedule,54.95,102% of GA fee schedule,42.84,100% of CMS fee schedule,190.4,80% of total billed charges,42.84,100% of CMS fee schedule,43.7,100% of CMS fee schedule,42.84,202.3,166.6
Outpatient Medical Services,LAB,87536,"RNA, RT PCR (Non-Graph) LC",306,321,256.8,80% of total billed charges,56.5,100% GA fee schedule,85.1,100% of CMS fee schedule,56.5,100% of GA fee schedule,272.85,85% of total billed charges,256.8,80% of total billed charges,85.95,101% of CMS fee schedule,56.5,100% of GA fee schedule,85.1,100% of CMS fee schedule,57.63,102% of GA fee schedule,85.1,100% of CMS fee schedule,256.8,80% of total billed charges,85.1,100% of CMS fee schedule,86.8,100% of CMS fee schedule,56.5,272.85,224.7
Outpatient Medical Services,LAB,87563,"Genital Mycoplasma Profile, NAA, Urine LC",306,158,126.4,80% of total billed charges,28.07,100% GA fee schedule,35.09,100% of CMS fee schedule,28.07,100% of GA fee schedule,134.3,85% of total billed charges,126.4,80% of total billed charges,35.44,101% of CMS fee schedule,28.07,100% of GA fee schedule,35.09,100% of CMS fee schedule,28.63,102% of GA fee schedule,35.09,100% of CMS fee schedule,126.4,80% of total billed charges,35.09,100% of CMS fee schedule,35.79,100% of CMS fee schedule,28.07,134.3,110.6
Outpatient Medical Services,LAB,87591,N gonorrhoeae NAA LC,306,195,156,80% of total billed charges,21.42,100% GA fee schedule,35.09,100% of CMS fee schedule,21.42,100% of GA fee schedule,165.75,85% of total billed charges,156,80% of total billed charges,35.44,101% of CMS fee schedule,21.42,100% of GA fee schedule,35.09,100% of CMS fee schedule,21.85,102% of GA fee schedule,35.09,100% of CMS fee schedule,156,80% of total billed charges,35.09,100% of CMS fee schedule,35.79,100% of CMS fee schedule,21.42,165.75,136.5
Outpatient Medical Services,LAB,87634,Respiratory Syncytial Virus (RSV) NAA 140205 LC,302,316,252.8,80% of total billed charges,69.33,100% GA fee schedule,70.2,100% of CMS fee schedule,69.33,100% of GA fee schedule,268.6,85% of total billed charges,252.8,80% of total billed charges,70.9,101% of CMS fee schedule,69.33,100% of GA fee schedule,70.2,100% of CMS fee schedule,70.72,102% of GA fee schedule,70.2,100% of CMS fee schedule,252.8,80% of total billed charges,70.2,100% of CMS fee schedule,71.6,100% of CMS fee schedule,69.33,268.6,221.2
Outpatient Medical Services,LAB,87799,"Epstein-Barr DNA Quant, PCR LC",306,265,212,80% of total billed charges,166.95,63% of total billed charges,42.84,100% of CMS fee schedule,166.95,63% of total billed charges,225.25,85% of total billed charges,212,80% of total billed charges,43.27,101% of CMS fee schedule,166.95,63% of total billed charges,42.84,100% of CMS fee schedule,166.95,63% of total billed charges,42.84,100% of CMS fee schedule,212,80% of total billed charges,42.84,100% of CMS fee schedule,43.7,100% of CMS fee schedule,42.84,225.25,185.5
Outpatient Medical Services,LAB,87804,Influenza A and B (Sofia),306,75,60,80% of total billed charges,15.08,100% GA fee schedule,16.55,100% of CMS fee schedule,15.08,100% of GA fee schedule,63.75,85% of total billed charges,60,80% of total billed charges,16.72,101% of CMS fee schedule,15.08,100% of GA fee schedule,16.55,100% of CMS fee schedule,15.38,102% of GA fee schedule,16.55,100% of CMS fee schedule,60,80% of total billed charges,16.55,100% of CMS fee schedule,16.88,100% of CMS fee schedule,15.08,63.75,52.5
Outpatient Medical Services,LAB,87807,Respiratory Syncytial Virus,300,67,53.6,80% of total billed charges,15.08,100% GA fee schedule,13.1,100% of CMS fee schedule,15.08,100% of GA fee schedule,56.95,85% of total billed charges,53.6,80% of total billed charges,13.23,101% of CMS fee schedule,15.08,100% of GA fee schedule,13.1,100% of CMS fee schedule,15.38,102% of GA fee schedule,13.1,100% of CMS fee schedule,53.6,80% of total billed charges,13.1,100% of CMS fee schedule,13.36,100% of CMS fee schedule,13.1,56.95,46.9
Outpatient Medical Services,LAB,87880,Strep A (Sofia),306,74,59.2,80% of total billed charges,15.08,100% GA fee schedule,16.53,100% of CMS fee schedule,15.08,100% of GA fee schedule,62.9,85% of total billed charges,59.2,80% of total billed charges,16.7,101% of CMS fee schedule,15.08,100% of GA fee schedule,16.53,100% of CMS fee schedule,15.38,102% of GA fee schedule,16.53,100% of CMS fee schedule,59.2,80% of total billed charges,16.53,100% of CMS fee schedule,16.86,100% of CMS fee schedule,15.08,62.9,51.8
Outpatient Medical Services,LAB,87902,HCV Genotyping Non Rflx LC,300,540,432,80% of total billed charges,109.67,100% GA fee schedule,257.45,100% of CMS fee schedule,109.67,100% of GA fee schedule,459,85% of total billed charges,432,80% of total billed charges,260.02,101% of CMS fee schedule,109.67,100% of GA fee schedule,257.45,100% of CMS fee schedule,111.86,102% of GA fee schedule,257.45,100% of CMS fee schedule,432,80% of total billed charges,257.45,100% of CMS fee schedule,262.6,100% of CMS fee schedule,109.67,459,378
Outpatient Medical Services,LAB,88112,Urine Cytology LC,310,316,252.8,80% of total billed charges,106.19,100% GA fee schedule,195.92,62% of total billed charges,106.19,100% of GA fee schedule,268.6,85% of total billed charges,252.8,80% of total billed charges,195.92,62% of total billed charges,106.19,100% of GA fee schedule,195.92,62% of total billed charges,108.31,102% of GA fee schedule,195.92,62% of total billed charges,252.8,80% of total billed charges,195.92,62% of total billed charges,195.92,62% of total billed charges,106.19,268.6,221.2
Outpatient Medical Services,LAB,89051,Cell Ct Synovial w/o Crystals LC,309,28,22.4,80% of total billed charges,2.21,100% GA fee schedule,5.6,100% of CMS fee schedule,2.21,100% of GA fee schedule,23.8,85% of total billed charges,22.4,80% of total billed charges,5.66,101% of CMS fee schedule,2.21,100% of GA fee schedule,5.6,100% of CMS fee schedule,2.25,102% of GA fee schedule,5.6,100% of CMS fee schedule,22.4,80% of total billed charges,5.6,100% of CMS fee schedule,5.71,100% of CMS fee schedule,2.21,23.8,19.6
Outpatient Medical Services,LAB,G0103,Prostate Specific Antigen Screening LC,301,102,81.6,80% of total billed charges,25.7,100% GA fee schedule,19.31,100% of CMS fee schedule,25.7,100% of GA fee schedule,86.7,85% of total billed charges,81.6,80% of total billed charges,19.5,101% of CMS fee schedule,25.7,100% of GA fee schedule,19.31,100% of CMS fee schedule,26.21,102% of GA fee schedule,19.31,100% of CMS fee schedule,81.6,80% of total billed charges,19.31,100% of CMS fee schedule,19.7,100% of CMS fee schedule,19.31,86.7,71.4
Outpatient Medical Services,NUTRITION THERAPY,97802,97802 Medical Nutrition Therapy 15 min Charge,942,99,79.2,80% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,84.15,85% of total billed charges,79.2,80% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,79.2,80% of total billed charges,61.38,62% of total billed charges,61.38,62% of total billed charges,61.38,84.15,69.3
Outpatient Medical Services,NUTRITION THERAPY,97803,97803 Reassessment/Intervention 15 min Charge,942,85,68,80% of total billed charges,53.55,63% of total billed charges,52.7,62% of total billed charges,53.55,63% of total billed charges,72.25,85% of total billed charges,68,80% of total billed charges,52.7,62% of total billed charges,53.55,63% of total billed charges,52.7,62% of total billed charges,53.55,63% of total billed charges,52.7,62% of total billed charges,68,80% of total billed charges,52.7,62% of total billed charges,52.7,62% of total billed charges,52.7,72.25,59.5
Outpatient Medical Services,NUTRITION THERAPY,97804,97804 Medical Nutrition Therapy Group 30 Min Charg,942,46,36.8,80% of total billed charges,28.98,63% of total billed charges,28.52,62% of total billed charges,28.98,63% of total billed charges,39.1,85% of total billed charges,36.8,80% of total billed charges,28.52,62% of total billed charges,28.98,63% of total billed charges,28.52,62% of total billed charges,28.98,63% of total billed charges,28.52,62% of total billed charges,36.8,80% of total billed charges,28.52,62% of total billed charges,28.52,62% of total billed charges,28.52,39.1,32.2
Outpatient Medical Services,OCCUPATIONAL THERAPY,97032,OT Attended E-Stim Units,430,51,40.8,80% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,43.35,85% of total billed charges,40.8,80% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,40.8,80% of total billed charges,31.62,62% of total billed charges,31.62,62% of total billed charges,31.62,43.35,35.7
Outpatient Medical Services,OCCUPATIONAL THERAPY,97033,OT Iontophoresis Units,430,84,67.2,80% of total billed charges,52.92,63% of total billed charges,52.08,62% of total billed charges,52.92,63% of total billed charges,71.4,85% of total billed charges,67.2,80% of total billed charges,52.08,62% of total billed charges,52.92,63% of total billed charges,52.08,62% of total billed charges,52.92,63% of total billed charges,52.08,62% of total billed charges,67.2,80% of total billed charges,52.08,62% of total billed charges,52.08,62% of total billed charges,52.08,71.4,58.8
Outpatient Medical Services,OCCUPATIONAL THERAPY,97140,OT Manual Therapy Units,430,80,64,80% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,68,85% of total billed charges,64,80% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,64,80% of total billed charges,49.6,62% of total billed charges,49.6,62% of total billed charges,49.6,68,56
Outpatient Medical Services,OCCUPATIONAL THERAPY,97124,OT Massage Units,430,70,56,80% of total billed charges,44.1,63% of total billed charges,43.4,62% of total billed charges,44.1,63% of total billed charges,59.5,85% of total billed charges,56,80% of total billed charges,43.4,62% of total billed charges,44.1,63% of total billed charges,43.4,62% of total billed charges,44.1,63% of total billed charges,43.4,62% of total billed charges,56,80% of total billed charges,43.4,62% of total billed charges,43.4,62% of total billed charges,43.4,59.5,49
Outpatient Medical Services,OCCUPATIONAL THERAPY,97112,OT Neuromuscular Reeducation Units,430,89,71.2,80% of total billed charges,56.07,63% of total billed charges,55.18,62% of total billed charges,56.07,63% of total billed charges,75.65,85% of total billed charges,71.2,80% of total billed charges,55.18,62% of total billed charges,56.07,63% of total billed charges,55.18,62% of total billed charges,56.07,63% of total billed charges,55.18,62% of total billed charges,71.2,80% of total billed charges,55.18,62% of total billed charges,55.18,62% of total billed charges,55.18,75.65,62.3
Outpatient Medical Services,OCCUPATIONAL THERAPY,97018,OT Paraffin Bath Units,430,30,24,80% of total billed charges,18.9,63% of total billed charges,18.6,62% of total billed charges,18.9,63% of total billed charges,25.5,85% of total billed charges,24,80% of total billed charges,18.6,62% of total billed charges,18.9,63% of total billed charges,18.6,62% of total billed charges,18.9,63% of total billed charges,18.6,62% of total billed charges,24,80% of total billed charges,18.6,62% of total billed charges,18.6,62% of total billed charges,18.6,25.5,21
Outpatient Medical Services,OCCUPATIONAL THERAPY,97035,OT Ultrasound Units,430,35,28,80% of total billed charges,22.05,63% of total billed charges,21.7,62% of total billed charges,22.05,63% of total billed charges,29.75,85% of total billed charges,28,80% of total billed charges,21.7,62% of total billed charges,22.05,63% of total billed charges,21.7,62% of total billed charges,22.05,63% of total billed charges,21.7,62% of total billed charges,28,80% of total billed charges,21.7,62% of total billed charges,21.7,62% of total billed charges,21.7,29.75,24.5
Outpatient Medical Services,OCCUPATIONAL THERAPY,97110,OT Therapeutic Exercise Units,430,86,68.8,80% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,73.1,85% of total billed charges,68.8,80% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,68.8,80% of total billed charges,53.32,62% of total billed charges,53.32,62% of total billed charges,53.32,73.1,60.2
Outpatient Medical Services,OCCUPATIONAL THERAPY,97530,OT Therapeutic Activities Units,430,93,74.4,80% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,79.05,85% of total billed charges,74.4,80% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,74.4,80% of total billed charges,57.66,62% of total billed charges,57.66,62% of total billed charges,57.66,79.05,65.1
Outpatient Medical Services,OCCUPATIONAL THERAPY,97535,"OT Self Care, Home Management Units",430,93,74.4,80% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,79.05,85% of total billed charges,74.4,80% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,58.59,63% of total billed charges,57.66,62% of total billed charges,74.4,80% of total billed charges,57.66,62% of total billed charges,57.66,62% of total billed charges,57.66,79.05,65.1
Outpatient Medical Services,OCCUPATIONAL THERAPY,97542,OT Wheelchair Management Units,430,82,65.6,80% of total billed charges,51.66,63% of total billed charges,50.84,62% of total billed charges,51.66,63% of total billed charges,69.7,85% of total billed charges,65.6,80% of total billed charges,50.84,62% of total billed charges,51.66,63% of total billed charges,50.84,62% of total billed charges,51.66,63% of total billed charges,50.84,62% of total billed charges,65.6,80% of total billed charges,50.84,62% of total billed charges,50.84,62% of total billed charges,50.84,69.7,57.4
Outpatient Medical Services,OCCUPATIONAL THERAPY,97760,"OT Orthotic Management, Train Units",430,165,132,80% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,140.25,85% of total billed charges,132,80% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,132,80% of total billed charges,102.3,62% of total billed charges,102.3,62% of total billed charges,102.3,140.25,115.5
Outpatient Medical Services,OCCUPATIONAL THERAPY,97165,"OT Evaluation Units, Low Complexity",434,230,184,80% of total billed charges,144.9,63% of total billed charges,142.6,62% of total billed charges,144.9,63% of total billed charges,195.5,85% of total billed charges,184,80% of total billed charges,142.6,62% of total billed charges,144.9,63% of total billed charges,142.6,62% of total billed charges,144.9,63% of total billed charges,142.6,62% of total billed charges,184,80% of total billed charges,142.6,62% of total billed charges,142.6,62% of total billed charges,142.6,195.5,161
Outpatient Medical Services,OCCUPATIONAL THERAPY,97166,"OT Evaluation Units, Moderate Complexity",434,255,204,80% of total billed charges,160.65,63% of total billed charges,158.1,62% of total billed charges,160.65,63% of total billed charges,216.75,85% of total billed charges,204,80% of total billed charges,158.1,62% of total billed charges,160.65,63% of total billed charges,158.1,62% of total billed charges,160.65,63% of total billed charges,158.1,62% of total billed charges,204,80% of total billed charges,158.1,62% of total billed charges,158.1,62% of total billed charges,158.1,216.75,178.5
Outpatient Medical Services,OCCUPATIONAL THERAPY,97167,"OT Evaluation Units, High Complexity",434,281,224.8,80% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,238.85,85% of total billed charges,224.8,80% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,224.8,80% of total billed charges,174.22,62% of total billed charges,174.22,62% of total billed charges,174.22,238.85,196.7
Outpatient Medical Services,OCCUPATIONAL THERAPY,97763,"OT Orthotic/Prosthetic Manage,Train Unit",430,189,151.2,80% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,160.65,85% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,117.18,62% of total billed charges,117.18,160.65,132.3
Outpatient Medical Services,OCCUPATIONAL THERAPY,97763,OT Orthotic/Prosthetic Manage/Train Unit,430,189,151.2,80% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,160.65,85% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,117.18,62% of total billed charges,117.18,160.65,132.3
Outpatient Medical Services,PHYSICAL THERAPY,97012,PT Mechanical Traction Units,420,52,41.6,80% of total billed charges,32.76,63% of total billed charges,32.24,62% of total billed charges,32.76,63% of total billed charges,44.2,85% of total billed charges,41.6,80% of total billed charges,32.24,62% of total billed charges,32.76,63% of total billed charges,32.24,62% of total billed charges,32.76,63% of total billed charges,32.24,62% of total billed charges,41.6,80% of total billed charges,32.24,62% of total billed charges,32.24,62% of total billed charges,32.24,44.2,36.4
Outpatient Medical Services,PHYSICAL THERAPY,97018,PT Paraffin Units,420,21,16.8,80% of total billed charges,13.23,63% of total billed charges,13.02,62% of total billed charges,13.23,63% of total billed charges,17.85,85% of total billed charges,16.8,80% of total billed charges,13.02,62% of total billed charges,13.23,63% of total billed charges,13.02,62% of total billed charges,13.23,63% of total billed charges,13.02,62% of total billed charges,16.8,80% of total billed charges,13.02,62% of total billed charges,13.02,62% of total billed charges,13.02,17.85,14.7
Outpatient Medical Services,PHYSICAL THERAPY,97032,PT Attended E-Stim Units,420,51,40.8,80% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,43.35,85% of total billed charges,40.8,80% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,32.13,63% of total billed charges,31.62,62% of total billed charges,40.8,80% of total billed charges,31.62,62% of total billed charges,31.62,62% of total billed charges,31.62,43.35,35.7
Outpatient Medical Services,PHYSICAL THERAPY,97033,PT Iontophoresis Units,420,71,56.8,80% of total billed charges,44.73,63% of total billed charges,44.02,62% of total billed charges,44.73,63% of total billed charges,60.35,85% of total billed charges,56.8,80% of total billed charges,44.02,62% of total billed charges,44.73,63% of total billed charges,44.02,62% of total billed charges,44.73,63% of total billed charges,44.02,62% of total billed charges,56.8,80% of total billed charges,44.02,62% of total billed charges,44.02,62% of total billed charges,44.02,60.35,49.7
Outpatient Medical Services,PHYSICAL THERAPY,97035,PT Ultrasound Units,420,50,40,80% of total billed charges,31.5,63% of total billed charges,31,62% of total billed charges,31.5,63% of total billed charges,42.5,85% of total billed charges,40,80% of total billed charges,31,62% of total billed charges,31.5,63% of total billed charges,31,62% of total billed charges,31.5,63% of total billed charges,31,62% of total billed charges,40,80% of total billed charges,31,62% of total billed charges,31,62% of total billed charges,31,42.5,35
Outpatient Medical Services,PHYSICAL THERAPY,97110,PT Therapeutic Exercise Units,420,86,68.8,80% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,73.1,85% of total billed charges,68.8,80% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,54.18,63% of total billed charges,53.32,62% of total billed charges,68.8,80% of total billed charges,53.32,62% of total billed charges,53.32,62% of total billed charges,53.32,73.1,60.2
Outpatient Medical Services,PHYSICAL THERAPY,97112,PT Neuromuscular Reeducation Units,420,120,96,80% of total billed charges,75.6,63% of total billed charges,74.4,62% of total billed charges,75.6,63% of total billed charges,102,85% of total billed charges,96,80% of total billed charges,74.4,62% of total billed charges,75.6,63% of total billed charges,74.4,62% of total billed charges,75.6,63% of total billed charges,74.4,62% of total billed charges,96,80% of total billed charges,74.4,62% of total billed charges,74.4,62% of total billed charges,74.4,102,84
Outpatient Medical Services,PHYSICAL THERAPY,97116,PT Gait Training Units,420,75,60,80% of total billed charges,47.25,63% of total billed charges,46.5,62% of total billed charges,47.25,63% of total billed charges,63.75,85% of total billed charges,60,80% of total billed charges,46.5,62% of total billed charges,47.25,63% of total billed charges,46.5,62% of total billed charges,47.25,63% of total billed charges,46.5,62% of total billed charges,60,80% of total billed charges,46.5,62% of total billed charges,46.5,62% of total billed charges,46.5,63.75,52.5
Outpatient Medical Services,PHYSICAL THERAPY,97124,PT Massage Units,420,99,79.2,80% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,84.15,85% of total billed charges,79.2,80% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,62.37,63% of total billed charges,61.38,62% of total billed charges,79.2,80% of total billed charges,61.38,62% of total billed charges,61.38,62% of total billed charges,61.38,84.15,69.3
Outpatient Medical Services,PHYSICAL THERAPY,97140,PT Manual Therapy Units,420,97,77.6,80% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,82.45,85% of total billed charges,77.6,80% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,77.6,80% of total billed charges,60.14,62% of total billed charges,60.14,62% of total billed charges,60.14,82.45,67.9
Outpatient Medical Services,PHYSICAL THERAPY,97161,"PT Evaluation Units, Low Complexity",424,291,232.8,80% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,247.35,85% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,180.42,62% of total billed charges,180.42,247.35,203.7
Outpatient Medical Services,PHYSICAL THERAPY,97162,"PT Evaluation Units, Moderate Complexity",424,291,232.8,80% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,247.35,85% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,180.42,62% of total billed charges,180.42,247.35,203.7
Outpatient Medical Services,PHYSICAL THERAPY,97163,"PT Evaluation Units, High Complexity",424,291,232.8,80% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,247.35,85% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,183.33,63% of total billed charges,180.42,62% of total billed charges,232.8,80% of total billed charges,180.42,62% of total billed charges,180.42,62% of total billed charges,180.42,247.35,203.7
Outpatient Medical Services,PHYSICAL THERAPY,97164,"PT Re-Evaluation Units, 97164",424,199,159.2,80% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,169.15,85% of total billed charges,159.2,80% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,159.2,80% of total billed charges,123.38,62% of total billed charges,123.38,62% of total billed charges,123.38,169.15,139.3
Outpatient Medical Services,PHYSICAL THERAPY,97530,PT Therapeutic Activity Units,420,133,106.4,80% of total billed charges,83.79,63% of total billed charges,82.46,62% of total billed charges,83.79,63% of total billed charges,113.05,85% of total billed charges,106.4,80% of total billed charges,82.46,62% of total billed charges,83.79,63% of total billed charges,82.46,62% of total billed charges,83.79,63% of total billed charges,82.46,62% of total billed charges,106.4,80% of total billed charges,82.46,62% of total billed charges,82.46,62% of total billed charges,82.46,113.05,93.1
Outpatient Medical Services,PHYSICAL THERAPY,97542,PT Wheelchair Management Units,420,107,85.6,80% of total billed charges,67.41,63% of total billed charges,66.34,62% of total billed charges,67.41,63% of total billed charges,90.95,85% of total billed charges,85.6,80% of total billed charges,66.34,62% of total billed charges,67.41,63% of total billed charges,66.34,62% of total billed charges,67.41,63% of total billed charges,66.34,62% of total billed charges,85.6,80% of total billed charges,66.34,62% of total billed charges,66.34,62% of total billed charges,66.34,90.95,74.9
Outpatient Medical Services,PHYSICAL THERAPY,97760,"PT Orthotic Management, Train Units",420,165,132,80% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,140.25,85% of total billed charges,132,80% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,103.95,63% of total billed charges,102.3,62% of total billed charges,132,80% of total billed charges,102.3,62% of total billed charges,102.3,62% of total billed charges,102.3,140.25,115.5
Outpatient Medical Services,PHYSICAL THERAPY,97761,"PT Prosthetic Management, Train Units",420,138,110.4,80% of total billed charges,86.94,63% of total billed charges,85.56,62% of total billed charges,86.94,63% of total billed charges,117.3,85% of total billed charges,110.4,80% of total billed charges,85.56,62% of total billed charges,86.94,63% of total billed charges,85.56,62% of total billed charges,86.94,63% of total billed charges,85.56,62% of total billed charges,110.4,80% of total billed charges,85.56,62% of total billed charges,85.56,62% of total billed charges,85.56,117.3,96.6
Outpatient Medical Services,PHYSICAL THERAPY,97763,"PT Orthotic/Prosthetic Manage,Train Unit",420,189,151.2,80% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,160.65,85% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,119.07,63% of total billed charges,117.18,62% of total billed charges,151.2,80% of total billed charges,117.18,62% of total billed charges,117.18,62% of total billed charges,117.18,160.65,132.3
Outpatient Medical Services,PULMONARY REHAB,94010,Spirometry/graph/vit cap/exp flow 94010,460,273,218.4,80% of total billed charges,171.99,63% of total billed charges,169.26,62% of total billed charges,171.99,63% of total billed charges,232.05,85% of total billed charges,218.4,80% of total billed charges,169.26,62% of total billed charges,171.99,63% of total billed charges,169.26,62% of total billed charges,171.99,63% of total billed charges,169.26,62% of total billed charges,218.4,80% of total billed charges,169.26,62% of total billed charges,169.26,62% of total billed charges,169.26,232.05,191.1
Outpatient Medical Services,PULMONARY REHAB,94060,Bronch resp spiro/pre/post dilator94060,460,498,398.4,80% of total billed charges,313.74,63% of total billed charges,308.76,62% of total billed charges,313.74,63% of total billed charges,423.3,85% of total billed charges,398.4,80% of total billed charges,308.76,62% of total billed charges,313.74,63% of total billed charges,308.76,62% of total billed charges,313.74,63% of total billed charges,308.76,62% of total billed charges,398.4,80% of total billed charges,308.76,62% of total billed charges,308.76,62% of total billed charges,308.76,423.3,348.6
Outpatient Medical Services,PULMONARY REHAB,94150,"Vital capacity, total 94150",460,409,327.2,80% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,347.65,85% of total billed charges,327.2,80% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,327.2,80% of total billed charges,253.58,62% of total billed charges,253.58,62% of total billed charges,253.58,347.65,286.3
Outpatient Medical Services,PULMONARY REHAB,94200,Max breathing cap/max volunt vent 94200,460,210,168,80% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,178.5,85% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,130.2,62% of total billed charges,130.2,178.5,147
Outpatient Medical Services,PULMONARY REHAB,94375,Respiratory Flow Volume Loop 94375,460,746,596.8,80% of total billed charges,469.98,63% of total billed charges,462.52,62% of total billed charges,469.98,63% of total billed charges,634.1,85% of total billed charges,596.8,80% of total billed charges,462.52,62% of total billed charges,469.98,63% of total billed charges,462.52,62% of total billed charges,469.98,63% of total billed charges,462.52,62% of total billed charges,596.8,80% of total billed charges,462.52,62% of total billed charges,462.52,62% of total billed charges,462.52,634.1,522.2
Outpatient Medical Services,PULMONARY REHAB,94617,"Exercise test for bronchospasm, including pre- and",460,210,168,80% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,178.5,85% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,130.2,62% of total billed charges,130.2,178.5,147
Outpatient Medical Services,PULMONARY REHAB,94618,"Pulmonary stress testing (eg, 6-minute walk test)",460,210,168,80% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,178.5,85% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,130.2,62% of total billed charges,130.2,178.5,147
Outpatient Medical Services,PULMONARY REHAB,94625,94625 Pulmonary Rehab W/O Oximetry Monitoring WLMH,460,115,92,80% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,97.75,85% of total billed charges,92,80% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,92,80% of total billed charges,71.3,62% of total billed charges,71.3,62% of total billed charges,71.3,97.75,80.5
Outpatient Medical Services,PULMONARY REHAB,94626,Pulmonary Rehab W/ Oximetry Monitoring 94626,460,112,89.6,80% of total billed charges,70.56,63% of total billed charges,69.44,62% of total billed charges,70.56,63% of total billed charges,95.2,85% of total billed charges,89.6,80% of total billed charges,69.44,62% of total billed charges,70.56,63% of total billed charges,69.44,62% of total billed charges,70.56,63% of total billed charges,69.44,62% of total billed charges,89.6,80% of total billed charges,69.44,62% of total billed charges,69.44,62% of total billed charges,69.44,95.2,78.4
Outpatient Medical Services,PULMONARY REHAB,94640,Inhalation tx/AAO/therapeutic/diag 94640,460,373,298.4,80% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,317.05,85% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,231.26,62% of total billed charges,231.26,317.05,261.1
Outpatient Medical Services,PULMONARY REHAB,94660,"CPAP vent, initiat/manage 94660",410,373,298.4,80% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,317.05,85% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,231.26,62% of total billed charges,231.26,317.05,261.1
Outpatient Medical Services,PULMONARY REHAB,94664,Demo/eval/pt use aerosol/neb/IPPB 94664,410,373,298.4,80% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,317.05,85% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,231.26,62% of total billed charges,231.26,317.05,261.1
Outpatient Medical Services,PULMONARY REHAB,94667,Manip chest wall/init demo/eval 94667,410,210,168,80% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,178.5,85% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,130.2,62% of total billed charges,130.2,178.5,147
Outpatient Medical Services,PULMONARY REHAB,94668,Manip chest wall/subseq demo/eval 94668,410,210,168,80% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,178.5,85% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,132.3,63% of total billed charges,130.2,62% of total billed charges,168,80% of total billed charges,130.2,62% of total billed charges,130.2,62% of total billed charges,130.2,178.5,147
Outpatient Medical Services,PULMONARY REHAB,94669,Mechanical chest wall oscillation to facilitate lu,410,373,298.4,80% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,317.05,85% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,234.99,63% of total billed charges,231.26,62% of total billed charges,298.4,80% of total billed charges,231.26,62% of total billed charges,231.26,62% of total billed charges,231.26,317.05,261.1
Outpatient Medical Services,PULMONARY REHAB,94727,Gas dilu/washout/det lung volumes94727,460,408,326.4,80% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,346.8,85% of total billed charges,326.4,80% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,326.4,80% of total billed charges,252.96,62% of total billed charges,252.96,62% of total billed charges,252.96,346.8,285.6
Outpatient Medical Services,PULMONARY REHAB,94729,Diffusing capacity/CO2/add on 94729,410,408,326.4,80% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,346.8,85% of total billed charges,326.4,80% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,257.04,63% of total billed charges,252.96,62% of total billed charges,326.4,80% of total billed charges,252.96,62% of total billed charges,252.96,62% of total billed charges,252.96,346.8,285.6
Outpatient Medical Services,PULMONARY REHAB,94799,Unlisted pulmonary serv/proc 94799,460,409,327.2,80% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,347.65,85% of total billed charges,327.2,80% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,257.67,63% of total billed charges,253.58,62% of total billed charges,327.2,80% of total billed charges,253.58,62% of total billed charges,253.58,62% of total billed charges,253.58,347.65,286.3
Outpatient Medical Services,PULMONARY REHAB,G0239,"Oth resp proc, group G0239",460,64,51.2,80% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,54.4,85% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,39.68,62% of total billed charges,39.68,54.4,44.8
Outpatient Medical Services,PULMONARY REHAB,G0238,"Oth resp proc, individual G0238",460,64,51.2,80% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,54.4,85% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,39.68,62% of total billed charges,39.68,54.4,44.8
Outpatient Medical Services,PULMONARY REHAB,G0237,Therapeutic procd strg endur G0237,460,64,51.2,80% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,54.4,85% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,40.32,63% of total billed charges,39.68,62% of total billed charges,51.2,80% of total billed charges,39.68,62% of total billed charges,39.68,62% of total billed charges,39.68,54.4,44.8
Outpatient Medical Services,RADIOLOGY,70100,XR Mandible Less Than 4 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70110,XR Mandible Complete 4+ Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,70140,XR Facial Bones < 3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70150,XR Facial Bones 3+ Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,70160,XR Nasal Bones 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70210,XR Sinuses Paranasal < 3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70220,XR Sinuses Paranasal Complete,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70250,XR Skull < 4 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70260,XR Skull Complete,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,70328,XR TMJ Open and Closed,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70330,XR TMJ Open and Closed Bilateral,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70360,XR Neck Soft Tissue,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,70450,CT Head w/o Contrast,351,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,70460,CT Head w/ Contrast,351,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,70470,CT Head w/ + w/o Contrast,351,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,70480,CT IAC w/o Contrast,351,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,70481,CT IAC w/ Contrast,351,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,70482,CT IAC w/ + w/o Contrast,351,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,70486,CT Maxillofacial w/o Contrast,351,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,70487,CT Maxillofacial w/ Contrast,351,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,70488,CT Maxillofacial w/ + w/o Contrast,351,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,70490,CT Neck Soft Tissue w/o Contrast,351,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,70491,CT Neck Soft Tissue w/ Contrast,351,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,70492,CT Neck Soft Tissue w/ + w/o Contrast,351,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,70496,CT Angio Brain/Head,351,2223,1778.4,80% of total billed charges,1400.49,63% of total billed charges,1378.26,62% of total billed charges,1400.49,63% of total billed charges,1889.55,85% of total billed charges,1778.4,80% of total billed charges,1378.26,62% of total billed charges,1400.49,63% of total billed charges,1378.26,62% of total billed charges,1400.49,63% of total billed charges,1378.26,62% of total billed charges,1778.4,80% of total billed charges,1378.26,62% of total billed charges,1378.26,62% of total billed charges,1378.26,1889.55,1556.1
Outpatient Medical Services,RADIOLOGY,70498,CT Angio Neck,351,1265,1012,80% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,1075.25,85% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,784.3,62% of total billed charges,784.3,1075.25,885.5
Outpatient Medical Services,RADIOLOGY,71045,XR Chest 1 View,324,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,71046,XR Chest 2 Views,324,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,71047,XR Chest 3 Views,324,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,71100,XR Ribs 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,71101,XR Ribs w/ PA Chest,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,71111,XR Ribs w/ PA Chest Bilateral,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,71120,XR Sternum 2+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,71250,CT Chest w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,71260,CT Chest w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,71270,CT Chest w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,71271,CT Low Dose Lung Scan,352,486,388.8,80% of total billed charges,306.18,63% of total billed charges,301.32,62% of total billed charges,306.18,63% of total billed charges,413.1,85% of total billed charges,388.8,80% of total billed charges,301.32,62% of total billed charges,306.18,63% of total billed charges,301.32,62% of total billed charges,306.18,63% of total billed charges,301.32,62% of total billed charges,388.8,80% of total billed charges,301.32,62% of total billed charges,301.32,62% of total billed charges,301.32,413.1,340.2
Outpatient Medical Services,RADIOLOGY,71275,CT Angio Chest PE Protocol,352,1489,1191.2,80% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,1265.65,85% of total billed charges,1191.2,80% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,1191.2,80% of total billed charges,923.18,62% of total billed charges,923.18,62% of total billed charges,923.18,1265.65,1042.3
Outpatient Medical Services,RADIOLOGY,72020,XR Spine 1 View,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72040,XR Spine Cervical 2 or 3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72050,XR Spine Cervical 4 or 5 Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,72052,XR Spine Cervical 6+ Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,72070,XR Spine Thoracic 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72072,XR Spine Thoracic 3 Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,72100,XR Spine Lumbosacral 2 or 3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72110,XR Spine Lumbosacral 4+ Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,72114,XR Spine Lumbosacral w/ Bending 6+ Views,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,72125,CT Spine Cervical w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,72126,CT Spine Cervical w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,72127,CT Spine Cervical w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,72128,CT Spine Thoracic w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,72129,CT Spine Thoracic w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,72130,CT Spine Thoracic w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,72131,CT Spine Lumbar w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,72132,CT Spine Lumbar w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,72133,CT Spine Lumbar w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,72170,XR Pelvis 1 or 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72191,CT Angio Pelvis,352,1489,1191.2,80% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,1265.65,85% of total billed charges,1191.2,80% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,938.07,63% of total billed charges,923.18,62% of total billed charges,1191.2,80% of total billed charges,923.18,62% of total billed charges,923.18,62% of total billed charges,923.18,1265.65,1042.3
Outpatient Medical Services,RADIOLOGY,72192,CT Pelvis w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,72193,CT Pelvis w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,72194,CT Pelvis w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,72200,XR Sacroiliac Joints 1 or 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,72220,XR Sacrum/Coccyx 2+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73000,XR Clavicle,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73010,XR Scapula,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73020,XR Shoulder 1 View,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73030,XR Shoulder Complete 2+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73050,XR AC Joints Bilateral,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73060,XR Humerus,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73070,XR Elbow 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73080,XR Elbow Complete 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73090,XR Forearm 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73100,XR Wrist 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73110,XR Wrist Complete 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73120,XR Hand 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73130,XR Hand Complete 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73140,XR Finger(s) 2+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73200,CT Upper Extremity w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,73201,CT Upper Extremity w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,73202,CT Upper Extremity w/+w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,73501,XR Hip 1 View,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73502,XR Hip 2-3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73521,XR Hips 2 Views w/AP Pelvis Bilat,320,278,222.4,80% of total billed charges,175.14,63% of total billed charges,172.36,62% of total billed charges,175.14,63% of total billed charges,236.3,85% of total billed charges,222.4,80% of total billed charges,172.36,62% of total billed charges,175.14,63% of total billed charges,172.36,62% of total billed charges,175.14,63% of total billed charges,172.36,62% of total billed charges,222.4,80% of total billed charges,172.36,62% of total billed charges,172.36,62% of total billed charges,172.36,236.3,194.6
Outpatient Medical Services,RADIOLOGY,73552,XR Femur 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73560,XR Knee 1 or 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73562,XR Knee 3 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73564,XR Knee Complete 4+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73590,XR Tibia/Fibula,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73600,XR Ankle 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73610,XR Ankle Complete 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73620,XR Foot 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73630,XR Foot Complete 3+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73650,XR Calcaneus,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73660,XR Toe(s) 2+ Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,73700,CT Lower Extremity w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,73701,CT Lower Extremity w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,73702,CT Lower Extremity w/+w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,73706,CT Angio Lower Extremity Bilateral,352,1265,1012,80% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,1075.25,85% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,784.3,62% of total billed charges,784.3,1075.25,885.5
Outpatient Medical Services,RADIOLOGY,74018,XR Abdomen KUB 1 View,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,74019,XR Abdomen 2 Views,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,74022,XR Abdomen Series + Chest 1 View,320,343,274.4,80% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,291.55,85% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,216.09,63% of total billed charges,212.66,62% of total billed charges,274.4,80% of total billed charges,212.66,62% of total billed charges,212.66,62% of total billed charges,212.66,291.55,240.1
Outpatient Medical Services,RADIOLOGY,74150,CT Abdomen w/o Contrast,352,646,516.8,80% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,549.1,85% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,406.98,63% of total billed charges,400.52,62% of total billed charges,516.8,80% of total billed charges,400.52,62% of total billed charges,400.52,62% of total billed charges,400.52,549.1,452.2
Outpatient Medical Services,RADIOLOGY,74160,CT Abdomen w/ Contrast,352,1270,1016,80% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,1079.5,85% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,800.1,63% of total billed charges,787.4,62% of total billed charges,1016,80% of total billed charges,787.4,62% of total billed charges,787.4,62% of total billed charges,787.4,1079.5,889
Outpatient Medical Services,RADIOLOGY,74170,CT Abdomen w/ + w/o Contrast,352,1430,1144,80% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,1215.5,85% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,900.9,63% of total billed charges,886.6,62% of total billed charges,1144,80% of total billed charges,886.6,62% of total billed charges,886.6,62% of total billed charges,886.6,1215.5,1001
Outpatient Medical Services,RADIOLOGY,74174,CT Angio Abdomen and Pelvis,352,1841,1472.8,80% of total billed charges,1159.83,63% of total billed charges,1141.42,62% of total billed charges,1159.83,63% of total billed charges,1564.85,85% of total billed charges,1472.8,80% of total billed charges,1141.42,62% of total billed charges,1159.83,63% of total billed charges,1141.42,62% of total billed charges,1159.83,63% of total billed charges,1141.42,62% of total billed charges,1472.8,80% of total billed charges,1141.42,62% of total billed charges,1141.42,62% of total billed charges,1141.42,1564.85,1288.7
Outpatient Medical Services,RADIOLOGY,74175,CT Angio Abdomen,352,1265,1012,80% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,1075.25,85% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,784.3,62% of total billed charges,784.3,1075.25,885.5
Outpatient Medical Services,RADIOLOGY,74176,CT Abdomen and Pelvis w/o Contrast,352,1233,986.4,80% of total billed charges,776.79,63% of total billed charges,764.46,62% of total billed charges,776.79,63% of total billed charges,1048.05,85% of total billed charges,986.4,80% of total billed charges,764.46,62% of total billed charges,776.79,63% of total billed charges,764.46,62% of total billed charges,776.79,63% of total billed charges,764.46,62% of total billed charges,986.4,80% of total billed charges,764.46,62% of total billed charges,764.46,62% of total billed charges,764.46,1048.05,863.1
Outpatient Medical Services,RADIOLOGY,74177,CT Abdomen and Pelvis w/ Contrast,352,1990,1592,80% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1691.5,85% of total billed charges,1592,80% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1592,80% of total billed charges,1233.8,62% of total billed charges,1233.8,62% of total billed charges,1233.8,1691.5,1393
Outpatient Medical Services,RADIOLOGY,74178,CT Abdomen and Pelvis w/ + w/o Contrast,352,1990,1592,80% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1691.5,85% of total billed charges,1592,80% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1253.7,63% of total billed charges,1233.8,62% of total billed charges,1592,80% of total billed charges,1233.8,62% of total billed charges,1233.8,62% of total billed charges,1233.8,1691.5,1393
Outpatient Medical Services,RADIOLOGY,75635,CT Angio Abdominal Aorta with Runoff,352,1265,1012,80% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,1075.25,85% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,796.95,63% of total billed charges,784.3,62% of total billed charges,1012,80% of total billed charges,784.3,62% of total billed charges,784.3,62% of total billed charges,784.3,1075.25,885.5
Outpatient Medical Services,RADIOLOGY,76010,XR Foreign Body Localization Child 1 Vw,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,76380,CT Limited or Localized F/U Study,352,406,324.8,80% of total billed charges,255.78,63% of total billed charges,251.72,62% of total billed charges,255.78,63% of total billed charges,345.1,85% of total billed charges,324.8,80% of total billed charges,251.72,62% of total billed charges,255.78,63% of total billed charges,251.72,62% of total billed charges,255.78,63% of total billed charges,251.72,62% of total billed charges,324.8,80% of total billed charges,251.72,62% of total billed charges,251.72,62% of total billed charges,251.72,345.1,284.2
Outpatient Medical Services,RADIOLOGY,76536,US Head/Neck Soft Tissue,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76604,US Chest,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76641,US Breast Complete,402,345,276,80% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,293.25,85% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,213.9,62% of total billed charges,213.9,293.25,241.5
Outpatient Medical Services,RADIOLOGY,76700,US Abdomen Complete,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76705,US Abdomen Limited,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76706,US AAA Screening,402,345,276,80% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,293.25,85% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,213.9,62% of total billed charges,213.9,293.25,241.5
Outpatient Medical Services,RADIOLOGY,76770,US Retroperitoneal Complete,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76775,US Retroperitoneal Limited,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76776,US Kidney Transplant w/ Doppler,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76801,US OB < 14 weeks,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76810,US OB < 14 Weeks Addl Fetus,402,345,276,80% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,293.25,85% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,213.9,62% of total billed charges,213.9,293.25,241.5
Outpatient Medical Services,RADIOLOGY,76817,US OB Transvaginal,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76830,US Transvaginal Non-OB,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76856,US Pelvic Non OB,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76857,US Bladder Scan,402,345,276,80% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,293.25,85% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,217.35,63% of total billed charges,213.9,62% of total billed charges,276,80% of total billed charges,213.9,62% of total billed charges,213.9,62% of total billed charges,213.9,293.25,241.5
Outpatient Medical Services,RADIOLOGY,76870,US Scrotum (Contents),402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76872,US Prostate Transrectal,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76881,US Extremity Nonvascular Complete,402,412,329.6,80% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,350.2,85% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,259.56,63% of total billed charges,255.44,62% of total billed charges,329.6,80% of total billed charges,255.44,62% of total billed charges,255.44,62% of total billed charges,255.44,350.2,288.4
Outpatient Medical Services,RADIOLOGY,76882,US Extremity Nonvascular Limited,402,337,269.6,80% of total billed charges,212.31,63% of total billed charges,208.94,62% of total billed charges,212.31,63% of total billed charges,286.45,85% of total billed charges,269.6,80% of total billed charges,208.94,62% of total billed charges,212.31,63% of total billed charges,208.94,62% of total billed charges,212.31,63% of total billed charges,208.94,62% of total billed charges,269.6,80% of total billed charges,208.94,62% of total billed charges,208.94,62% of total billed charges,208.94,286.45,235.9
Outpatient Medical Services,RADIOLOGY,76942,US Guided Needle Placement,402,281,224.8,80% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,238.85,85% of total billed charges,224.8,80% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,177.03,63% of total billed charges,174.22,62% of total billed charges,224.8,80% of total billed charges,174.22,62% of total billed charges,174.22,62% of total billed charges,174.22,238.85,196.7
Outpatient Medical Services,RADIOLOGY,76999,US Soft Tissue,402,261,208.8,80% of total billed charges,164.43,63% of total billed charges,161.82,62% of total billed charges,164.43,63% of total billed charges,221.85,85% of total billed charges,208.8,80% of total billed charges,161.82,62% of total billed charges,164.43,63% of total billed charges,161.82,62% of total billed charges,164.43,63% of total billed charges,161.82,62% of total billed charges,208.8,80% of total billed charges,161.82,62% of total billed charges,161.82,62% of total billed charges,161.82,221.85,182.7
Outpatient Medical Services,RADIOLOGY,77072,XR Bone Age Studies,320,186,148.8,80% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,158.1,85% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,117.18,63% of total billed charges,115.32,62% of total billed charges,148.8,80% of total billed charges,115.32,62% of total billed charges,115.32,62% of total billed charges,115.32,158.1,130.2
Outpatient Medical Services,RADIOLOGY,77080,BD Bone Density DEXA Axial Skeleton,320,436,348.8,80% of total billed charges,274.68,63% of total billed charges,270.32,62% of total billed charges,274.68,63% of total billed charges,370.6,85% of total billed charges,348.8,80% of total billed charges,270.32,62% of total billed charges,274.68,63% of total billed charges,270.32,62% of total billed charges,274.68,63% of total billed charges,270.32,62% of total billed charges,348.8,80% of total billed charges,270.32,62% of total billed charges,270.32,62% of total billed charges,270.32,370.6,305.2
Outpatient Medical Services,RADIOLOGY,77081,BD Bone Density DEXA App Skeleton,320,324,259.2,80% of total billed charges,204.12,63% of total billed charges,200.88,62% of total billed charges,204.12,63% of total billed charges,275.4,85% of total billed charges,259.2,80% of total billed charges,200.88,62% of total billed charges,204.12,63% of total billed charges,200.88,62% of total billed charges,204.12,63% of total billed charges,200.88,62% of total billed charges,259.2,80% of total billed charges,200.88,62% of total billed charges,200.88,62% of total billed charges,200.88,275.4,226.8
Outpatient Medical Services,RADIOLOGY,93306,US Echo Doppler Complete,921,975,780,80% of total billed charges,614.25,63% of total billed charges,604.5,62% of total billed charges,614.25,63% of total billed charges,828.75,85% of total billed charges,780,80% of total billed charges,604.5,62% of total billed charges,614.25,63% of total billed charges,604.5,62% of total billed charges,614.25,63% of total billed charges,604.5,62% of total billed charges,780,80% of total billed charges,604.5,62% of total billed charges,604.5,62% of total billed charges,604.5,828.75,682.5
Outpatient Medical Services,RADIOLOGY,93308,US Echo Doppler Limited,480,502,401.6,80% of total billed charges,316.26,63% of total billed charges,311.24,62% of total billed charges,316.26,63% of total billed charges,426.7,85% of total billed charges,401.6,80% of total billed charges,311.24,62% of total billed charges,316.26,63% of total billed charges,311.24,62% of total billed charges,316.26,63% of total billed charges,311.24,62% of total billed charges,401.6,80% of total billed charges,311.24,62% of total billed charges,311.24,62% of total billed charges,311.24,426.7,351.4
Outpatient Medical Services,RADIOLOGY,93880,US Carotid Duplex Bilateral,921,681,544.8,80% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,578.85,85% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,422.22,62% of total billed charges,422.22,578.85,476.7
Outpatient Medical Services,RADIOLOGY,93925,US Lower Ext Arterial Duplex Bilateral,921,536,428.8,80% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,455.6,85% of total billed charges,428.8,80% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,428.8,80% of total billed charges,332.32,62% of total billed charges,332.32,62% of total billed charges,332.32,455.6,375.2
Outpatient Medical Services,RADIOLOGY,93926,US Lower Ext Arterial Duplex,921,474,379.2,80% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,402.9,85% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,293.88,62% of total billed charges,293.88,402.9,331.8
Outpatient Medical Services,RADIOLOGY,93930,US Upper Ext Arterial Duplex Bilateral,921,536,428.8,80% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,455.6,85% of total billed charges,428.8,80% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,337.68,63% of total billed charges,332.32,62% of total billed charges,428.8,80% of total billed charges,332.32,62% of total billed charges,332.32,62% of total billed charges,332.32,455.6,375.2
Outpatient Medical Services,RADIOLOGY,93931,US Upper Ext Arterial Duplex,921,474,379.2,80% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,402.9,85% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,293.88,62% of total billed charges,293.88,402.9,331.8
Outpatient Medical Services,RADIOLOGY,93970,US Lower Ext Venous Duplex Bilateral,921,681,544.8,80% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,578.85,85% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,422.22,62% of total billed charges,422.22,578.85,476.7
Outpatient Medical Services,RADIOLOGY,93970,US Upper Ext Venous Duplex Bilateral,921,681,544.8,80% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,578.85,85% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,429.03,63% of total billed charges,422.22,62% of total billed charges,544.8,80% of total billed charges,422.22,62% of total billed charges,422.22,62% of total billed charges,422.22,578.85,476.7
Outpatient Medical Services,RADIOLOGY,93971,US Lower Ext Venous Duplex,921,480,384,80% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,408,85% of total billed charges,384,80% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,384,80% of total billed charges,297.6,62% of total billed charges,297.6,62% of total billed charges,297.6,408,336
Outpatient Medical Services,RADIOLOGY,93971,US Upper Ext Venous Duplex,921,480,384,80% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,408,85% of total billed charges,384,80% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,302.4,63% of total billed charges,297.6,62% of total billed charges,384,80% of total billed charges,297.6,62% of total billed charges,297.6,62% of total billed charges,297.6,408,336
Outpatient Medical Services,RADIOLOGY,93975,US Art/Vein Abd/Pelvis/Scrotal Complete,921,474,379.2,80% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,402.9,85% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,298.62,63% of total billed charges,293.88,62% of total billed charges,379.2,80% of total billed charges,293.88,62% of total billed charges,293.88,62% of total billed charges,293.88,402.9,331.8
Outpatient Medical Services,RADIOLOGY,93978,US Aorta IVC Iliac Duplex Complete,921,465,372,80% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,395.25,85% of total billed charges,372,80% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,372,80% of total billed charges,288.3,62% of total billed charges,288.3,62% of total billed charges,288.3,395.25,325.5
Outpatient Medical Services,RADIOLOGY,93979,US Aorta IVC Iliac Duplex Limited,921,334,267.2,80% of total billed charges,210.42,63% of total billed charges,207.08,62% of total billed charges,210.42,63% of total billed charges,283.9,85% of total billed charges,267.2,80% of total billed charges,207.08,62% of total billed charges,210.42,63% of total billed charges,207.08,62% of total billed charges,210.42,63% of total billed charges,207.08,62% of total billed charges,267.2,80% of total billed charges,207.08,62% of total billed charges,207.08,62% of total billed charges,207.08,283.9,233.8
Outpatient Medical Services,RESPIRATORY THERAPY,31500,RT Intubation Assist CHARGE,410,355,284,80% of total billed charges,223.65,63% of total billed charges,220.1,62% of total billed charges,223.65,63% of total billed charges,301.75,85% of total billed charges,284,80% of total billed charges,220.1,62% of total billed charges,223.65,63% of total billed charges,220.1,62% of total billed charges,223.65,63% of total billed charges,220.1,62% of total billed charges,284,80% of total billed charges,220.1,62% of total billed charges,220.1,62% of total billed charges,220.1,301.75,248.5
Outpatient Medical Services,RESPIRATORY THERAPY,31720,RT Airway Suction CHARGE,410,325,260,80% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,276.25,85% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,201.5,62% of total billed charges,201.5,276.25,227.5
Outpatient Medical Services,RESPIRATORY THERAPY,92950,RT Cardiopulmonary Resuscitation CHARGE,410,465,372,80% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,395.25,85% of total billed charges,372,80% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,292.95,63% of total billed charges,288.3,62% of total billed charges,372,80% of total billed charges,288.3,62% of total billed charges,288.3,62% of total billed charges,288.3,395.25,325.5
Outpatient Medical Services,RESPIRATORY THERAPY,93005,RT Electrocardiogram (EKG) CHARGE,730,97,77.6,80% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,82.45,85% of total billed charges,77.6,80% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,61.11,63% of total billed charges,60.14,62% of total billed charges,77.6,80% of total billed charges,60.14,62% of total billed charges,60.14,62% of total billed charges,60.14,82.45,67.9
Outpatient Medical Services,RESPIRATORY THERAPY,93922,93922 PADNET LIMITED ARTERIAL STDY,921,244,195.2,80% of total billed charges,153.72,63% of total billed charges,151.28,62% of total billed charges,153.72,63% of total billed charges,207.4,85% of total billed charges,195.2,80% of total billed charges,151.28,62% of total billed charges,153.72,63% of total billed charges,151.28,62% of total billed charges,153.72,63% of total billed charges,151.28,62% of total billed charges,195.2,80% of total billed charges,151.28,62% of total billed charges,151.28,62% of total billed charges,151.28,207.4,170.8
Outpatient Medical Services,RESPIRATORY THERAPY,93923,93923 PADNET UPR/LXTR ART STDY 3+ LV,921,280,224,80% of total billed charges,176.4,63% of total billed charges,173.6,62% of total billed charges,176.4,63% of total billed charges,238,85% of total billed charges,224,80% of total billed charges,173.6,62% of total billed charges,176.4,63% of total billed charges,173.6,62% of total billed charges,176.4,63% of total billed charges,173.6,62% of total billed charges,224,80% of total billed charges,173.6,62% of total billed charges,173.6,62% of total billed charges,173.6,238,196
Outpatient Medical Services,RESPIRATORY THERAPY,94002,RT Ventilator Services Initial CHARGE,410,848,678.4,80% of total billed charges,534.24,63% of total billed charges,525.76,62% of total billed charges,534.24,63% of total billed charges,720.8,85% of total billed charges,678.4,80% of total billed charges,525.76,62% of total billed charges,534.24,63% of total billed charges,525.76,62% of total billed charges,534.24,63% of total billed charges,525.76,62% of total billed charges,678.4,80% of total billed charges,525.76,62% of total billed charges,525.76,62% of total billed charges,525.76,720.8,593.6
Outpatient Medical Services,RESPIRATORY THERAPY,94003,RT Ventilator Services Subsequent CHARGE,410,713,570.4,80% of total billed charges,449.19,63% of total billed charges,442.06,62% of total billed charges,449.19,63% of total billed charges,606.05,85% of total billed charges,570.4,80% of total billed charges,442.06,62% of total billed charges,449.19,63% of total billed charges,442.06,62% of total billed charges,449.19,63% of total billed charges,442.06,62% of total billed charges,570.4,80% of total billed charges,442.06,62% of total billed charges,442.06,62% of total billed charges,442.06,606.05,499.1
Outpatient Medical Services,RESPIRATORY THERAPY,94010,94010 BEDSIDE SPIROMETRY,410,277,221.6,80% of total billed charges,174.51,63% of total billed charges,171.74,62% of total billed charges,174.51,63% of total billed charges,235.45,85% of total billed charges,221.6,80% of total billed charges,171.74,62% of total billed charges,174.51,63% of total billed charges,171.74,62% of total billed charges,174.51,63% of total billed charges,171.74,62% of total billed charges,221.6,80% of total billed charges,171.74,62% of total billed charges,171.74,62% of total billed charges,171.74,235.45,193.9
Outpatient Medical Services,RESPIRATORY THERAPY,94618,"RT Pulse Oximetry, Exercise CHARGE",410,300,240,80% of total billed charges,189,63% of total billed charges,186,62% of total billed charges,189,63% of total billed charges,255,85% of total billed charges,240,80% of total billed charges,186,62% of total billed charges,189,63% of total billed charges,186,62% of total billed charges,189,63% of total billed charges,186,62% of total billed charges,240,80% of total billed charges,186,62% of total billed charges,186,62% of total billed charges,186,255,210
Outpatient Medical Services,RESPIRATORY THERAPY,94625,94625 Pulmonary Rehab W/O Oximetry Monitoring,460,115,92,80% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,97.75,85% of total billed charges,92,80% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,72.45,63% of total billed charges,71.3,62% of total billed charges,92,80% of total billed charges,71.3,62% of total billed charges,71.3,62% of total billed charges,71.3,97.75,80.5
Outpatient Medical Services,RESPIRATORY THERAPY,94640,RT Sputum Induction Initial CHARGE,410,325,260,80% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,276.25,85% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,201.5,62% of total billed charges,201.5,276.25,227.5
Outpatient Medical Services,RESPIRATORY THERAPY,94644,RT Continuous Neb Initial CHARGE,410,201,160.8,80% of total billed charges,126.63,63% of total billed charges,124.62,62% of total billed charges,126.63,63% of total billed charges,170.85,85% of total billed charges,160.8,80% of total billed charges,124.62,62% of total billed charges,126.63,63% of total billed charges,124.62,62% of total billed charges,126.63,63% of total billed charges,124.62,62% of total billed charges,160.8,80% of total billed charges,124.62,62% of total billed charges,124.62,62% of total billed charges,124.62,170.85,140.7
Outpatient Medical Services,RESPIRATORY THERAPY,94645,RT Continuous Neb Subsequent CHARGE,410,39,31.2,80% of total billed charges,24.57,63% of total billed charges,24.18,62% of total billed charges,24.57,63% of total billed charges,33.15,85% of total billed charges,31.2,80% of total billed charges,24.18,62% of total billed charges,24.57,63% of total billed charges,24.18,62% of total billed charges,24.57,63% of total billed charges,24.18,62% of total billed charges,31.2,80% of total billed charges,24.18,62% of total billed charges,24.18,62% of total billed charges,24.18,33.15,27.3
Outpatient Medical Services,RESPIRATORY THERAPY,94660,RT BiPAP Initial CHARGE,410,325,260,80% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,276.25,85% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,201.5,62% of total billed charges,201.5,276.25,227.5
Outpatient Medical Services,RESPIRATORY THERAPY,94660,RT CPAP Initial CHARGE,410,325,260,80% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,276.25,85% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,204.75,63% of total billed charges,201.5,62% of total billed charges,260,80% of total billed charges,201.5,62% of total billed charges,201.5,62% of total billed charges,201.5,276.25,227.5
Outpatient Medical Services,RESPIRATORY THERAPY,94664,RT Aerosol Therapy Instruction CHARGE,410,200,160,80% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,170,85% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,124,62% of total billed charges,124,170,140
Outpatient Medical Services,RESPIRATORY THERAPY,94667,RT CPT Initial CHARGE,410,200,160,80% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,170,85% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,124,62% of total billed charges,124,170,140
Outpatient Medical Services,RESPIRATORY THERAPY,94668,RT CPT Subsequent CHARGE,410,200,160,80% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,170,85% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,126,63% of total billed charges,124,62% of total billed charges,160,80% of total billed charges,124,62% of total billed charges,124,62% of total billed charges,124,170,140
Outpatient Medical Services,RESPIRATORY THERAPY,94669,RT CPT w/ Vest Initial CHARGE,410,368,294.4,80% of total billed charges,231.84,63% of total billed charges,228.16,62% of total billed charges,231.84,63% of total billed charges,312.8,85% of total billed charges,294.4,80% of total billed charges,228.16,62% of total billed charges,231.84,63% of total billed charges,228.16,62% of total billed charges,231.84,63% of total billed charges,228.16,62% of total billed charges,294.4,80% of total billed charges,228.16,62% of total billed charges,228.16,62% of total billed charges,228.16,312.8,257.6
Outpatient Medical Services,RESPIRATORY THERAPY,94762,RT Overnight Oximetry CHARGE,460,268,214.4,80% of total billed charges,168.84,63% of total billed charges,166.16,62% of total billed charges,168.84,63% of total billed charges,227.8,85% of total billed charges,214.4,80% of total billed charges,166.16,62% of total billed charges,168.84,63% of total billed charges,166.16,62% of total billed charges,168.84,63% of total billed charges,166.16,62% of total billed charges,214.4,80% of total billed charges,166.16,62% of total billed charges,166.16,62% of total billed charges,166.16,227.8,187.6
Outpatient Medical Services,SPECIALTY CLINIC,99203,99203 Office Visit New Pt. Level 3,510,224,179.2,80% of total billed charges,141.12,63% of total billed charges,188.14,pays based on per visit rate,141.12,63% of total billed charges,190.4,85% of total billed charges,179.2,80% of total billed charges,190.02,pays based on per visit rate,141.12,63% of total billed charges,188.14,pays based on per visit rate,141.12,63% of total billed charges,188.14,pays based on per visit rate,179.2,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,141.12,190.4,156.8
Outpatient Medical Services,SPECIALTY CLINIC,99203,99203 Office Visit New Pt. Level 3,510,224,179.2,80% of total billed charges,141.12,63% of total billed charges,188.14,pays based on per visit rate,141.12,63% of total billed charges,190.4,85% of total billed charges,179.2,80% of total billed charges,190.02,pays based on per visit rate,141.12,63% of total billed charges,188.14,pays based on per visit rate,141.12,63% of total billed charges,188.14,pays based on per visit rate,179.2,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,141.12,190.4,156.8
Outpatient Medical Services,SPECIALTY CLINIC,99204,99204 Office Visit New Pt. Level 4,510,342,273.6,80% of total billed charges,215.46,63% of total billed charges,188.14,pays based on per visit rate,215.46,63% of total billed charges,290.7,85% of total billed charges,273.6,80% of total billed charges,190.02,pays based on per visit rate,215.46,63% of total billed charges,188.14,pays based on per visit rate,215.46,63% of total billed charges,188.14,pays based on per visit rate,273.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,290.7,239.4
Outpatient Medical Services,SPECIALTY CLINIC,99205,99205 Office Visit New Pt. Level 5,510,425,340,80% of total billed charges,267.75,63% of total billed charges,188.14,pays based on per visit rate,267.75,63% of total billed charges,361.25,85% of total billed charges,340,80% of total billed charges,190.02,pays based on per visit rate,267.75,63% of total billed charges,188.14,pays based on per visit rate,267.75,63% of total billed charges,188.14,pays based on per visit rate,340,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,361.25,297.5
Outpatient Medical Services,SPEECH THERAPY,92507,SLP Auditory Processing Tx Units,440,183,146.4,80% of total billed charges,115.29,63% of total billed charges,113.46,62% of total billed charges,115.29,63% of total billed charges,155.55,85% of total billed charges,146.4,80% of total billed charges,113.46,62% of total billed charges,115.29,63% of total billed charges,113.46,62% of total billed charges,115.29,63% of total billed charges,113.46,62% of total billed charges,146.4,80% of total billed charges,113.46,62% of total billed charges,113.46,62% of total billed charges,113.46,155.55,128.1
Outpatient Medical Services,SPEECH THERAPY,92521,SLP Evaluation of Speech Fluency Units,444,390,312,80% of total billed charges,245.7,63% of total billed charges,241.8,62% of total billed charges,245.7,63% of total billed charges,331.5,85% of total billed charges,312,80% of total billed charges,241.8,62% of total billed charges,245.7,63% of total billed charges,241.8,62% of total billed charges,245.7,63% of total billed charges,241.8,62% of total billed charges,312,80% of total billed charges,241.8,62% of total billed charges,241.8,62% of total billed charges,241.8,331.5,273
Outpatient Medical Services,SPEECH THERAPY,92522,SLP Eval of Speech Sound Prod Units,444,148,118.4,80% of total billed charges,93.24,63% of total billed charges,91.76,62% of total billed charges,93.24,63% of total billed charges,125.8,85% of total billed charges,118.4,80% of total billed charges,91.76,62% of total billed charges,93.24,63% of total billed charges,91.76,62% of total billed charges,93.24,63% of total billed charges,91.76,62% of total billed charges,118.4,80% of total billed charges,91.76,62% of total billed charges,91.76,62% of total billed charges,91.76,125.8,103.6
Outpatient Medical Services,SPEECH THERAPY,92523,"SLP Eval Lang Comprehension,Express Unit",444,284,227.2,80% of total billed charges,178.92,63% of total billed charges,176.08,62% of total billed charges,178.92,63% of total billed charges,241.4,85% of total billed charges,227.2,80% of total billed charges,176.08,62% of total billed charges,178.92,63% of total billed charges,176.08,62% of total billed charges,178.92,63% of total billed charges,176.08,62% of total billed charges,227.2,80% of total billed charges,176.08,62% of total billed charges,176.08,62% of total billed charges,176.08,241.4,198.8
Outpatient Medical Services,SPEECH THERAPY,92524,"Behavioral, Qualitative Analysis Units",440,320,256,80% of total billed charges,201.6,63% of total billed charges,198.4,62% of total billed charges,201.6,63% of total billed charges,272,85% of total billed charges,256,80% of total billed charges,198.4,62% of total billed charges,201.6,63% of total billed charges,198.4,62% of total billed charges,201.6,63% of total billed charges,198.4,62% of total billed charges,256,80% of total billed charges,198.4,62% of total billed charges,198.4,62% of total billed charges,198.4,272,224
Outpatient Medical Services,SPEECH THERAPY,92526,SLP Swallow Dysfunction Oral Feed Units,440,199,159.2,80% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,169.15,85% of total billed charges,159.2,80% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,125.37,63% of total billed charges,123.38,62% of total billed charges,159.2,80% of total billed charges,123.38,62% of total billed charges,123.38,62% of total billed charges,123.38,169.15,139.3
Outpatient Medical Services,SPEECH THERAPY,92597,"SLP Use,Fit Speech Prosthetic Eval Units",444,226,180.8,80% of total billed charges,142.38,63% of total billed charges,140.12,62% of total billed charges,142.38,63% of total billed charges,192.1,85% of total billed charges,180.8,80% of total billed charges,140.12,62% of total billed charges,142.38,63% of total billed charges,140.12,62% of total billed charges,142.38,63% of total billed charges,140.12,62% of total billed charges,180.8,80% of total billed charges,140.12,62% of total billed charges,140.12,62% of total billed charges,140.12,192.1,158.2
Outpatient Medical Services,SPEECH THERAPY,92609,SLP Tx Generating Device Units,440,301,240.8,80% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,255.85,85% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,186.62,62% of total billed charges,186.62,255.85,210.7
Outpatient Medical Services,SPEECH THERAPY,92610,SLP Pharyngeal Swallow Eval Units,444,167,133.6,80% of total billed charges,105.21,63% of total billed charges,103.54,62% of total billed charges,105.21,63% of total billed charges,141.95,85% of total billed charges,133.6,80% of total billed charges,103.54,62% of total billed charges,105.21,63% of total billed charges,103.54,62% of total billed charges,105.21,63% of total billed charges,103.54,62% of total billed charges,133.6,80% of total billed charges,103.54,62% of total billed charges,103.54,62% of total billed charges,103.54,141.95,116.9
Outpatient Medical Services,SPEECH THERAPY,92612,SLP Fiberoptic Swallow Eval Units,444,611,488.8,80% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,519.35,85% of total billed charges,488.8,80% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,488.8,80% of total billed charges,378.82,62% of total billed charges,378.82,62% of total billed charges,378.82,519.35,427.7
Outpatient Medical Services,SPEECH THERAPY,96105,SLP Assessment of Aphasia Units,444,232,185.6,80% of total billed charges,146.16,63% of total billed charges,143.84,62% of total billed charges,146.16,63% of total billed charges,197.2,85% of total billed charges,185.6,80% of total billed charges,143.84,62% of total billed charges,146.16,63% of total billed charges,143.84,62% of total billed charges,146.16,63% of total billed charges,143.84,62% of total billed charges,185.6,80% of total billed charges,143.84,62% of total billed charges,143.84,62% of total billed charges,143.84,197.2,162.4
Outpatient Medical Services,SPEECH THERAPY,97129,"SLP Cog Ther Intervent,First 15Min Units",440,69,55.2,80% of total billed charges,43.47,63% of total billed charges,42.78,62% of total billed charges,43.47,63% of total billed charges,58.65,85% of total billed charges,55.2,80% of total billed charges,42.78,62% of total billed charges,43.47,63% of total billed charges,42.78,62% of total billed charges,43.47,63% of total billed charges,42.78,62% of total billed charges,55.2,80% of total billed charges,42.78,62% of total billed charges,42.78,62% of total billed charges,42.78,58.65,48.3
Outpatient Medical Services,SPEECH THERAPY,97130,"SLP Cog Ther Intervent, Addl 15Min Units",440,66,52.8,80% of total billed charges,41.58,63% of total billed charges,40.92,62% of total billed charges,41.58,63% of total billed charges,56.1,85% of total billed charges,52.8,80% of total billed charges,40.92,62% of total billed charges,41.58,63% of total billed charges,40.92,62% of total billed charges,41.58,63% of total billed charges,40.92,62% of total billed charges,52.8,80% of total billed charges,40.92,62% of total billed charges,40.92,62% of total billed charges,40.92,56.1,46.2
Outpatient Medical Services,SPEECH THERAPY,92612,92612 SLP FIBEROPTIC SWALLOW EVAL BY VIDEO CHARGE,444,611,488.8,80% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,519.35,85% of total billed charges,488.8,80% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,384.93,63% of total billed charges,378.82,62% of total billed charges,488.8,80% of total billed charges,378.82,62% of total billed charges,378.82,62% of total billed charges,378.82,519.35,427.7
Outpatient Medical Services,SPEECH THERAPY,96125,96125 SLP STANDARDIZED COGNITIVE EVAL CHARGE,440,305,244,80% of total billed charges,192.15,63% of total billed charges,189.1,62% of total billed charges,192.15,63% of total billed charges,259.25,85% of total billed charges,244,80% of total billed charges,189.1,62% of total billed charges,192.15,63% of total billed charges,189.1,62% of total billed charges,192.15,63% of total billed charges,189.1,62% of total billed charges,244,80% of total billed charges,189.1,62% of total billed charges,189.1,62% of total billed charges,189.1,259.25,213.5
Outpatient Medical Services,SPEECH THERAPY,97110,SP TH THER PROC EX/15MIN,440,73,58.4,80% of total billed charges,45.99,63% of total billed charges,45.26,62% of total billed charges,45.99,63% of total billed charges,62.05,85% of total billed charges,58.4,80% of total billed charges,45.26,62% of total billed charges,45.99,63% of total billed charges,45.26,62% of total billed charges,45.99,63% of total billed charges,45.26,62% of total billed charges,58.4,80% of total billed charges,45.26,62% of total billed charges,45.26,62% of total billed charges,45.26,62.05,51.1
Outpatient Medical Services,SPEECH THERAPY,97530,SP TH THER ACT 1 ON1/15MN,440,80,64,80% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,68,85% of total billed charges,64,80% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,50.4,63% of total billed charges,49.6,62% of total billed charges,64,80% of total billed charges,49.6,62% of total billed charges,49.6,62% of total billed charges,49.6,68,56
Outpatient Medical Services,WOUND CARE,10060,10060 Incision & Drainage Abscess (Simple),361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,10080,10080 Drainage of Pilonidal Cyst Simple Charge,510,1341,1072.8,80% of total billed charges,844.83,63% of total billed charges,188.14,pays based on per visit rate,844.83,63% of total billed charges,1139.85,85% of total billed charges,1072.8,80% of total billed charges,190.02,pays based on per visit rate,844.83,63% of total billed charges,188.14,pays based on per visit rate,844.83,63% of total billed charges,188.14,pays based on per visit rate,1072.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,1139.85,938.7
Outpatient Medical Services,WOUND CARE,10120,10120 Incision & removal of Foreign Body Simple Ch,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,10140,"10140 I&D hematoma, seroma, or fluid collection Ch",361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,10160,10160 Puncture Aspiration of Abscess Charge,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,10180,10180 I&D Post op Infection Charge,361,5415,4332,80% of total billed charges,3411.45,63% of total billed charges,3357.3,62% of total billed charges,3411.45,63% of total billed charges,4602.75,85% of total billed charges,4332,80% of total billed charges,3357.3,62% of total billed charges,3411.45,63% of total billed charges,3357.3,62% of total billed charges,3411.45,63% of total billed charges,3357.3,62% of total billed charges,4332,80% of total billed charges,3357.3,62% of total billed charges,3357.3,62% of total billed charges,3357.3,4602.75,3790.5
Outpatient Medical Services,WOUND CARE,11042,"11042 Debride, subq tissue - 1st 20 sq. cm Charge",361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,11043,"11043 Debride, muscle/fascia - 1st 20 sq. cm Charg",361,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,742.14,62% of total billed charges,742.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,11044,"11044 Debride, bone - 1st 20 sq. cm Charge",361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,11045,"11045 Debride, subq tissue -  each add'l 20 sq. cm",361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,11046,"11046 Debride, muscle/fascia - each add'l 20 sq. c",361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,11047,"11047 Debride, bone - each add'l 20 sq. cm Charge",361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,11055,11055 Trim Skin Lesion Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11056,11056 Trim 2-4 Lesions Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11057,11057 Trim > 4 Lesions Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11102,"11102 Tangential Biopsy of Skin, 1 lesion Charge",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11103,"11103 Tangential Biopsy of Skin, each additional l",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11104,11104 Punch Biopsy of Skin 1 Lesion Charge,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,11105,"11105 Punch Biospy of Skin, each additional lesion",361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,11106,"11106 Incisional Biopsy of Skin, 1 lesion Charge",361,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,742.14,62% of total billed charges,742.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,11107,"11107 Incisional Biopsy of Skin, Each additional l",361,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,742.14,62% of total billed charges,742.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,11719,11719 Trimming of Nondystrophic Nails Charge,361,117,93.6,80% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,99.45,85% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,72.54,62% of total billed charges,72.54,99.45,81.9
Outpatient Medical Services,WOUND CARE,11720,Debride Nail 1-5,361,117,93.6,80% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,99.45,85% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,72.54,62% of total billed charges,72.54,99.45,81.9
Outpatient Medical Services,WOUND CARE,11721,11721 Debride Nails >5 Charge,361,117,93.6,80% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,99.45,85% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,72.54,62% of total billed charges,72.54,99.45,81.9
Outpatient Medical Services,WOUND CARE,11730,11730 Remove Nail Plate Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11732,"11732 Remove Nail Plate, Additional Charge",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,11750,11750 Permanent Nail Removal Charge,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,15002,"15002 Surgical prep-trunk/arm/leg, 1st 100 sq cm C",361,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2780.8,80% of total billed charges,2155.12,62% of total billed charges,2155.12,62% of total billed charges,2155.12,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15004,15004 Surgical prep-face/hands/feet 1st 100 sq cm,361,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,754.11,63% of total billed charges,742.14,62% of total billed charges,957.6,80% of total billed charges,742.14,62% of total billed charges,742.14,62% of total billed charges,742.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,15271,"15271 Application high cost graft legs, 1st 25 sq.",510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15272,"15272 Application high cost graft legs, each add'l",361,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2189.88,63% of total billed charges,2155.12,62% of total billed charges,2780.8,80% of total billed charges,2155.12,62% of total billed charges,2155.12,62% of total billed charges,2155.12,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15273,"15273 Application high cost graft trunk/arm/legs,",510,6837,5469.6,80% of total billed charges,4307.31,63% of total billed charges,188.14,pays based on per visit rate,4307.31,63% of total billed charges,5811.45,85% of total billed charges,5469.6,80% of total billed charges,190.02,pays based on per visit rate,4307.31,63% of total billed charges,188.14,pays based on per visit rate,4307.31,63% of total billed charges,188.14,pays based on per visit rate,5469.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,5811.45,4785.9
Outpatient Medical Services,WOUND CARE,15274,"15274 Application high cost graft trunk/arm/legs,",510,6837,5469.6,80% of total billed charges,4307.31,63% of total billed charges,188.14,pays based on per visit rate,4307.31,63% of total billed charges,5811.45,85% of total billed charges,5469.6,80% of total billed charges,190.02,pays based on per visit rate,4307.31,63% of total billed charges,188.14,pays based on per visit rate,4307.31,63% of total billed charges,188.14,pays based on per visit rate,5469.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,5811.45,4785.9
Outpatient Medical Services,WOUND CARE,15275,"15275 Application high cost graft feet, 1st 25 sq.",510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15276,"15276 Application high cost graft feet, 1st 25 sq.",510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15277,15277 Application high cost graft not trunk/arm/le,510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,15278,15278 Application high cost graft not trunk/arm/le,510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,16000,"16000 Initial treatment, 1st degree burn(s) Charge",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,16020,"16020 Dsg and/or debride PT burns, int/sub small (",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,16025,"16025 Dsg and/or debride PT burns, int/sub medium",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,16030,"16030 Dsg and/or debride PT burns, int/sub large (",361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,17250,17250 Chemical Cauterization of Granulation Tissue,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,20220,"20220 Biopsy of Bone - superficial, needle Charge",361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,20225,"20225 Biopsy of Bone - deep, needle Charge",361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,20600,20600 Aspiration/Injection of Small Joint/Bursa Ch,361,565,452,80% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,480.25,85% of total billed charges,452,80% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,452,80% of total billed charges,350.3,62% of total billed charges,350.3,62% of total billed charges,350.3,480.25,395.5
Outpatient Medical Services,WOUND CARE,20605,20605 Aspiration/Injection intermediate joint/burs,361,565,452,80% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,480.25,85% of total billed charges,452,80% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,355.95,63% of total billed charges,350.3,62% of total billed charges,452,80% of total billed charges,350.3,62% of total billed charges,350.3,62% of total billed charges,350.3,480.25,395.5
Outpatient Medical Services,WOUND CARE,28001,28001 Level 3 I&D Dran Bursa Foot Charge,361,3090,2472,80% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,2626.5,85% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,1946.7,63% of total billed charges,1915.8,62% of total billed charges,2472,80% of total billed charges,1915.8,62% of total billed charges,1915.8,62% of total billed charges,1915.8,2626.5,2163
Outpatient Medical Services,WOUND CARE,28190,"28190 Removal of Foreign Body, SubQ Foot Charge",361,1341,1072.8,80% of total billed charges,844.83,63% of total billed charges,831.42,62% of total billed charges,844.83,63% of total billed charges,1139.85,85% of total billed charges,1072.8,80% of total billed charges,831.42,62% of total billed charges,844.83,63% of total billed charges,831.42,62% of total billed charges,844.83,63% of total billed charges,831.42,62% of total billed charges,1072.8,80% of total billed charges,831.42,62% of total billed charges,831.42,62% of total billed charges,831.42,1139.85,938.7
Outpatient Medical Services,WOUND CARE,29445,29445 Total Contact Cast Charge,361,512,409.6,80% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,435.2,85% of total billed charges,409.6,80% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,409.6,80% of total billed charges,317.44,62% of total billed charges,317.44,62% of total billed charges,317.44,435.2,358.4
Outpatient Medical Services,WOUND CARE,29515,29515 Application of Short Leg Cast Charge,361,301,240.8,80% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,255.85,85% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,186.62,62% of total billed charges,186.62,255.85,210.7
Outpatient Medical Services,WOUND CARE,29580,29580 Application of unna boot Charge,361,301,240.8,80% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,255.85,85% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,186.62,62% of total billed charges,186.62,255.85,210.7
Outpatient Medical Services,WOUND CARE,29581,"29581 Application of multilayer venous wnd comp, l",361,301,240.8,80% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,255.85,85% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,186.62,62% of total billed charges,186.62,255.85,210.7
Outpatient Medical Services,WOUND CARE,29581,"29581 Application of multilayer venous wnd comp, b",361,301,240.8,80% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,255.85,85% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,189.63,63% of total billed charges,186.62,62% of total billed charges,240.8,80% of total billed charges,186.62,62% of total billed charges,186.62,62% of total billed charges,186.62,255.85,210.7
Outpatient Medical Services,WOUND CARE,29700,29700 Removal of Gauntlet/Boot/Body Cast Charge,361,512,409.6,80% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,435.2,85% of total billed charges,409.6,80% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,322.56,63% of total billed charges,317.44,62% of total billed charges,409.6,80% of total billed charges,317.44,62% of total billed charges,317.44,62% of total billed charges,317.44,435.2,358.4
Outpatient Medical Services,WOUND CARE,97597,"97597 Debride, devitalized tissue, dermis, and/or",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,97598,"97598 Debride, devitalized tissue, dermis, and/or",361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,97602,97602 Non-Selective Wound Care Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,97605,97605 NPWT < 50 sq. cm (wound vac) Charge,361,382,305.6,80% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,324.7,85% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,240.66,63% of total billed charges,236.84,62% of total billed charges,305.6,80% of total billed charges,236.84,62% of total billed charges,236.84,62% of total billed charges,236.84,324.7,267.4
Outpatient Medical Services,WOUND CARE,97606,97606 NPWT > 50 sq. cm (wound vac) Charge,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,97607,97607 NPWT <50 sq cm disposable Charge,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,99202,99202 New patient visit level 2 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99203,99203 New patient visit level 3 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99204,99204 New patient visit level 4 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99205,99205 New patient visit level 5 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99211,99211 Established patient visit level 1 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99212,99212 Established patient visit level 2 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99213,99213 Established patient visit level 3 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99214,99214 Established patient visit level 4 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,99215,99215 Established patient visit level 5 Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,10061,10061 Incision & Drainage Complicated/Multiple Cha,361,760,608,80% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,646,85% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,478.8,63% of total billed charges,471.2,62% of total billed charges,608,80% of total billed charges,471.2,62% of total billed charges,471.2,62% of total billed charges,471.2,646,532
Outpatient Medical Services,WOUND CARE,G0127,G0127 Trimming of Nondystrophic Nails Charge,361,117,93.6,80% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,99.45,85% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,72.54,62% of total billed charges,72.54,99.45,81.9
Outpatient Medical Services,WOUND CARE,G0127,G0127 Trimming of Dystrophic Nails Charge,361,117,93.6,80% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,99.45,85% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,73.71,63% of total billed charges,72.54,62% of total billed charges,93.6,80% of total billed charges,72.54,62% of total billed charges,72.54,62% of total billed charges,72.54,99.45,81.9
Outpatient Medical Services,WOUND CARE,G0463,G0463 Hospital Outpatient Clinic Visit. Charge,361,252,201.6,80% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,214.2,85% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,158.76,63% of total billed charges,156.24,62% of total billed charges,201.6,80% of total billed charges,156.24,62% of total billed charges,156.24,62% of total billed charges,156.24,214.2,176.4
Outpatient Medical Services,WOUND CARE,C5271,"C5271 Application low cost graft legs, 1st 25 sq.",510,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,190.02,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,957.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,C5272,"C5272 Application low cost graft legs, each add'l",510,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,190.02,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,957.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,1017.45,837.9
Outpatient Medical Services,WOUND CARE,C5273,"C5273 Application low cost graft trunk/arm/legs, 1",510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,C5274,"C5274 Application low cost graft trunk/arm/legs, e",510,3476,2780.8,80% of total billed charges,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,2954.6,85% of total billed charges,2780.8,80% of total billed charges,190.02,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2189.88,63% of total billed charges,188.14,pays based on per visit rate,2780.8,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,2954.6,2433.2
Outpatient Medical Services,WOUND CARE,C5275,"C5275 Application low cost graft feet, 1st 25 sq.",510,1197,957.6,80% of total billed charges,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,1017.45,85% of total billed charges,957.6,80% of total billed charges,190.02,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,754.11,63% of total billed charges,188.14,pays based on per visit rate,957.6,80% of total billed charges,188.14,pays based on per visit rate,188.14,pays based on per visit rate,188.14,1017.45,837.9