hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WV,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Mon Health Medical Center,11/1/2025,2.0.0,Mon Health Medical Center,"1200 J D Anderson Dr Morgantown, WV 26505",35,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION TYPE,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,ACPN PLAN,ACPN REIMBURSEMENT METHOD,ACPN MEDICARE ADVANTAGE PLAN,ACPN MEDICARE ADVANTAGE REIMBURSEMENT METHOD,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,GATEWAY HEALTH PLAN,GATEWAY HEALTH REIMBURSEMENT METHOD,GEHA PLAN,GEHA REIMBURSEMENT METHOD,GEHA MEDICARE PLAN,GEHA MEDICARE REIMBURSEMENT METHOD,HEALTH PAYORS ORGANIZATION PLAN,HEALTH PAYORS ORGANIZATION REIMBURSEMENT METHOD,HEALTH SOUTH MOUNTAIN VIEW PLAN,HEALTH SOUTH MOUNTAIN VIEW REIMBURSEMENT METHOD,HIGHMARK BCBS ACA PLAN,HIGHMARK BCBS ACA REIMBURSEMENT METHOD,HIGHMARK BCBS MEDICARE PLAN,HIGHMARK BCBS MEDICARE REIMBURSEMENT METHOD,HIGHMARK BCBS PPO POS FEP PLAN,HIGHMARK BCBS PPO POS FEP REIMBURSEMENT METHOD,HIGHMARK BCBS TRADITIONAL PLAN,HIGHMARK BCBS TRADITIONAL REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,HUMANA MEDICARE PLAN,HUMANA MEDICARE REIMBURSEMENT METHOD,MARYLAND PHYSICIANS CARE PLAN,MARYLAND PHYSICIANS CARE REIMBURSEMENT METHOD,MON COUNTY COMMISSION PLAN,MON COUNTY COMMISSION REIMBURSEMENT METHOD,MULTI PLAN PHCS PLAN,MULTI PLAN PHCS REIMBURSEMENT METHOD,MUTUAL OF OMAHA PLAN,MUTUAL OF OMAHA REIMBURSEMENT METHOD,PARAMOUNT ELITE PLAN,PARAMOUNT ELITE REIMBURSEMENT METHOD,SEVEN CORNERS PLAN,SEVEN CORNERS REIMBURSEMENT METHOD,THE HEALTH  PLAN PLAN,THE HEALTH  PLAN REIMBURSEMENT METHOD,THE HEALTH  PLAN MURRAY ENERGY COMMERCIAL ASO PLAN,THE HEALTH  PLAN MURRAY ENERGY COMMERCIAL ASO REIMBURSEMENT METHOD,THE HEALTH  PLAN PEIA PLAN,THE HEALTH  PLAN PEIA REIMBURSEMENT METHOD,THREE RIVERS PLAN,THREE RIVERS REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,UHC ONENET PPO PLAN,UHC ONENET PPO REIMBURSEMENT METHOD,UHC OPTIONS PPO PLAN,UHC OPTIONS PPO REIMBURSEMENT METHOD,UHC VA PLAN,UHC VA REIMBURSEMENT METHOD,UMWA PLAN,UMWA REIMBURSEMENT METHOD,UNISON PLAN,UNISON REIMBURSEMENT METHOD,UPMC PLAN,UPMC REIMBURSEMENT METHOD,UPMC MEDICARE PLAN,UPMC MEDICARE REIMBURSEMENT METHOD,ZELIS GROUP HEALTH PLAN,ZELIS GROUP HEALTH REIMBURSEMENT METHOD,ZELIS OTHER PLAN,ZELIS OTHER REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,LAB,36415,COLLECTION: Venous Draw,300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,Kit Collection-Venous Blood Draw,300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,RI INF Venipuncture,300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,COLLECTION VENOUS DRAW (HIDDEN),300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,COLLECTION VENOUS BLOOD VENIPUNCTURE,450,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,Number of Straight Stick Attempts -> 2,450,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,Number of Straight Stick Attempts -> 1,450,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,Natera NIPT,300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36415,Regional Eye Autologous Serum,300,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,38.32,80% of total billed charges,9.09,100% of CMS fee schedule,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,44.07,92% of total billed charges,9.09,100% of CMS fee schedule,35.82, 405.66% of CMS fee schedule,9.09,100% of CMS fee schedule,43.64,494.23% of CMS fee schedule,40.48, 458.54% of CMS fee schedule,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,9.09,100% of CMS fee schedule,17.66,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,3.33,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,46.46,97% of total billed charges,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,7.72,85% of CMS fee schedule,3.33,46.46,23.95
Outpatient Medical Services,LAB,36416,COLLECTION: Capillary,300,21.65,19.49,90% of total billed charges,N/A,not seperately reimbursable,17.32,80% of total billed charges,N/A,not seperately reimbursable,19.49,90% of total billed charges,N/A,not seperately reimbursable,21,97% of total billed charges,N/A,not seperately reimbursable,19.92,92% of total billed charges,N/A,not seperately reimbursable,13.83,63.86% of total billed charges,N/A,not seperately reimbursable,17.03, 78.65% of total billed charges,19.34,89.33% of total billed charges,19.49,90% of total billed charges,N/A,not seperately reimbursable,15.16,70% of total billed charges,19.49,90% of total billed charges,20.57,95% of total billed charges,20.57,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18.62,86% of total billed charges,17.32,80% of total billed charges,N/A,not seperately reimbursable,21,97% of total billed charges,19.49,90% of total billed charges,N/A,not seperately reimbursable,21,97% of total billed charges,20.13,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13.83,21,10.83
Outpatient Medical Services,LAB,36430,BB Administration Charge,391,2623.08,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,2098.46,80% of total billed charges,415.8,100% of CMS IPPS rate,2360.77,90% of total billed charges,30.62,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,2413.23,92% of total billed charges,415.8,100% of CMS IPPS rate,998.55,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,1591.9,100% of CMS IPPS rate,2016.4,100% of CMS IPPS rate,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,1836.16,70% of total billed charges,2360.77,90% of total billed charges,2491.93,95% of total billed charges,2491.93,95% of total billed charges,415.8,100% of CMS IPPS rate,751.33,100% of CMS IPPS rate,2255.85,86% of total billed charges,2098.46,80% of total billed charges,401.18,100% of CMS IPPS rate,2544.39,97% of total billed charges,2360.77,90% of total billed charges,N/A,not seperately reimbursable,2544.39,97% of total billed charges,2439.46,93% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,27.84,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,353.42,100% of CMS IPPS rate,27.84,2544.39,1311.54
Outpatient Medical Services,LAB,36430,"RI INF Blood Transfusion -> TRANSFUSION, > 4 HOURS",940,2623.08,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,2098.46,80% of total billed charges,415.8,100% of CMS IPPS rate,2360.77,90% of total billed charges,30.62,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,2413.23,92% of total billed charges,415.8,100% of CMS IPPS rate,998.55,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,1591.9,100% of CMS IPPS rate,2016.4,100% of CMS IPPS rate,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,1836.16,70% of total billed charges,2360.77,90% of total billed charges,2491.93,95% of total billed charges,2491.93,95% of total billed charges,415.8,100% of CMS IPPS rate,751.33,100% of CMS IPPS rate,2255.85,86% of total billed charges,2098.46,80% of total billed charges,401.18,100% of CMS IPPS rate,2544.39,97% of total billed charges,2360.77,90% of total billed charges,N/A,not seperately reimbursable,2544.39,97% of total billed charges,2439.46,93% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,27.84,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,353.42,100% of CMS IPPS rate,27.84,2544.39,1311.54
Outpatient Medical Services,LAB,36430,"RI INF Blood Transfusion -> TRANSFUSION, <4 HOURS",940,2623.08,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,2098.46,80% of total billed charges,415.8,100% of CMS IPPS rate,2360.77,90% of total billed charges,30.62,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,2413.23,92% of total billed charges,415.8,100% of CMS IPPS rate,998.55,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,1591.9,100% of CMS IPPS rate,2016.4,100% of CMS IPPS rate,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,1836.16,70% of total billed charges,2360.77,90% of total billed charges,2491.93,95% of total billed charges,2491.93,95% of total billed charges,415.8,100% of CMS IPPS rate,751.33,100% of CMS IPPS rate,2255.85,86% of total billed charges,2098.46,80% of total billed charges,401.18,100% of CMS IPPS rate,2544.39,97% of total billed charges,2360.77,90% of total billed charges,N/A,not seperately reimbursable,2544.39,97% of total billed charges,2439.46,93% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,27.84,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,353.42,100% of CMS IPPS rate,27.84,2544.39,1311.54
Outpatient Medical Services,LAB,36430,36430 - TRANSFUSION BLD/BLD COMPONENTS,391,2623.08,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,2098.46,80% of total billed charges,415.8,100% of CMS IPPS rate,2360.77,90% of total billed charges,30.62,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,2413.23,92% of total billed charges,415.8,100% of CMS IPPS rate,998.55,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,1591.9,100% of CMS IPPS rate,2016.4,100% of CMS IPPS rate,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,1836.16,70% of total billed charges,2360.77,90% of total billed charges,2491.93,95% of total billed charges,2491.93,95% of total billed charges,415.8,100% of CMS IPPS rate,751.33,100% of CMS IPPS rate,2255.85,86% of total billed charges,2098.46,80% of total billed charges,401.18,100% of CMS IPPS rate,2544.39,97% of total billed charges,2360.77,90% of total billed charges,N/A,not seperately reimbursable,2544.39,97% of total billed charges,2439.46,93% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,27.84,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,353.42,100% of CMS IPPS rate,27.84,2544.39,1311.54
Outpatient Medical Services,LAB,36430,TRANSFUSION BLOOD/BLOOD COMPONENTS,450,2623.08,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,2098.46,80% of total billed charges,415.8,100% of CMS IPPS rate,2360.77,90% of total billed charges,30.62,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,2413.23,92% of total billed charges,415.8,100% of CMS IPPS rate,998.55,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,1591.9,100% of CMS IPPS rate,2016.4,100% of CMS IPPS rate,2360.77,90% of total billed charges,415.8,100% of CMS IPPS rate,1836.16,70% of total billed charges,2360.77,90% of total billed charges,2491.93,95% of total billed charges,2491.93,95% of total billed charges,415.8,100% of CMS IPPS rate,751.33,100% of CMS IPPS rate,2255.85,86% of total billed charges,2098.46,80% of total billed charges,401.18,100% of CMS IPPS rate,2544.39,97% of total billed charges,2360.77,90% of total billed charges,N/A,not seperately reimbursable,2544.39,97% of total billed charges,2439.46,93% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,27.84,100% of CMS fee schedule,2544.39,97% of total billed charges,415.8,100% of CMS IPPS rate,415.8,100% of CMS IPPS rate,353.42,100% of CMS IPPS rate,27.84,2544.39,1311.54
Outpatient Medical Services,LAB,36600,ABG Puncture Charge,300,660.28,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,528.22,80% of total billed charges,122.59,100% of CMS IPPS rate,594.25,90% of total billed charges,14.3,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,607.46,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,462.2,70% of total billed charges,594.25,90% of total billed charges,627.27,95% of total billed charges,627.27,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,567.84,86% of total billed charges,528.22,80% of total billed charges,112.72,100% of CMS IPPS rate,640.47,97% of total billed charges,594.25,90% of total billed charges,N/A,not seperately reimbursable,640.47,97% of total billed charges,614.06,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,13,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,13,640.47,330.14
Outpatient Medical Services,LAB,36600,COLLECTION: Arterial Draw,300,660.28,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,528.22,80% of total billed charges,122.59,100% of CMS IPPS rate,594.25,90% of total billed charges,14.3,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,607.46,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,462.2,70% of total billed charges,594.25,90% of total billed charges,627.27,95% of total billed charges,627.27,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,567.84,86% of total billed charges,528.22,80% of total billed charges,112.72,100% of CMS IPPS rate,640.47,97% of total billed charges,594.25,90% of total billed charges,N/A,not seperately reimbursable,640.47,97% of total billed charges,614.06,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,13,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,13,640.47,330.14
Outpatient Medical Services,LAB,36600,ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,450,660.28,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,528.22,80% of total billed charges,122.59,100% of CMS IPPS rate,594.25,90% of total billed charges,14.3,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,607.46,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,594.25,90% of total billed charges,122.59,100% of CMS IPPS rate,462.2,70% of total billed charges,594.25,90% of total billed charges,627.27,95% of total billed charges,627.27,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,567.84,86% of total billed charges,528.22,80% of total billed charges,112.72,100% of CMS IPPS rate,640.47,97% of total billed charges,594.25,90% of total billed charges,N/A,not seperately reimbursable,640.47,97% of total billed charges,614.06,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,13,100% of CMS fee schedule,640.47,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,13,640.47,330.14
Outpatient Medical Services,OUTPATIENT SERVICES,43235,ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,450,5625.36,5062.82,90% of total billed charges,891.71,100% of CMS IPPS rate,4500.29,80% of total billed charges,891.71,100% of CMS IPPS rate,5062.82,90% of total billed charges,137.74,100% of CMS fee schedule,5456.6,97% of total billed charges,891.71,100% of CMS IPPS rate,5175.33,92% of total billed charges,891.71,100% of CMS IPPS rate,2085.17,100% of CMS IPPS rate,891.71,100% of CMS IPPS rate,3324.19,100% of CMS IPPS rate,4210.59,100% of CMS IPPS rate,5062.82,90% of total billed charges,891.71,100% of CMS IPPS rate,3937.75,70% of total billed charges,5062.82,90% of total billed charges,5344.09,95% of total billed charges,5344.09,95% of total billed charges,891.71,100% of CMS IPPS rate,1568.91,100% of CMS IPPS rate,4837.81,86% of total billed charges,4500.29,80% of total billed charges,812.54,100% of CMS IPPS rate,5456.6,97% of total billed charges,5062.82,90% of total billed charges,N/A,not seperately reimbursable,5456.6,97% of total billed charges,5231.58,93% of total billed charges,891.71,100% of CMS IPPS rate,891.71,100% of CMS IPPS rate,125.22,100% of CMS fee schedule,5456.6,97% of total billed charges,891.71,100% of CMS IPPS rate,891.71,100% of CMS IPPS rate,757.95,100% of CMS IPPS rate,125.22,5456.6,2812.68
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Gastrointestinal Procedures: -> Colonoscopy w/o biopsy,761,5470.26,4923.23,90% of total billed charges,867.12,100% of CMS IPPS rate,4376.21,80% of total billed charges,867.12,100% of CMS IPPS rate,4923.23,90% of total billed charges,198.55,100% of CMS fee schedule,5306.15,97% of total billed charges,867.12,100% of CMS IPPS rate,5032.64,92% of total billed charges,867.12,100% of CMS IPPS rate,2102.35,100% of CMS IPPS rate,867.12,100% of CMS IPPS rate,3351.59,100% of CMS IPPS rate,4245.3,100% of CMS IPPS rate,4923.23,90% of total billed charges,867.12,100% of CMS IPPS rate,3829.18,70% of total billed charges,4923.23,90% of total billed charges,5196.75,95% of total billed charges,5196.75,95% of total billed charges,867.12,100% of CMS IPPS rate,1581.84,100% of CMS IPPS rate,4704.42,86% of total billed charges,4376.21,80% of total billed charges,789.75,100% of CMS IPPS rate,5306.15,97% of total billed charges,4923.23,90% of total billed charges,N/A,not seperately reimbursable,5306.15,97% of total billed charges,5087.34,93% of total billed charges,867.12,100% of CMS IPPS rate,867.12,100% of CMS IPPS rate,180.5,100% of CMS fee schedule,5306.15,97% of total billed charges,867.12,100% of CMS IPPS rate,867.12,100% of CMS IPPS rate,737.05,100% of CMS IPPS rate,180.5,5306.15,2735.13
Outpatient Medical Services,AMBULATORY SURGERY,45380,45380 - Colonoscopy and biopsy,360,7074.48,6367.03,90% of total billed charges,1121.42,100% of CMS IPPS rate,5659.58,80% of total billed charges,1121.42,100% of CMS IPPS rate,6367.03,90% of total billed charges,247.96,100% of CMS fee schedule,6862.25,97% of total billed charges,1121.42,100% of CMS IPPS rate,6508.52,92% of total billed charges,1121.42,100% of CMS IPPS rate,2714.49,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,4327.46,100% of CMS IPPS rate,5481.39,100% of CMS IPPS rate,6367.03,90% of total billed charges,1121.42,100% of CMS IPPS rate,4952.14,70% of total billed charges,6367.03,90% of total billed charges,6720.76,95% of total billed charges,6720.76,95% of total billed charges,1121.42,100% of CMS IPPS rate,2042.41,100% of CMS IPPS rate,6084.05,86% of total billed charges,5659.58,80% of total billed charges,1038.23,100% of CMS IPPS rate,6862.25,97% of total billed charges,6367.03,90% of total billed charges,N/A,not seperately reimbursable,6862.25,97% of total billed charges,6579.27,93% of total billed charges,1121.42,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,225.42,100% of CMS fee schedule,6862.25,97% of total billed charges,1121.42,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,953.2,100% of CMS IPPS rate,225.42,6862.25,3537.24
Outpatient Medical Services,AMBULATORY SURGERY,45380,Gastrointestinal Procedures: -> Colonoscopy w/biopsy (single or multiple),761,7074.48,6367.03,90% of total billed charges,1121.42,100% of CMS IPPS rate,5659.58,80% of total billed charges,1121.42,100% of CMS IPPS rate,6367.03,90% of total billed charges,247.96,100% of CMS fee schedule,6862.25,97% of total billed charges,1121.42,100% of CMS IPPS rate,6508.52,92% of total billed charges,1121.42,100% of CMS IPPS rate,2714.49,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,4327.46,100% of CMS IPPS rate,5481.39,100% of CMS IPPS rate,6367.03,90% of total billed charges,1121.42,100% of CMS IPPS rate,4952.14,70% of total billed charges,6367.03,90% of total billed charges,6720.76,95% of total billed charges,6720.76,95% of total billed charges,1121.42,100% of CMS IPPS rate,2042.41,100% of CMS IPPS rate,6084.05,86% of total billed charges,5659.58,80% of total billed charges,1038.23,100% of CMS IPPS rate,6862.25,97% of total billed charges,6367.03,90% of total billed charges,N/A,not seperately reimbursable,6862.25,97% of total billed charges,6579.27,93% of total billed charges,1121.42,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,225.42,100% of CMS fee schedule,6862.25,97% of total billed charges,1121.42,100% of CMS IPPS rate,1121.42,100% of CMS IPPS rate,953.2,100% of CMS IPPS rate,225.42,6862.25,3537.24
Outpatient Medical Services,AMBULATORY SURGERY,55700,US add Needle Bx Prostate,320,12291.06,11061.95,90% of total billed charges,N/A,not seperately reimbursable,9832.85,80% of total billed charges,N/A,not seperately reimbursable,11061.95,90% of total billed charges,98.45,100% of CMS fee schedule,11922.33,97% of total billed charges,N/A,not seperately reimbursable,11307.78,92% of total billed charges,N/A,not seperately reimbursable,4685.25,100% of CMS IPPS rate,N/A,not seperately reimbursable,7469.27,100% of CMS IPPS rate,9460.95,100% of CMS IPPS rate,11061.95,90% of total billed charges,N/A,not seperately reimbursable,8603.74,70% of total billed charges,11061.95,90% of total billed charges,11676.51,95% of total billed charges,11676.51,95% of total billed charges,N/A,not seperately reimbursable,3525.24,100% of CMS IPPS rate,10570.31,86% of total billed charges,9832.85,80% of total billed charges,1831.56,100% of CMS IPPS rate,11922.33,97% of total billed charges,11061.95,90% of total billed charges,N/A,not seperately reimbursable,11922.33,97% of total billed charges,11430.69,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,100% of CMS fee schedule,11922.33,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,11922.33,6145.53
Outpatient Medical Services,AMBULATORY SURGERY,55700,55700- Bx/prostate/needle/punch/sng/mul,510,12291.06,11061.95,90% of total billed charges,N/A,not seperately reimbursable,9832.85,80% of total billed charges,N/A,not seperately reimbursable,11061.95,90% of total billed charges,98.45,100% of CMS fee schedule,11922.33,97% of total billed charges,N/A,not seperately reimbursable,11307.78,92% of total billed charges,N/A,not seperately reimbursable,4685.25,100% of CMS IPPS rate,N/A,not seperately reimbursable,7469.27,100% of CMS IPPS rate,9460.95,100% of CMS IPPS rate,11061.95,90% of total billed charges,N/A,not seperately reimbursable,8603.74,70% of total billed charges,11061.95,90% of total billed charges,11676.51,95% of total billed charges,11676.51,95% of total billed charges,N/A,not seperately reimbursable,3525.24,100% of CMS IPPS rate,10570.31,86% of total billed charges,9832.85,80% of total billed charges,1831.56,100% of CMS IPPS rate,11922.33,97% of total billed charges,11061.95,90% of total billed charges,N/A,not seperately reimbursable,11922.33,97% of total billed charges,11430.69,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,100% of CMS fee schedule,11922.33,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,11922.33,6145.53
Outpatient Medical Services,AMBULATORY SURGERY,62322,INJECT SPINE LUMBAR/SACRAL,360,5341.74,4807.57,90% of total billed charges,846.75,100% of CMS IPPS rate,4273.39,80% of total billed charges,846.75,100% of CMS IPPS rate,4807.57,90% of total billed charges,78.27,100% of CMS fee schedule,5181.49,97% of total billed charges,846.75,100% of CMS IPPS rate,4914.4,92% of total billed charges,846.75,100% of CMS IPPS rate,2096.66,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,3342.51,100% of CMS IPPS rate,4233.8,100% of CMS IPPS rate,4807.57,90% of total billed charges,846.75,100% of CMS IPPS rate,3739.22,70% of total billed charges,4807.57,90% of total billed charges,5074.65,95% of total billed charges,5074.65,95% of total billed charges,846.75,100% of CMS IPPS rate,1577.55,100% of CMS IPPS rate,4593.9,86% of total billed charges,4273.39,80% of total billed charges,646.21,100% of CMS IPPS rate,5181.49,97% of total billed charges,4807.57,90% of total billed charges,N/A,not seperately reimbursable,5181.49,97% of total billed charges,4967.82,93% of total billed charges,846.75,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,71.15,100% of CMS fee schedule,5181.49,97% of total billed charges,846.75,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,719.73,100% of CMS IPPS rate,71.15,5181.49,2670.87
Outpatient Medical Services,AMBULATORY SURGERY,64483,General Diagnostic Exam,360,5341.74,4807.57,90% of total billed charges,846.75,100% of CMS IPPS rate,4273.39,80% of total billed charges,846.75,100% of CMS IPPS rate,4807.57,90% of total billed charges,104.54,100% of CMS fee schedule,5181.49,97% of total billed charges,846.75,100% of CMS IPPS rate,4914.4,92% of total billed charges,846.75,100% of CMS IPPS rate,2096.66,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,3342.51,100% of CMS IPPS rate,4233.8,100% of CMS IPPS rate,4807.57,90% of total billed charges,846.75,100% of CMS IPPS rate,3739.22,70% of total billed charges,4807.57,90% of total billed charges,5074.65,95% of total billed charges,5074.65,95% of total billed charges,846.75,100% of CMS IPPS rate,1577.55,100% of CMS IPPS rate,4593.9,86% of total billed charges,4273.39,80% of total billed charges,839.55,100% of CMS IPPS rate,5181.49,97% of total billed charges,4807.57,90% of total billed charges,N/A,not seperately reimbursable,5181.49,97% of total billed charges,4967.82,93% of total billed charges,846.75,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,95.04,100% of CMS fee schedule,5181.49,97% of total billed charges,846.75,100% of CMS IPPS rate,846.75,100% of CMS IPPS rate,719.73,100% of CMS IPPS rate,95.04,5181.49,2670.87
Outpatient Medical Services,OUTPATIENT SERVICES,66821,66821- Cataract/secondar/discission/laser,510,3291.6,2962.44,90% of total billed charges,521.77,100% of CMS IPPS rate,2633.28,80% of total billed charges,521.77,100% of CMS IPPS rate,2962.44,90% of total billed charges,238.16,100% of CMS fee schedule,3192.85,97% of total billed charges,521.77,100% of CMS IPPS rate,3028.27,92% of total billed charges,521.77,100% of CMS IPPS rate,1337.08,100% of CMS IPPS rate,521.77,100% of CMS IPPS rate,2131.59,100% of CMS IPPS rate,2699.98,100% of CMS IPPS rate,2962.44,90% of total billed charges,521.77,100% of CMS IPPS rate,2304.12,70% of total billed charges,2962.44,90% of total billed charges,3127.02,95% of total billed charges,3127.02,95% of total billed charges,521.77,100% of CMS IPPS rate,1006.04,100% of CMS IPPS rate,2830.78,86% of total billed charges,2633.28,80% of total billed charges,524.1,100% of CMS IPPS rate,3192.85,97% of total billed charges,2962.44,90% of total billed charges,N/A,not seperately reimbursable,3192.85,97% of total billed charges,3061.19,93% of total billed charges,521.77,100% of CMS IPPS rate,521.77,100% of CMS IPPS rate,216.51,100% of CMS fee schedule,3192.85,97% of total billed charges,521.77,100% of CMS IPPS rate,521.77,100% of CMS IPPS rate,443.5,100% of CMS IPPS rate,216.51,3192.85,1645.80
Outpatient Medical Services,OUTPATIENT SERVICES,66984,66984- Extracaps catarac rmv/w lens prost,510,13684.38,12315.94,90% of total billed charges,N/A,not seperately reimbursable,10947.5,80% of total billed charges,N/A,not seperately reimbursable,12315.94,90% of total billed charges,662.78,100% of CMS fee schedule,13273.85,97% of total billed charges,N/A,not seperately reimbursable,12589.63,92% of total billed charges,N/A,not seperately reimbursable,5360.5,100% of CMS IPPS rate,N/A,not seperately reimbursable,8545.75,100% of CMS IPPS rate,10824.48,100% of CMS IPPS rate,12315.94,90% of total billed charges,N/A,not seperately reimbursable,9579.07,70% of total billed charges,12315.94,90% of total billed charges,13000.16,95% of total billed charges,13000.16,95% of total billed charges,N/A,not seperately reimbursable,4033.31,100% of CMS IPPS rate,11768.57,86% of total billed charges,10947.5,80% of total billed charges,2090.34,100% of CMS IPPS rate,13273.85,97% of total billed charges,12315.94,90% of total billed charges,N/A,not seperately reimbursable,13273.85,97% of total billed charges,12726.47,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,602.53,100% of CMS fee schedule,13273.85,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,602.53,13273.85,6842.19
Outpatient Medical Services,EMERGENCY ROOM,69209,Remove Impacted Ear Wax Uni,450,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,N/A,not seperately reimbursable,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,48.02,345.71,178.20
Outpatient Medical Services,EMERGENCY ROOM,69209,69209- Ear Irrigation,450,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,N/A,not seperately reimbursable,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,48.02,345.71,178.20
Outpatient Medical Services,RADIOLOGY,70220,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,55.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,24.75,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,22.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,70360,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,70450,Computerized Tomography Exam,351,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,153.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,85.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,77.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,77.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70450,CT Head UN,351,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,153.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,85.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,77.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,77.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70450,Computerized Tomography Exam,351,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,153.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,85.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,77.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,77.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70460,Computerized Tomography Exam,351,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,224.33,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,88,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,80,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,80,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70460,CT Head ENH,351,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,224.33,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,88,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,80,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,80,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70470,CT Head UN and ENH,351,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,268.53,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,110,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,100,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,100,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70470,Computerized Tomography Exam,351,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,268.53,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,110,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,100,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,100,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70486,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,202.6,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,85.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,77.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,77.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70487,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,233.33,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,88,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,80,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,80,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70490,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70490,CT Neck Soft Tissue UN,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79,618.9,319.02
Outpatient Medical Services,RADIOLOGY,70491,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,280.5,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70491,CT Neck Soft Tissue Routine ENH,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,280.5,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70496,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70496,CTA Head,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70496,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70498,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70498,CTA Neck Soft Tissue ENH,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70498,CT Angiography Neck,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,220.22,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,200.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,70553,Magnetic Resonance Imaging Exam,611,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,540.03,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,295.9,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,269,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,269,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,70553,Magnetic Resonance Imaging Exam,611,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,540.03,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,295.9,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,269,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,269,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,71045,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,DR Portable Chest,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,DR Post PICC Line Chest,510,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,DR Chest single view AP or PA,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71045,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,8.92,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,8.11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,8.11,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,General Diagnostic Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,WW DR Exam,324,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71046,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,16.34,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.5,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.85,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.85,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71100,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71100,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71101,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,54.3,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,18.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,16.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71101,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,54.3,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,18.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,16.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71111,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,68.55,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,18.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,16.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71120,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,CT Chest UN,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,CT Chest Hi Resolution,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71250,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,210.85,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,71260,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71260,CT Chest Routine ENH,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71260,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71260,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71260,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71260,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,282,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,96.25,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,87.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,87.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71275,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,238.48,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,216.8,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71275,CTA Chest,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,238.48,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,216.8,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71275,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,238.48,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,216.8,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,71275,CT Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,238.48,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,216.8,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,72040,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,53.55,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,72050,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,73.03,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,29.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,26.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,26.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72050,WW DR Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,73.03,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,29.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,26.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,26.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72050,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,73.03,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,29.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,26.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,26.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72070,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,22.21,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,20.19,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,20.19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72072,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,53.55,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,23.65,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,21.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,21.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72072,WW DR Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,53.55,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,23.65,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,21.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,21.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72100,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,53.55,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.75,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72100,DR Lumbar Spine 2-3 Views,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,53.55,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.75,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72110,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,74.53,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.75,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72110,WW DR Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,74.53,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.75,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72110,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,74.53,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.75,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72125,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,91.41,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,83.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,83.1,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72126,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,349.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,103.4,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,94,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,94,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,72128,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,99.66,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,90.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,85.96,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72131,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,96.91,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,88.1,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,85.96,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72148,Magnetic Resonance Imaging Exam,612,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,308.2,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,205.92,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,187.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,187.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,72170,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72170,72170-PELVIS AP,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72170,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72192,CT Pelvis UN,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,191.38,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,74.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,67.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,67.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72192,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,191.38,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,74.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,67.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,67.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72192,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,191.38,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,74.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,67.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,67.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72192,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,191.38,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,74.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,67.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,67.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,72193,CT Pelvis Routine ENH,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,369.63,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,95.15,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,86.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,86.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,72193,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,369.63,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,95.15,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,86.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,86.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,72193,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,369.63,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,95.15,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,86.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,86.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,72220,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73000,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73000,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73000,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73000,DR Clavicle Rt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73000,DR Clavicle Lt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73020,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.96,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.51,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.51,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73020,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,33.35,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.96,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,14.51,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,14.51,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73030,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73030,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73030,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73030,DR Shoulder Lt Routine min 2 views,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73030,DR Shoulder Rt Routine min 2 views,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73060,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73060,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73060,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73060,DR Lt Humerus,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73060,DR Rt Humerus,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73070,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73070,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73070,DR Elbow Lt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73070,DR Elbow Rt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73070,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,DR Elbow Lt AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,DR Elbow Rt AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73080,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,44.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73090,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,41.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73090,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,41.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73090,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,41.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73090,DR Forearm Lt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,41.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73090,DR Forearm Rt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,41.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73100,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73100,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73100,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73100,DR Wrist Lt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73100,DR Wrist Rt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,49.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73110,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73110,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73110,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73110,DR Wrist Lt Routine  AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73110,DR Wrist Rt Routine AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73120,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73120,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73120,DR Hand Rt PA and Lat,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73120,DR Hand Lt PA and Lat,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73120,DR Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,43.83,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,11,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,10,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,10,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73130,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73130,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73130,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73130,DR Hand Lt PA Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73130,DR Hand Rt PA Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73140,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,56.55,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,9.9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,9,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73140,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,56.55,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,9.9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,9,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73140,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,56.55,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,9.9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,9,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73200,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73201,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,346.4,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,90.75,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,82.5,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,73502,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,67.05,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,24.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,22.36,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,22.36,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73502,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,67.05,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,24.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,22.36,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,22.36,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73502,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,67.05,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,24.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,22.36,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,22.36,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73502,DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,67.05,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,24.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,22.36,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,22.36,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73521,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,57.3,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,22.85,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,20.77,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,20.77,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73552,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.76,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,17.05,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,17.05,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73552,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.76,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,17.05,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,17.05,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73552,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.76,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,17.05,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,17.05,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73552,DR Femur Lt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.76,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,17.05,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,17.05,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73552,DR Femur Rt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,51.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.76,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,17.05,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,17.05,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73560,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73560,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73560,DR Knee Lt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73560,DR Knee Rt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73560,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,DR Knee Rt 3 View,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,DR Knee Lt 3 View,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73562,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,58.8,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73564,DR Knee Series Lt,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,64.05,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.66,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.42,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.42,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73564,DR Knee Series Rt,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,64.05,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.66,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.42,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.42,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73564,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,64.05,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.66,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.42,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.42,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73564,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,64.05,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,24.66,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,22.42,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,22.42,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73590,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,45.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73590,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,45.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73590,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,45.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73590,DR Tibia Fibula Lt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,45.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73590,DR Tibia Fibula Rt,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,45.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,18.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73600,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,47.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73600,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,47.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73600,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,47.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73600,DR Ankle Lt  AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,47.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73600,DR Ankle Rt AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,47.58,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73610,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,20.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,18.73,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,18.73,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73610,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,20.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,18.73,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,18.73,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73610,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,20.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,18.73,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,18.73,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73610,DR Ankle Rt Routine AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,20.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,18.73,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,18.73,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73610,DR Ankle Lt Routine AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,52.08,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,20.6,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,18.73,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,18.73,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73620,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73620,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73620,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73620,DR Lt Foot AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73620,DR Rt Foot AP and Lat,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,11,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,10,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,10,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,DR Lt Foot AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,DR Rt Foot AP Lat and Oblique,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73630,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,48.33,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,12.65,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,11.5,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,11.5,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73660,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,9.9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,9,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73660,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,46.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,9.9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,9,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,9,512.45,264.15
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73700,Computerized Tomography Exam,350,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,234.08,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.94,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,79.04,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,79.04,618.9,319.02
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73701,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,352.4,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,90.75,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,82.5,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,82.5,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,73721,Magnetic Resonance Imaging Exam,610,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,347.55,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,295.9,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,269,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,195.41,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74018,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,13.77,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,13.77,512.45,264.15
Outpatient Medical Services,RADIOLOGY,74018,DR Abdomen AP,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,13.77,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,13.77,512.45,264.15
Outpatient Medical Services,RADIOLOGY,74018,WW DR Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,13.77,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,13.77,512.45,264.15
Outpatient Medical Services,RADIOLOGY,74018,General Diagnostic Exam,320,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,40.83,250% of AETNA fee schedule,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,15.15,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,209.02,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,333.23,100% of CMS IPPS rate,422.08,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,157.27,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,82.51,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,13.77,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,13.77,512.45,264.15
Outpatient Medical Services,RADIOLOGY,74019,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,49.08,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,18.13,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,16.48,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,16.48,618.9,319.02
Outpatient Medical Services,RADIOLOGY,74022,General Diagnostic Exam,320,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,64.05,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,26.4,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,24,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,24,618.9,319.02
Outpatient Medical Services,RADIOLOGY,74160,CT Abdomen ENH,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,368.13,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,99,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,90,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,90,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,74160,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,368.13,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,99,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,90,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,90,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,74160,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,368.13,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,99,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,90,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,90,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,74160,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,368.13,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,99,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,318,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.38,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,90,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,90,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,74174,CTA Abdomen Pelvis,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,604.45,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,367.07,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,333.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,288.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74174,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,604.45,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,367.07,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,333.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,288.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74174,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,604.45,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,367.07,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,333.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,288.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74174,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,604.45,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,367.07,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,333.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,288.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74176,CT Abdomen Pelvis UN,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74176,Computerized Tomography Exam,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74176,Computerized Tomography Exam,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74176,Computerized Tomography Exam,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74176,Computerized Tomography Exam,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74176,CT AbdPelvis w/o Contrast,350,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,237.8,250% of AETNA fee schedule,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,111.18,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,101.07,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,101.07,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,74177,CT Abdomen Pelvis ENH,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74177,CT Abdomen Pelvis ENH,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,478.98,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,212,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,192.73,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,192.73,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,CT Abdomen Pelvis UN & ENH,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,74178,Computerized Tomography Exam,350,2142.78,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,547.53,250% of AETNA fee schedule,339.66,100% of CMS IPPS rate,1928.5,90% of total billed charges,280.17,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,1971.36,92% of total billed charges,339.66,100% of CMS IPPS rate,884.62,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,1410.28,100% of CMS IPPS rate,1786.33,100% of CMS IPPS rate,1928.5,90% of total billed charges,339.66,100% of CMS IPPS rate,1499.95,70% of total billed charges,1928.5,90% of total billed charges,2035.64,95% of total billed charges,2035.64,95% of total billed charges,339.66,100% of CMS IPPS rate,665.6,100% of CMS IPPS rate,1842.79,86% of total billed charges,1714.22,80% of total billed charges,394.78,100% of CMS IPPS rate,2078.5,97% of total billed charges,1928.5,90% of total billed charges,N/A,not seperately reimbursable,2078.5,97% of total billed charges,1992.79,93% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,254.7,100% of CMS fee schedule,2078.5,97% of total billed charges,339.66,100% of CMS IPPS rate,339.66,100% of CMS IPPS rate,288.7,100% of CMS IPPS rate,254.7,2078.5,1071.39
Outpatient Medical Services,RADIOLOGY,75635,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,251.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,317.99,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.39,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,228.36,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,75635,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,251.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,317.99,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.39,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,228.36,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,75635,Computerized Tomography Exam,350,1068.12,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,420.2,250% of AETNA fee schedule,169.31,100% of CMS IPPS rate,961.31,90% of total billed charges,251.2,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,982.67,92% of total billed charges,169.31,100% of CMS IPPS rate,422.64,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,673.77,100% of CMS IPPS rate,853.43,100% of CMS IPPS rate,961.31,90% of total billed charges,169.31,100% of CMS IPPS rate,747.68,70% of total billed charges,961.31,90% of total billed charges,1014.71,95% of total billed charges,1014.71,95% of total billed charges,169.31,100% of CMS IPPS rate,317.99,100% of CMS IPPS rate,918.58,86% of total billed charges,854.5,80% of total billed charges,188.39,100% of CMS IPPS rate,1036.08,97% of total billed charges,961.31,90% of total billed charges,N/A,not seperately reimbursable,1036.08,97% of total billed charges,993.35,93% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,228.36,100% of CMS fee schedule,1036.08,97% of total billed charges,169.31,100% of CMS IPPS rate,169.31,100% of CMS IPPS rate,143.91,100% of CMS IPPS rate,143.91,1036.08,534.06
Outpatient Medical Services,RADIOLOGY,76536,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,SCMP US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,76536- US head and neck,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,450,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76536,WHFMT US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,56.08,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,50.98,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,50.98,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76700,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,171.15,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,63.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,57.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,57.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76700,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,171.15,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,63.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,57.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,57.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76700,76700- US abdommen complete,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,171.15,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,63.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,57.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,57.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76700,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,171.15,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,63.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,57.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,57.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76700,"76700 (TC) Ultrasound, abdominal, real time with image documentation; complete",510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,171.15,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,63.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,57.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,57.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Abdomen Limited,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,"76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, qua",510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,76705 - (TC) Echo Exam of Abdomen -Limited,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US ABDOMINAL REAL TIME W/IMAGE LIMITED,450,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,WHFMT US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76705,WHFMT US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,129.95,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,41.25,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,37.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,37.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,76770- US abdomen back wall complete,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,SCMP US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,SCSN US Exam,320,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76770,WHFMT US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,159.93,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,53.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,49,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,49,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76801,US Pelvic OB <14 wks comp,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,153.18,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,42.23,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,38.39,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,38.39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76801,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,153.18,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,42.23,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,38.39,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,38.39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76805,US Pelvic OB Comp >14 wks,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,190.63,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76805,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,190.63,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,OBGYN Ultrasound,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,US Pelvic OB Limited,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,WHMP US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76815,US PREGNANT UTERUS LIMITED 1/> FETUSES,450,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,108.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,42.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76816,US Pelvic OB Follow Up,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,149.43,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,43.76,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39.78,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39.78,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76816,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,149.43,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,43.76,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,39.78,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,39.78,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76817,US Transvaginal OB,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,123.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,58.33,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,53.03,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,53.03,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76817,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,123.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,58.33,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,53.03,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,53.03,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76817,WHMP US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,123.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,58.33,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,53.03,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,53.03,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76817,"76817(TC)- Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart",510,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,123.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,58.33,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,53.03,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,53.03,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76817,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,450,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,123.98,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,58.33,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,53.03,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,53.03,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76830,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76830,US Transvaginal non ob,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76830,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76830,WHMP US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76830,"76830- US Transvaginal, non-ob",402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,183.88,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76856,US Pelvic Complete Non OB,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,158.43,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76856,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,158.43,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76856,76856- US pelvic complete,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,158.43,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,51.15,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,46.5,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,46.5,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,US Pelvic Limited Non OB,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,76857 Us exam pelvic limited,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76857,URMC US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,50.58,250% of AETNA fee schedule,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,20.9,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,19,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,19,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76870,US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,154.68,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,48.4,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,44,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,44,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76870,URMC US Exam,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,154.68,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,48.4,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,44,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,44,618.9,319.02
Outpatient Medical Services,RADIOLOGY,76870,76870- Us exam scrotum,402,638.04,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,154.68,250% of AETNA fee schedule,101.13,100% of CMS IPPS rate,574.24,90% of total billed charges,48.4,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,587,92% of total billed charges,101.13,100% of CMS IPPS rate,252.89,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,403.16,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.13,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.13,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.87,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,44,100% of CMS fee schedule,618.9,97% of total billed charges,101.13,100% of CMS IPPS rate,101.13,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,44,618.9,319.02
Outpatient Medical Services,RADIOLOGY,77065,Mammography Exam,401,782.38,704.14,90% of total billed charges,N/A,not seperately reimbursable,195.88,250% of AETNA fee schedule,N/A,not seperately reimbursable,704.14,90% of total billed charges,78.11,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,719.79,92% of total billed charges,N/A,not seperately reimbursable,304.78, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,371.32,494.23% of CMS fee schedule,344.5, 458.54% of CMS fee schedule,704.14,90% of total billed charges,N/A,not seperately reimbursable,547.67,70% of total billed charges,704.14,90% of total billed charges,743.26,95% of total billed charges,743.26,95% of total billed charges,N/A,not seperately reimbursable,150.26,200% of CMS fee schedule,672.85,86% of total billed charges,625.9,80% of total billed charges,90.1,111% of CMS fee schedule,758.91,97% of total billed charges,704.14,90% of total billed charges,N/A,not seperately reimbursable,758.91,97% of total billed charges,727.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,758.91,391.19
Outpatient Medical Services,RADIOLOGY,77065,Mammography Exam,401,782.38,704.14,90% of total billed charges,N/A,not seperately reimbursable,195.88,250% of AETNA fee schedule,N/A,not seperately reimbursable,704.14,90% of total billed charges,78.11,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,719.79,92% of total billed charges,N/A,not seperately reimbursable,304.78, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,371.32,494.23% of CMS fee schedule,344.5, 458.54% of CMS fee schedule,704.14,90% of total billed charges,N/A,not seperately reimbursable,547.67,70% of total billed charges,704.14,90% of total billed charges,743.26,95% of total billed charges,743.26,95% of total billed charges,N/A,not seperately reimbursable,150.26,200% of CMS fee schedule,672.85,86% of total billed charges,625.9,80% of total billed charges,90.1,111% of CMS fee schedule,758.91,97% of total billed charges,704.14,90% of total billed charges,N/A,not seperately reimbursable,758.91,97% of total billed charges,727.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,758.91,391.19
Outpatient Medical Services,RADIOLOGY,77065,MA Mammo Lt Diagnostic,401,782.38,704.14,90% of total billed charges,N/A,not seperately reimbursable,195.88,250% of AETNA fee schedule,N/A,not seperately reimbursable,704.14,90% of total billed charges,78.11,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,719.79,92% of total billed charges,N/A,not seperately reimbursable,304.78, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,371.32,494.23% of CMS fee schedule,344.5, 458.54% of CMS fee schedule,704.14,90% of total billed charges,N/A,not seperately reimbursable,547.67,70% of total billed charges,704.14,90% of total billed charges,743.26,95% of total billed charges,743.26,95% of total billed charges,N/A,not seperately reimbursable,150.26,200% of CMS fee schedule,672.85,86% of total billed charges,625.9,80% of total billed charges,90.1,111% of CMS fee schedule,758.91,97% of total billed charges,704.14,90% of total billed charges,N/A,not seperately reimbursable,758.91,97% of total billed charges,727.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,758.91,391.19
Outpatient Medical Services,RADIOLOGY,77065,MA Mammo Rt Diagnostic,401,782.38,704.14,90% of total billed charges,N/A,not seperately reimbursable,195.88,250% of AETNA fee schedule,N/A,not seperately reimbursable,704.14,90% of total billed charges,78.11,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,719.79,92% of total billed charges,N/A,not seperately reimbursable,304.78, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,371.32,494.23% of CMS fee schedule,344.5, 458.54% of CMS fee schedule,704.14,90% of total billed charges,N/A,not seperately reimbursable,547.67,70% of total billed charges,704.14,90% of total billed charges,743.26,95% of total billed charges,743.26,95% of total billed charges,N/A,not seperately reimbursable,150.26,200% of CMS fee schedule,672.85,86% of total billed charges,625.9,80% of total billed charges,90.1,111% of CMS fee schedule,758.91,97% of total billed charges,704.14,90% of total billed charges,N/A,not seperately reimbursable,758.91,97% of total billed charges,727.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,100% of CMS fee schedule,758.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,71.01,758.91,391.19
Outpatient Medical Services,RADIOLOGY,77066,Mammography Exam,401,987.09,888.38,90% of total billed charges,N/A,not seperately reimbursable,250.55,250% of AETNA fee schedule,N/A,not seperately reimbursable,888.38,90% of total billed charges,99.91,100% of CMS fee schedule,957.48,97% of total billed charges,N/A,not seperately reimbursable,908.12,92% of total billed charges,N/A,not seperately reimbursable,391.26, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,476.69,494.23% of CMS fee schedule,442.26, 458.54% of CMS fee schedule,888.38,90% of total billed charges,N/A,not seperately reimbursable,690.96,70% of total billed charges,888.38,90% of total billed charges,937.74,95% of total billed charges,937.74,95% of total billed charges,N/A,not seperately reimbursable,192.9,200% of CMS fee schedule,848.9,86% of total billed charges,789.67,80% of total billed charges,114.82,111% of CMS fee schedule,957.48,97% of total billed charges,888.38,90% of total billed charges,N/A,not seperately reimbursable,957.48,97% of total billed charges,917.99,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.83,100% of CMS fee schedule,957.48,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.83,957.48,493.55
Outpatient Medical Services,RADIOLOGY,77066,MA Mammo Bilat Diagnostic,401,987.09,888.38,90% of total billed charges,N/A,not seperately reimbursable,250.55,250% of AETNA fee schedule,N/A,not seperately reimbursable,888.38,90% of total billed charges,99.91,100% of CMS fee schedule,957.48,97% of total billed charges,N/A,not seperately reimbursable,908.12,92% of total billed charges,N/A,not seperately reimbursable,391.26, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,476.69,494.23% of CMS fee schedule,442.26, 458.54% of CMS fee schedule,888.38,90% of total billed charges,N/A,not seperately reimbursable,690.96,70% of total billed charges,888.38,90% of total billed charges,937.74,95% of total billed charges,937.74,95% of total billed charges,N/A,not seperately reimbursable,192.9,200% of CMS fee schedule,848.9,86% of total billed charges,789.67,80% of total billed charges,114.82,111% of CMS fee schedule,957.48,97% of total billed charges,888.38,90% of total billed charges,N/A,not seperately reimbursable,957.48,97% of total billed charges,917.99,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.83,100% of CMS fee schedule,957.48,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.83,957.48,493.55
Outpatient Medical Services,RADIOLOGY,77067,Mammography Exam,403,1586.95,1428.26,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,1428.26,90% of total billed charges,82.52,100% of CMS fee schedule,1539.34,97% of total billed charges,N/A,not seperately reimbursable,1459.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,1428.26,90% of total billed charges,N/A,not seperately reimbursable,1110.87,70% of total billed charges,1428.26,90% of total billed charges,1507.6,95% of total billed charges,1507.6,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,1364.78,86% of total billed charges,1269.56,80% of total billed charges,95.25,111% of CMS fee schedule,1539.34,97% of total billed charges,1428.26,90% of total billed charges,N/A,not seperately reimbursable,1539.34,97% of total billed charges,1475.86,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,1539.34,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,1539.34,793.48
Outpatient Medical Services,RADIOLOGY,77067,Mammography Exam,403,793.47,714.12,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,714.12,90% of total billed charges,82.52,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,729.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,714.12,90% of total billed charges,N/A,not seperately reimbursable,555.43,70% of total billed charges,714.12,90% of total billed charges,753.8,95% of total billed charges,753.8,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,682.38,86% of total billed charges,634.78,80% of total billed charges,95.25,111% of CMS fee schedule,769.67,97% of total billed charges,714.12,90% of total billed charges,N/A,not seperately reimbursable,769.67,97% of total billed charges,737.93,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,769.67,396.74
Outpatient Medical Services,RADIOLOGY,77067,Mammography Exam,403,793.47,714.12,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,714.12,90% of total billed charges,82.52,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,729.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,714.12,90% of total billed charges,N/A,not seperately reimbursable,555.43,70% of total billed charges,714.12,90% of total billed charges,753.8,95% of total billed charges,753.8,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,682.38,86% of total billed charges,634.78,80% of total billed charges,95.25,111% of CMS fee schedule,769.67,97% of total billed charges,714.12,90% of total billed charges,N/A,not seperately reimbursable,769.67,97% of total billed charges,737.93,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,769.67,396.74
Outpatient Medical Services,RADIOLOGY,77067,MA Mammo Rt Screening,403,793.47,714.12,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,714.12,90% of total billed charges,82.52,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,729.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,714.12,90% of total billed charges,N/A,not seperately reimbursable,555.43,70% of total billed charges,714.12,90% of total billed charges,753.8,95% of total billed charges,753.8,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,682.38,86% of total billed charges,634.78,80% of total billed charges,95.25,111% of CMS fee schedule,769.67,97% of total billed charges,714.12,90% of total billed charges,N/A,not seperately reimbursable,769.67,97% of total billed charges,737.93,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,769.67,396.74
Outpatient Medical Services,RADIOLOGY,77067,MA Mammo Lt Screening,403,793.47,714.12,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,714.12,90% of total billed charges,82.52,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,729.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,714.12,90% of total billed charges,N/A,not seperately reimbursable,555.43,70% of total billed charges,714.12,90% of total billed charges,753.8,95% of total billed charges,753.8,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,682.38,86% of total billed charges,634.78,80% of total billed charges,95.25,111% of CMS fee schedule,769.67,97% of total billed charges,714.12,90% of total billed charges,N/A,not seperately reimbursable,769.67,97% of total billed charges,737.93,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,769.67,396.74
Outpatient Medical Services,RADIOLOGY,77067,MA Mammo Bilat Screening,403,793.47,714.12,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,714.12,90% of total billed charges,82.52,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,729.99,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,714.12,90% of total billed charges,N/A,not seperately reimbursable,555.43,70% of total billed charges,714.12,90% of total billed charges,753.8,95% of total billed charges,753.8,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,682.38,86% of total billed charges,634.78,80% of total billed charges,95.25,111% of CMS fee schedule,769.67,97% of total billed charges,714.12,90% of total billed charges,N/A,not seperately reimbursable,769.67,97% of total billed charges,737.93,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,769.67,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,769.67,396.74
Outpatient Medical Services,RADIOLOGY,77067,"77067 (TC) Screening mammography, bilateral (2-view study of each breast), including computer-aided",510,477.27,429.54,90% of total billed charges,N/A,not seperately reimbursable,207.1,250% of AETNA fee schedule,N/A,not seperately reimbursable,429.54,90% of total billed charges,82.52,100% of CMS fee schedule,462.95,97% of total billed charges,N/A,not seperately reimbursable,439.09,92% of total billed charges,N/A,not seperately reimbursable,322.22, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,392.57,494.23% of CMS fee schedule,364.22, 458.54% of CMS fee schedule,429.54,90% of total billed charges,N/A,not seperately reimbursable,334.09,70% of total billed charges,429.54,90% of total billed charges,453.41,95% of total billed charges,453.41,95% of total billed charges,N/A,not seperately reimbursable,158.86,200% of CMS fee schedule,410.45,86% of total billed charges,381.82,80% of total billed charges,95.25,111% of CMS fee schedule,462.95,97% of total billed charges,429.54,90% of total billed charges,N/A,not seperately reimbursable,462.95,97% of total billed charges,443.86,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,100% of CMS fee schedule,462.95,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.02,462.95,238.64
Outpatient Medical Services,LAB,80048,Basic Metabolic Panel,300,50.22,45.2,90% of total billed charges,8.46,100% of CMS fee schedule,12.72,150% of AETNA fee schedule,8.46,100% of CMS fee schedule,45.2,90% of total billed charges,10.3,100% of CMS fee schedule,48.71,97% of total billed charges,8.46,100% of CMS fee schedule,46.2,92% of total billed charges,8.46,100% of CMS fee schedule,34.31, 405.66% of CMS fee schedule,8.46,100% of CMS fee schedule,41.81,494.23% of CMS fee schedule,38.79, 458.54% of CMS fee schedule,45.2,90% of total billed charges,8.46,100% of CMS fee schedule,35.15,70% of total billed charges,45.2,90% of total billed charges,47.71,95% of total billed charges,47.71,95% of total billed charges,8.46,100% of CMS fee schedule,16.92,200% of CMS fee schedule,43.19,86% of total billed charges,40.18,80% of total billed charges,9.39,111% of CMS fee schedule,48.71,97% of total billed charges,45.2,90% of total billed charges,N/A,not seperately reimbursable,48.71,97% of total billed charges,46.7,93% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,9.36,100% of CMS fee schedule,48.71,97% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,7.19,85% of CMS fee schedule,7.19,48.71,25.11
Outpatient Medical Services,LAB,80048,BMP MC,300,50.22,45.2,90% of total billed charges,8.46,100% of CMS fee schedule,12.72,150% of AETNA fee schedule,8.46,100% of CMS fee schedule,45.2,90% of total billed charges,10.3,100% of CMS fee schedule,48.71,97% of total billed charges,8.46,100% of CMS fee schedule,46.2,92% of total billed charges,8.46,100% of CMS fee schedule,34.31, 405.66% of CMS fee schedule,8.46,100% of CMS fee schedule,41.81,494.23% of CMS fee schedule,38.79, 458.54% of CMS fee schedule,45.2,90% of total billed charges,8.46,100% of CMS fee schedule,35.15,70% of total billed charges,45.2,90% of total billed charges,47.71,95% of total billed charges,47.71,95% of total billed charges,8.46,100% of CMS fee schedule,16.92,200% of CMS fee schedule,43.19,86% of total billed charges,40.18,80% of total billed charges,9.39,111% of CMS fee schedule,48.71,97% of total billed charges,45.2,90% of total billed charges,N/A,not seperately reimbursable,48.71,97% of total billed charges,46.7,93% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,9.36,100% of CMS fee schedule,48.71,97% of total billed charges,8.46,100% of CMS fee schedule,8.46,100% of CMS fee schedule,7.19,85% of CMS fee schedule,7.19,48.71,25.11
Outpatient Medical Services,LAB,80053,Comprehensive Metabolic Panel,300,62.69,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,15.9,150% of AETNA fee schedule,10.56,100% of CMS fee schedule,56.42,90% of total billed charges,12.86,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,57.67,92% of total billed charges,10.56,100% of CMS fee schedule,42.83, 405.66% of CMS fee schedule,10.56,100% of CMS fee schedule,52.19,494.23% of CMS fee schedule,48.42, 458.54% of CMS fee schedule,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,43.88,70% of total billed charges,56.42,90% of total billed charges,59.56,95% of total billed charges,59.56,95% of total billed charges,10.56,100% of CMS fee schedule,21.12,200% of CMS fee schedule,53.91,86% of total billed charges,50.15,80% of total billed charges,11.72,111% of CMS fee schedule,60.81,97% of total billed charges,56.42,90% of total billed charges,N/A,not seperately reimbursable,60.81,97% of total billed charges,58.3,93% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,11.69,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,8.97,85% of CMS fee schedule,8.97,60.81,31.35
Outpatient Medical Services,LAB,80053,Direct Access Lab CMP,300,62.69,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,15.9,150% of AETNA fee schedule,10.56,100% of CMS fee schedule,56.42,90% of total billed charges,12.86,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,57.67,92% of total billed charges,10.56,100% of CMS fee schedule,42.83, 405.66% of CMS fee schedule,10.56,100% of CMS fee schedule,52.19,494.23% of CMS fee schedule,48.42, 458.54% of CMS fee schedule,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,43.88,70% of total billed charges,56.42,90% of total billed charges,59.56,95% of total billed charges,59.56,95% of total billed charges,10.56,100% of CMS fee schedule,21.12,200% of CMS fee schedule,53.91,86% of total billed charges,50.15,80% of total billed charges,11.72,111% of CMS fee schedule,60.81,97% of total billed charges,56.42,90% of total billed charges,N/A,not seperately reimbursable,60.81,97% of total billed charges,58.3,93% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,11.69,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,8.97,85% of CMS fee schedule,8.97,60.81,31.35
Outpatient Medical Services,LAB,80053,CMP MC,300,62.69,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,15.9,150% of AETNA fee schedule,10.56,100% of CMS fee schedule,56.42,90% of total billed charges,12.86,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,57.67,92% of total billed charges,10.56,100% of CMS fee schedule,42.83, 405.66% of CMS fee schedule,10.56,100% of CMS fee schedule,52.19,494.23% of CMS fee schedule,48.42, 458.54% of CMS fee schedule,56.42,90% of total billed charges,10.56,100% of CMS fee schedule,43.88,70% of total billed charges,56.42,90% of total billed charges,59.56,95% of total billed charges,59.56,95% of total billed charges,10.56,100% of CMS fee schedule,21.12,200% of CMS fee schedule,53.91,86% of total billed charges,50.15,80% of total billed charges,11.72,111% of CMS fee schedule,60.81,97% of total billed charges,56.42,90% of total billed charges,N/A,not seperately reimbursable,60.81,97% of total billed charges,58.3,93% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,11.69,100% of CMS fee schedule,60.81,97% of total billed charges,10.56,100% of CMS fee schedule,10.56,100% of CMS fee schedule,8.97,85% of CMS fee schedule,8.97,60.81,31.35
Outpatient Medical Services,LAB,80055,Prenatal Profile,300,283.8,255.42,90% of total billed charges,47.81,100% of CMS fee schedule,227.04,80% of total billed charges,47.81,100% of CMS fee schedule,255.42,90% of total billed charges,13.2,100% of CMS fee schedule,275.29,97% of total billed charges,47.81,100% of CMS fee schedule,261.1,92% of total billed charges,47.81,100% of CMS fee schedule,193.94, 405.66% of CMS fee schedule,47.81,100% of CMS fee schedule,236.29,494.23% of CMS fee schedule,219.22, 458.54% of CMS fee schedule,255.42,90% of total billed charges,47.81,100% of CMS fee schedule,198.66,70% of total billed charges,255.42,90% of total billed charges,269.61,95% of total billed charges,269.61,95% of total billed charges,47.81,100% of CMS fee schedule,95.62,200% of CMS fee schedule,244.07,86% of total billed charges,227.04,80% of total billed charges,53.06,111% of CMS fee schedule,275.29,97% of total billed charges,255.42,90% of total billed charges,N/A,not seperately reimbursable,275.29,97% of total billed charges,263.93,93% of total billed charges,47.81,100% of CMS fee schedule,47.81,100% of CMS fee schedule,12,100% of CMS fee schedule,275.29,97% of total billed charges,47.81,100% of CMS fee schedule,47.81,100% of CMS fee schedule,40.63,85% of CMS fee schedule,12,275.29,141.90
Outpatient Medical Services,LAB,80061,Lipid Profile,300,79.48,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,14.75,150% of AETNA fee schedule,13.39,100% of CMS fee schedule,71.53,90% of total billed charges,15.4,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,73.12,92% of total billed charges,13.39,100% of CMS fee schedule,54.31, 405.66% of CMS fee schedule,13.39,100% of CMS fee schedule,66.17,494.23% of CMS fee schedule,61.39, 458.54% of CMS fee schedule,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,55.64,70% of total billed charges,71.53,90% of total billed charges,75.51,95% of total billed charges,75.51,95% of total billed charges,13.39,100% of CMS fee schedule,26.78,200% of CMS fee schedule,68.35,86% of total billed charges,63.58,80% of total billed charges,14.86,111% of CMS fee schedule,77.1,97% of total billed charges,71.53,90% of total billed charges,N/A,not seperately reimbursable,77.1,97% of total billed charges,73.92,93% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,14,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,11.38,85% of CMS fee schedule,11.38,77.1,39.74
Outpatient Medical Services,LAB,80061,Health Fair Lipid Profile,300,79.48,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,14.75,150% of AETNA fee schedule,13.39,100% of CMS fee schedule,71.53,90% of total billed charges,15.4,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,73.12,92% of total billed charges,13.39,100% of CMS fee schedule,54.31, 405.66% of CMS fee schedule,13.39,100% of CMS fee schedule,66.17,494.23% of CMS fee schedule,61.39, 458.54% of CMS fee schedule,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,55.64,70% of total billed charges,71.53,90% of total billed charges,75.51,95% of total billed charges,75.51,95% of total billed charges,13.39,100% of CMS fee schedule,26.78,200% of CMS fee schedule,68.35,86% of total billed charges,63.58,80% of total billed charges,14.86,111% of CMS fee schedule,77.1,97% of total billed charges,71.53,90% of total billed charges,N/A,not seperately reimbursable,77.1,97% of total billed charges,73.92,93% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,14,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,11.38,85% of CMS fee schedule,11.38,77.1,39.74
Outpatient Medical Services,LAB,80061,NMR Lipoprofile,300,79.48,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,14.75,150% of AETNA fee schedule,13.39,100% of CMS fee schedule,71.53,90% of total billed charges,15.4,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,73.12,92% of total billed charges,13.39,100% of CMS fee schedule,54.31, 405.66% of CMS fee schedule,13.39,100% of CMS fee schedule,66.17,494.23% of CMS fee schedule,61.39, 458.54% of CMS fee schedule,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,55.64,70% of total billed charges,71.53,90% of total billed charges,75.51,95% of total billed charges,75.51,95% of total billed charges,13.39,100% of CMS fee schedule,26.78,200% of CMS fee schedule,68.35,86% of total billed charges,63.58,80% of total billed charges,14.86,111% of CMS fee schedule,77.1,97% of total billed charges,71.53,90% of total billed charges,N/A,not seperately reimbursable,77.1,97% of total billed charges,73.92,93% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,14,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,11.38,85% of CMS fee schedule,11.38,77.1,39.74
Outpatient Medical Services,LAB,80061,Direct Access Lab Lipid Panel,300,15.9,14.31,90% of total billed charges,13.39,100% of CMS fee schedule,14.75,150% of AETNA fee schedule,13.39,100% of CMS fee schedule,14.31,90% of total billed charges,15.4,100% of CMS fee schedule,15.42,97% of total billed charges,13.39,100% of CMS fee schedule,14.63,92% of total billed charges,13.39,100% of CMS fee schedule,54.31, 405.66% of CMS fee schedule,13.39,100% of CMS fee schedule,66.17,494.23% of CMS fee schedule,61.39, 458.54% of CMS fee schedule,14.31,90% of total billed charges,13.39,100% of CMS fee schedule,11.13,70% of total billed charges,14.31,90% of total billed charges,15.11,95% of total billed charges,15.11,95% of total billed charges,13.39,100% of CMS fee schedule,26.78,200% of CMS fee schedule,13.67,86% of total billed charges,12.72,80% of total billed charges,14.86,111% of CMS fee schedule,15.42,97% of total billed charges,14.31,90% of total billed charges,N/A,not seperately reimbursable,15.42,97% of total billed charges,14.79,93% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,14,100% of CMS fee schedule,15.42,97% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,11.38,85% of CMS fee schedule,11.13,66.17,7.95
Outpatient Medical Services,LAB,80061,NMR LipoProfile+Lipids LC,300,79.48,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,14.75,150% of AETNA fee schedule,13.39,100% of CMS fee schedule,71.53,90% of total billed charges,15.4,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,73.12,92% of total billed charges,13.39,100% of CMS fee schedule,54.31, 405.66% of CMS fee schedule,13.39,100% of CMS fee schedule,66.17,494.23% of CMS fee schedule,61.39, 458.54% of CMS fee schedule,71.53,90% of total billed charges,13.39,100% of CMS fee schedule,55.64,70% of total billed charges,71.53,90% of total billed charges,75.51,95% of total billed charges,75.51,95% of total billed charges,13.39,100% of CMS fee schedule,26.78,200% of CMS fee schedule,68.35,86% of total billed charges,63.58,80% of total billed charges,14.86,111% of CMS fee schedule,77.1,97% of total billed charges,71.53,90% of total billed charges,N/A,not seperately reimbursable,77.1,97% of total billed charges,73.92,93% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,14,100% of CMS fee schedule,77.1,97% of total billed charges,13.39,100% of CMS fee schedule,13.39,100% of CMS fee schedule,11.38,85% of CMS fee schedule,11.38,77.1,39.74
Outpatient Medical Services,LAB,80069,Renal Function Panel,300,51.53,46.38,90% of total billed charges,8.68,100% of CMS fee schedule,41.22,80% of total billed charges,8.68,100% of CMS fee schedule,46.38,90% of total billed charges,10.56,100% of CMS fee schedule,49.98,97% of total billed charges,8.68,100% of CMS fee schedule,47.41,92% of total billed charges,8.68,100% of CMS fee schedule,35.21, 405.66% of CMS fee schedule,8.68,100% of CMS fee schedule,42.89,494.23% of CMS fee schedule,39.8, 458.54% of CMS fee schedule,46.38,90% of total billed charges,8.68,100% of CMS fee schedule,36.07,70% of total billed charges,46.38,90% of total billed charges,48.95,95% of total billed charges,48.95,95% of total billed charges,8.68,100% of CMS fee schedule,17.36,200% of CMS fee schedule,44.32,86% of total billed charges,41.22,80% of total billed charges,9.63,111% of CMS fee schedule,49.98,97% of total billed charges,46.38,90% of total billed charges,N/A,not seperately reimbursable,49.98,97% of total billed charges,47.92,93% of total billed charges,8.68,100% of CMS fee schedule,8.68,100% of CMS fee schedule,9.6,100% of CMS fee schedule,49.98,97% of total billed charges,8.68,100% of CMS fee schedule,8.68,100% of CMS fee schedule,7.37,85% of CMS fee schedule,7.37,49.98,25.77
Outpatient Medical Services,LAB,80076,Hepatic Function Panel,300,48.5,43.65,90% of total billed charges,8.17,100% of CMS fee schedule,12.29,150% of AETNA fee schedule,8.17,100% of CMS fee schedule,43.65,90% of total billed charges,9.93,100% of CMS fee schedule,47.05,97% of total billed charges,8.17,100% of CMS fee schedule,44.62,92% of total billed charges,8.17,100% of CMS fee schedule,33.14, 405.66% of CMS fee schedule,8.17,100% of CMS fee schedule,40.37,494.23% of CMS fee schedule,37.46, 458.54% of CMS fee schedule,43.65,90% of total billed charges,8.17,100% of CMS fee schedule,33.95,70% of total billed charges,43.65,90% of total billed charges,46.08,95% of total billed charges,46.08,95% of total billed charges,8.17,100% of CMS fee schedule,16.34,200% of CMS fee schedule,41.71,86% of total billed charges,38.8,80% of total billed charges,9.06,111% of CMS fee schedule,47.05,97% of total billed charges,43.65,90% of total billed charges,N/A,not seperately reimbursable,47.05,97% of total billed charges,45.11,93% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,9.03,100% of CMS fee schedule,47.05,97% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,6.94,85% of CMS fee schedule,6.94,47.05,24.25
Outpatient Medical Services,LAB,80076,MC Liver Function Panel,300,48.5,43.65,90% of total billed charges,8.17,100% of CMS fee schedule,12.29,150% of AETNA fee schedule,8.17,100% of CMS fee schedule,43.65,90% of total billed charges,9.93,100% of CMS fee schedule,47.05,97% of total billed charges,8.17,100% of CMS fee schedule,44.62,92% of total billed charges,8.17,100% of CMS fee schedule,33.14, 405.66% of CMS fee schedule,8.17,100% of CMS fee schedule,40.37,494.23% of CMS fee schedule,37.46, 458.54% of CMS fee schedule,43.65,90% of total billed charges,8.17,100% of CMS fee schedule,33.95,70% of total billed charges,43.65,90% of total billed charges,46.08,95% of total billed charges,46.08,95% of total billed charges,8.17,100% of CMS fee schedule,16.34,200% of CMS fee schedule,41.71,86% of total billed charges,38.8,80% of total billed charges,9.06,111% of CMS fee schedule,47.05,97% of total billed charges,43.65,90% of total billed charges,N/A,not seperately reimbursable,47.05,97% of total billed charges,45.11,93% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,9.03,100% of CMS fee schedule,47.05,97% of total billed charges,8.17,100% of CMS fee schedule,8.17,100% of CMS fee schedule,6.94,85% of CMS fee schedule,6.94,47.05,24.25
Outpatient Medical Services,LAB,80162,Digoxin Level,300,78.83,70.95,90% of total billed charges,13.28,100% of CMS fee schedule,63.06,80% of total billed charges,13.28,100% of CMS fee schedule,70.95,90% of total billed charges,12.1,100% of CMS fee schedule,76.47,97% of total billed charges,13.28,100% of CMS fee schedule,72.52,92% of total billed charges,13.28,100% of CMS fee schedule,53.87, 405.66% of CMS fee schedule,13.28,100% of CMS fee schedule,65.63,494.23% of CMS fee schedule,60.89, 458.54% of CMS fee schedule,70.95,90% of total billed charges,13.28,100% of CMS fee schedule,55.18,70% of total billed charges,70.95,90% of total billed charges,74.89,95% of total billed charges,74.89,95% of total billed charges,13.28,100% of CMS fee schedule,26.56,200% of CMS fee schedule,67.79,86% of total billed charges,63.06,80% of total billed charges,14.74,111% of CMS fee schedule,76.47,97% of total billed charges,70.95,90% of total billed charges,N/A,not seperately reimbursable,76.47,97% of total billed charges,73.31,93% of total billed charges,13.28,100% of CMS fee schedule,13.28,100% of CMS fee schedule,11,100% of CMS fee schedule,76.47,97% of total billed charges,13.28,100% of CMS fee schedule,13.28,100% of CMS fee schedule,11.28,85% of CMS fee schedule,11,76.47,39.42
Outpatient Medical Services,LAB,80164,Valproic Acid Level,300,80.37,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,64.3,80% of total billed charges,13.54,100% of CMS fee schedule,72.33,90% of total billed charges,20.59,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,73.94,92% of total billed charges,13.54,100% of CMS fee schedule,54.92, 405.66% of CMS fee schedule,13.54,100% of CMS fee schedule,66.91,494.23% of CMS fee schedule,62.08, 458.54% of CMS fee schedule,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,56.26,70% of total billed charges,72.33,90% of total billed charges,76.35,95% of total billed charges,76.35,95% of total billed charges,13.54,100% of CMS fee schedule,27.08,200% of CMS fee schedule,69.12,86% of total billed charges,64.3,80% of total billed charges,15.02,111% of CMS fee schedule,77.96,97% of total billed charges,72.33,90% of total billed charges,N/A,not seperately reimbursable,77.96,97% of total billed charges,74.74,93% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,18.72,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,11.5,85% of CMS fee schedule,11.5,77.96,40.19
Outpatient Medical Services,LAB,80178,Lithium Level,300,39.24,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,31.39,80% of total billed charges,6.61,100% of CMS fee schedule,35.32,90% of total billed charges,8.8,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,36.1,92% of total billed charges,6.61,100% of CMS fee schedule,26.81, 405.66% of CMS fee schedule,6.61,100% of CMS fee schedule,32.66,494.23% of CMS fee schedule,30.3, 458.54% of CMS fee schedule,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,27.47,70% of total billed charges,35.32,90% of total billed charges,37.28,95% of total billed charges,37.28,95% of total billed charges,6.61,100% of CMS fee schedule,13.22,200% of CMS fee schedule,33.75,86% of total billed charges,31.39,80% of total billed charges,7.33,111% of CMS fee schedule,38.06,97% of total billed charges,35.32,90% of total billed charges,N/A,not seperately reimbursable,38.06,97% of total billed charges,36.49,93% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,8,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,5.61,85% of CMS fee schedule,5.61,38.06,19.62
Outpatient Medical Services,LAB,80184,Phenobarbital Level,300,90.82,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,72.66,80% of total billed charges,15.3,100% of CMS fee schedule,81.74,90% of total billed charges,17.61,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,83.55,92% of total billed charges,15.3,100% of CMS fee schedule,62.06, 405.66% of CMS fee schedule,15.3,100% of CMS fee schedule,75.61,494.23% of CMS fee schedule,70.15, 458.54% of CMS fee schedule,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,63.57,70% of total billed charges,81.74,90% of total billed charges,86.28,95% of total billed charges,86.28,95% of total billed charges,15.3,100% of CMS fee schedule,30.6,200% of CMS fee schedule,78.11,86% of total billed charges,72.66,80% of total billed charges,16.98,111% of CMS fee schedule,88.1,97% of total billed charges,81.74,90% of total billed charges,N/A,not seperately reimbursable,88.1,97% of total billed charges,84.46,93% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,16.01,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,13,85% of CMS fee schedule,13,88.1,45.41
Outpatient Medical Services,LAB,80184,Phenobarb,300,90.82,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,72.66,80% of total billed charges,15.3,100% of CMS fee schedule,81.74,90% of total billed charges,17.61,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,83.55,92% of total billed charges,15.3,100% of CMS fee schedule,62.06, 405.66% of CMS fee schedule,15.3,100% of CMS fee schedule,75.61,494.23% of CMS fee schedule,70.15, 458.54% of CMS fee schedule,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,63.57,70% of total billed charges,81.74,90% of total billed charges,86.28,95% of total billed charges,86.28,95% of total billed charges,15.3,100% of CMS fee schedule,30.6,200% of CMS fee schedule,78.11,86% of total billed charges,72.66,80% of total billed charges,16.98,111% of CMS fee schedule,88.1,97% of total billed charges,81.74,90% of total billed charges,N/A,not seperately reimbursable,88.1,97% of total billed charges,84.46,93% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,16.01,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,13,85% of CMS fee schedule,13,88.1,45.41
Outpatient Medical Services,LAB,80184,80184 add-on,300,90.82,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,72.66,80% of total billed charges,15.3,100% of CMS fee schedule,81.74,90% of total billed charges,17.61,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,83.55,92% of total billed charges,15.3,100% of CMS fee schedule,62.06, 405.66% of CMS fee schedule,15.3,100% of CMS fee schedule,75.61,494.23% of CMS fee schedule,70.15, 458.54% of CMS fee schedule,81.74,90% of total billed charges,15.3,100% of CMS fee schedule,63.57,70% of total billed charges,81.74,90% of total billed charges,86.28,95% of total billed charges,86.28,95% of total billed charges,15.3,100% of CMS fee schedule,30.6,200% of CMS fee schedule,78.11,86% of total billed charges,72.66,80% of total billed charges,16.98,111% of CMS fee schedule,88.1,97% of total billed charges,81.74,90% of total billed charges,N/A,not seperately reimbursable,88.1,97% of total billed charges,84.46,93% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,16.01,100% of CMS fee schedule,88.1,97% of total billed charges,15.3,100% of CMS fee schedule,15.3,100% of CMS fee schedule,13,85% of CMS fee schedule,13,88.1,45.41
Outpatient Medical Services,LAB,80185,Phenytoin Level,300,78.65,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,62.92,80% of total billed charges,13.25,100% of CMS fee schedule,70.79,90% of total billed charges,14.3,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,72.36,92% of total billed charges,13.25,100% of CMS fee schedule,53.75, 405.66% of CMS fee schedule,13.25,100% of CMS fee schedule,65.48,494.23% of CMS fee schedule,60.75, 458.54% of CMS fee schedule,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,55.06,70% of total billed charges,70.79,90% of total billed charges,74.72,95% of total billed charges,74.72,95% of total billed charges,13.25,100% of CMS fee schedule,26.5,200% of CMS fee schedule,67.64,86% of total billed charges,62.92,80% of total billed charges,14.7,111% of CMS fee schedule,76.29,97% of total billed charges,70.79,90% of total billed charges,N/A,not seperately reimbursable,76.29,97% of total billed charges,73.14,93% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,13,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,11.26,85% of CMS fee schedule,11.26,76.29,39.33
Outpatient Medical Services,LAB,80185,Drug Profile - Phenytoin,300,78.65,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,62.92,80% of total billed charges,13.25,100% of CMS fee schedule,70.79,90% of total billed charges,14.3,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,72.36,92% of total billed charges,13.25,100% of CMS fee schedule,53.75, 405.66% of CMS fee schedule,13.25,100% of CMS fee schedule,65.48,494.23% of CMS fee schedule,60.75, 458.54% of CMS fee schedule,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,55.06,70% of total billed charges,70.79,90% of total billed charges,74.72,95% of total billed charges,74.72,95% of total billed charges,13.25,100% of CMS fee schedule,26.5,200% of CMS fee schedule,67.64,86% of total billed charges,62.92,80% of total billed charges,14.7,111% of CMS fee schedule,76.29,97% of total billed charges,70.79,90% of total billed charges,N/A,not seperately reimbursable,76.29,97% of total billed charges,73.14,93% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,13,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,11.26,85% of CMS fee schedule,11.26,76.29,39.33
Outpatient Medical Services,LAB,80185,80185 add-on,300,78.65,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,62.92,80% of total billed charges,13.25,100% of CMS fee schedule,70.79,90% of total billed charges,14.3,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,72.36,92% of total billed charges,13.25,100% of CMS fee schedule,53.75, 405.66% of CMS fee schedule,13.25,100% of CMS fee schedule,65.48,494.23% of CMS fee schedule,60.75, 458.54% of CMS fee schedule,70.79,90% of total billed charges,13.25,100% of CMS fee schedule,55.06,70% of total billed charges,70.79,90% of total billed charges,74.72,95% of total billed charges,74.72,95% of total billed charges,13.25,100% of CMS fee schedule,26.5,200% of CMS fee schedule,67.64,86% of total billed charges,62.92,80% of total billed charges,14.7,111% of CMS fee schedule,76.29,97% of total billed charges,70.79,90% of total billed charges,N/A,not seperately reimbursable,76.29,97% of total billed charges,73.14,93% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,13,100% of CMS fee schedule,76.29,97% of total billed charges,13.25,100% of CMS fee schedule,13.25,100% of CMS fee schedule,11.26,85% of CMS fee schedule,11.26,76.29,39.33
Outpatient Medical Services,LAB,80197,Tacrolimus Level,300,81.5,73.35,90% of total billed charges,13.73,100% of CMS fee schedule,65.2,80% of total billed charges,13.73,100% of CMS fee schedule,73.35,90% of total billed charges,17.12,100% of CMS fee schedule,79.06,97% of total billed charges,13.73,100% of CMS fee schedule,74.98,92% of total billed charges,13.73,100% of CMS fee schedule,55.69, 405.66% of CMS fee schedule,13.73,100% of CMS fee schedule,67.85,494.23% of CMS fee schedule,62.95, 458.54% of CMS fee schedule,73.35,90% of total billed charges,13.73,100% of CMS fee schedule,57.05,70% of total billed charges,73.35,90% of total billed charges,77.43,95% of total billed charges,77.43,95% of total billed charges,13.73,100% of CMS fee schedule,27.46,200% of CMS fee schedule,70.09,86% of total billed charges,65.2,80% of total billed charges,15.24,111% of CMS fee schedule,79.06,97% of total billed charges,73.35,90% of total billed charges,N/A,not seperately reimbursable,79.06,97% of total billed charges,75.8,93% of total billed charges,13.73,100% of CMS fee schedule,13.73,100% of CMS fee schedule,15.56,100% of CMS fee schedule,79.06,97% of total billed charges,13.73,100% of CMS fee schedule,13.73,100% of CMS fee schedule,11.67,85% of CMS fee schedule,11.67,79.06,40.75
Outpatient Medical Services,LAB,80198,Theophylline Level,300,83.93,75.54,90% of total billed charges,14.14,100% of CMS fee schedule,67.14,80% of total billed charges,14.14,100% of CMS fee schedule,75.54,90% of total billed charges,12.1,100% of CMS fee schedule,81.41,97% of total billed charges,14.14,100% of CMS fee schedule,77.22,92% of total billed charges,14.14,100% of CMS fee schedule,57.36, 405.66% of CMS fee schedule,14.14,100% of CMS fee schedule,69.88,494.23% of CMS fee schedule,64.83, 458.54% of CMS fee schedule,75.54,90% of total billed charges,14.14,100% of CMS fee schedule,58.75,70% of total billed charges,75.54,90% of total billed charges,79.73,95% of total billed charges,79.73,95% of total billed charges,14.14,100% of CMS fee schedule,28.28,200% of CMS fee schedule,72.18,86% of total billed charges,67.14,80% of total billed charges,15.69,111% of CMS fee schedule,81.41,97% of total billed charges,75.54,90% of total billed charges,N/A,not seperately reimbursable,81.41,97% of total billed charges,78.05,93% of total billed charges,14.14,100% of CMS fee schedule,14.14,100% of CMS fee schedule,11,100% of CMS fee schedule,81.41,97% of total billed charges,14.14,100% of CMS fee schedule,14.14,100% of CMS fee schedule,12.01,85% of CMS fee schedule,11,81.41,41.97
Outpatient Medical Services,LAB,80202,Vancomycin Level Peak,300,80.37,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,64.3,80% of total billed charges,13.54,100% of CMS fee schedule,72.33,90% of total billed charges,20.59,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,73.94,92% of total billed charges,13.54,100% of CMS fee schedule,54.92, 405.66% of CMS fee schedule,13.54,100% of CMS fee schedule,66.91,494.23% of CMS fee schedule,62.08, 458.54% of CMS fee schedule,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,56.26,70% of total billed charges,72.33,90% of total billed charges,76.35,95% of total billed charges,76.35,95% of total billed charges,13.54,100% of CMS fee schedule,27.08,200% of CMS fee schedule,69.12,86% of total billed charges,64.3,80% of total billed charges,15.02,111% of CMS fee schedule,77.96,97% of total billed charges,72.33,90% of total billed charges,N/A,not seperately reimbursable,77.96,97% of total billed charges,74.74,93% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,18.72,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,11.5,85% of CMS fee schedule,11.5,77.96,40.19
Outpatient Medical Services,LAB,80202,Vancomycin Level Trough,300,80.37,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,64.3,80% of total billed charges,13.54,100% of CMS fee schedule,72.33,90% of total billed charges,20.59,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,73.94,92% of total billed charges,13.54,100% of CMS fee schedule,54.92, 405.66% of CMS fee schedule,13.54,100% of CMS fee schedule,66.91,494.23% of CMS fee schedule,62.08, 458.54% of CMS fee schedule,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,56.26,70% of total billed charges,72.33,90% of total billed charges,76.35,95% of total billed charges,76.35,95% of total billed charges,13.54,100% of CMS fee schedule,27.08,200% of CMS fee schedule,69.12,86% of total billed charges,64.3,80% of total billed charges,15.02,111% of CMS fee schedule,77.96,97% of total billed charges,72.33,90% of total billed charges,N/A,not seperately reimbursable,77.96,97% of total billed charges,74.74,93% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,18.72,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,11.5,85% of CMS fee schedule,11.5,77.96,40.19
Outpatient Medical Services,LAB,80202,Vancomycin Level Random,300,80.37,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,64.3,80% of total billed charges,13.54,100% of CMS fee schedule,72.33,90% of total billed charges,20.59,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,73.94,92% of total billed charges,13.54,100% of CMS fee schedule,54.92, 405.66% of CMS fee schedule,13.54,100% of CMS fee schedule,66.91,494.23% of CMS fee schedule,62.08, 458.54% of CMS fee schedule,72.33,90% of total billed charges,13.54,100% of CMS fee schedule,56.26,70% of total billed charges,72.33,90% of total billed charges,76.35,95% of total billed charges,76.35,95% of total billed charges,13.54,100% of CMS fee schedule,27.08,200% of CMS fee schedule,69.12,86% of total billed charges,64.3,80% of total billed charges,15.02,111% of CMS fee schedule,77.96,97% of total billed charges,72.33,90% of total billed charges,N/A,not seperately reimbursable,77.96,97% of total billed charges,74.74,93% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,18.72,100% of CMS fee schedule,77.96,97% of total billed charges,13.54,100% of CMS fee schedule,13.54,100% of CMS fee schedule,11.5,85% of CMS fee schedule,11.5,77.96,40.19
Outpatient Medical Services,LAB,80305,Drug Screening POC,300,74.79,67.31,90% of total billed charges,12.6,100% of CMS fee schedule,59.83,80% of total billed charges,12.6,100% of CMS fee schedule,67.31,90% of total billed charges,13.17,100% of CMS fee schedule,72.55,97% of total billed charges,12.6,100% of CMS fee schedule,68.81,92% of total billed charges,12.6,100% of CMS fee schedule,51.11, 405.66% of CMS fee schedule,12.6,100% of CMS fee schedule,62.27,494.23% of CMS fee schedule,57.77, 458.54% of CMS fee schedule,67.31,90% of total billed charges,12.6,100% of CMS fee schedule,52.35,70% of total billed charges,67.31,90% of total billed charges,71.05,95% of total billed charges,71.05,95% of total billed charges,12.6,100% of CMS fee schedule,25.2,200% of CMS fee schedule,64.32,86% of total billed charges,59.83,80% of total billed charges,13.98,111% of CMS fee schedule,72.55,97% of total billed charges,67.31,90% of total billed charges,N/A,not seperately reimbursable,72.55,97% of total billed charges,69.55,93% of total billed charges,12.6,100% of CMS fee schedule,12.6,100% of CMS fee schedule,11.97,100% of CMS fee schedule,72.55,97% of total billed charges,12.6,100% of CMS fee schedule,12.6,100% of CMS fee schedule,10.71,85% of CMS fee schedule,10.71,72.55,37.40
Outpatient Medical Services,LAB,80305,Drug Screen MC,300,74.79,67.31,90% of total billed charges,12.6,100% of CMS fee schedule,59.83,80% of total billed charges,12.6,100% of CMS fee schedule,67.31,90% of total billed charges,13.17,100% of CMS fee schedule,72.55,97% of total billed charges,12.6,100% of CMS fee schedule,68.81,92% of total billed charges,12.6,100% of CMS fee schedule,51.11, 405.66% of CMS fee schedule,12.6,100% of CMS fee schedule,62.27,494.23% of CMS fee schedule,57.77, 458.54% of CMS fee schedule,67.31,90% of total billed charges,12.6,100% of CMS fee schedule,52.35,70% of total billed charges,67.31,90% of total billed charges,71.05,95% of total billed charges,71.05,95% of total billed charges,12.6,100% of CMS fee schedule,25.2,200% of CMS fee schedule,64.32,86% of total billed charges,59.83,80% of total billed charges,13.98,111% of CMS fee schedule,72.55,97% of total billed charges,67.31,90% of total billed charges,N/A,not seperately reimbursable,72.55,97% of total billed charges,69.55,93% of total billed charges,12.6,100% of CMS fee schedule,12.6,100% of CMS fee schedule,11.97,100% of CMS fee schedule,72.55,97% of total billed charges,12.6,100% of CMS fee schedule,12.6,100% of CMS fee schedule,10.71,85% of CMS fee schedule,10.71,72.55,37.40
Outpatient Medical Services,LAB,80307,Ethyl Alcohol Level,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Salicylate Level,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Analysis Comp with Volitiles,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Analysis Serum,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Screen w/ Cannabinoids Urine,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Volitiles Screen Ur GC,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Screen BL TLC,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Screen UGC TLC,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Ethclorv Screen SPL Color,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Benzodiaz Screen UGC IA,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Med Pro-11 Drugs,Screen+Conf, SO",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Med Pro-11-Ea Drug Class,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Meconium 5-Drug Screen,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Profile - Ethchlorvynol,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Profile - Meprobamate,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Drug Profile - Tricyclics,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Cannabinoid Screen by Immunoassay,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Benzodiazepines Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Cocaine Metabolite Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Amphetamines/Methamphetamines Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Barbiturates Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Methadone Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Opiates Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Phencyclidine Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Cannabinoids Screen, UR",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Meconium 9 Drug Screen SO,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Amphetamines",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Barbiturates",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Cannabinoids",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Cocaine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Methadone",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Opiates",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Propoxyphene",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Meconium 9, Benzodiazepines",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug Profile 14, SO",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Barbiturate",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Benzodiazapine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Cannabinoid",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Cocaine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Opiates",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Oxycodone",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Phencyclidine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Methadone",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Propoxyphene",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Meperidine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Tramadol",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Fentanyl",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Monitor Drug 14, Buprenorphine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Buprenorphine Screen, Urine",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Salicylate Level,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,Monitor Drug Profile 14(MW) LC,300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Drug Screen 9 w/Conf,Meconium LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Comprehensive Drug Analysis,Ur LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Comp. Drug Scr, Umbil.Cord LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Drug Screen 13 w/Conf, Serum LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Oxycodone/Oxymorphone, Urine LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,80307 add-on,300,0.01,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,0.01,N/A
Outpatient Medical Services,LAB,80307,"Expanded Drug Scr, Umbil. Cord LC",300,453.15,407.84,90% of total billed charges,62.14,100% of CMS fee schedule,362.52,80% of total billed charges,62.14,100% of CMS fee schedule,407.84,90% of total billed charges,70.24,100% of CMS fee schedule,439.56,97% of total billed charges,62.14,100% of CMS fee schedule,416.9,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,407.84,90% of total billed charges,62.14,100% of CMS fee schedule,317.21,70% of total billed charges,407.84,90% of total billed charges,430.49,95% of total billed charges,430.49,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,389.71,86% of total billed charges,362.52,80% of total billed charges,68.97,111% of CMS fee schedule,439.56,97% of total billed charges,407.84,90% of total billed charges,N/A,not seperately reimbursable,439.56,97% of total billed charges,421.43,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,439.56,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,439.56,226.58
Outpatient Medical Services,LAB,80307,"Gabapentin, Urine LC",300,455.57,410.01,90% of total billed charges,62.14,100% of CMS fee schedule,364.46,80% of total billed charges,62.14,100% of CMS fee schedule,410.01,90% of total billed charges,70.24,100% of CMS fee schedule,441.9,97% of total billed charges,62.14,100% of CMS fee schedule,419.12,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,410.01,90% of total billed charges,62.14,100% of CMS fee schedule,318.9,70% of total billed charges,410.01,90% of total billed charges,432.79,95% of total billed charges,432.79,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,391.79,86% of total billed charges,364.46,80% of total billed charges,68.97,111% of CMS fee schedule,441.9,97% of total billed charges,410.01,90% of total billed charges,N/A,not seperately reimbursable,441.9,97% of total billed charges,423.68,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,441.9,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,441.9,227.79
Outpatient Medical Services,LAB,80307,"THC, Scr w/Conf, SE LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Drug Screen 10 w/Conf, Serum LC",300,513.34,462.01,90% of total billed charges,62.14,100% of CMS fee schedule,410.67,80% of total billed charges,62.14,100% of CMS fee schedule,462.01,90% of total billed charges,70.24,100% of CMS fee schedule,497.94,97% of total billed charges,62.14,100% of CMS fee schedule,472.27,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,462.01,90% of total billed charges,62.14,100% of CMS fee schedule,359.34,70% of total billed charges,462.01,90% of total billed charges,487.67,95% of total billed charges,487.67,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,441.47,86% of total billed charges,410.67,80% of total billed charges,68.97,111% of CMS fee schedule,497.94,97% of total billed charges,462.01,90% of total billed charges,N/A,not seperately reimbursable,497.94,97% of total billed charges,477.41,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,497.94,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,497.94,256.67
Outpatient Medical Services,LAB,80307,"THC, Scr w/Conf, WB LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Drug Screen 13 w/Conf, WB LC",300,641.67,577.5,90% of total billed charges,62.14,100% of CMS fee schedule,513.34,80% of total billed charges,62.14,100% of CMS fee schedule,577.5,90% of total billed charges,70.24,100% of CMS fee schedule,622.42,97% of total billed charges,62.14,100% of CMS fee schedule,590.34,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,577.5,90% of total billed charges,62.14,100% of CMS fee schedule,449.17,70% of total billed charges,577.5,90% of total billed charges,609.59,95% of total billed charges,609.59,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,551.84,86% of total billed charges,513.34,80% of total billed charges,68.97,111% of CMS fee schedule,622.42,97% of total billed charges,577.5,90% of total billed charges,N/A,not seperately reimbursable,622.42,97% of total billed charges,596.75,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,622.42,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,622.42,320.84
Outpatient Medical Services,LAB,80307,"General Tox Profile, Ur, 15 LC",300,522.72,470.45,90% of total billed charges,62.14,100% of CMS fee schedule,418.18,80% of total billed charges,62.14,100% of CMS fee schedule,470.45,90% of total billed charges,70.24,100% of CMS fee schedule,507.04,97% of total billed charges,62.14,100% of CMS fee schedule,480.9,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,470.45,90% of total billed charges,62.14,100% of CMS fee schedule,365.9,70% of total billed charges,470.45,90% of total billed charges,496.58,95% of total billed charges,496.58,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,449.54,86% of total billed charges,418.18,80% of total billed charges,68.97,111% of CMS fee schedule,507.04,97% of total billed charges,470.45,90% of total billed charges,N/A,not seperately reimbursable,507.04,97% of total billed charges,486.13,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,507.04,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,507.04,261.36
Outpatient Medical Services,LAB,80307,"General Tox Profile, Ur, 8 LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Expanded Drug Scr+EtG, Umb LC",300,612.15,550.94,90% of total billed charges,62.14,100% of CMS fee schedule,489.72,80% of total billed charges,62.14,100% of CMS fee schedule,550.94,90% of total billed charges,70.24,100% of CMS fee schedule,593.79,97% of total billed charges,62.14,100% of CMS fee schedule,563.18,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,550.94,90% of total billed charges,62.14,100% of CMS fee schedule,428.51,70% of total billed charges,550.94,90% of total billed charges,581.54,95% of total billed charges,581.54,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,526.45,86% of total billed charges,489.72,80% of total billed charges,68.97,111% of CMS fee schedule,593.79,97% of total billed charges,550.94,90% of total billed charges,N/A,not seperately reimbursable,593.79,97% of total billed charges,569.3,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,593.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,593.79,306.08
Outpatient Medical Services,LAB,80307,"Opiates, Urine LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Nicotine Metabolite, Urine LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80307,"Buprenorphine Scr/Cnf,Meconium LC",300,368.86,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,295.09,80% of total billed charges,62.14,100% of CMS fee schedule,331.97,90% of total billed charges,70.24,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,339.35,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,331.97,90% of total billed charges,62.14,100% of CMS fee schedule,258.2,70% of total billed charges,331.97,90% of total billed charges,350.42,95% of total billed charges,350.42,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,317.22,86% of total billed charges,295.09,80% of total billed charges,68.97,111% of CMS fee schedule,357.79,97% of total billed charges,331.97,90% of total billed charges,N/A,not seperately reimbursable,357.79,97% of total billed charges,343.04,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,357.79,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,357.79,184.43
Outpatient Medical Services,LAB,80329,Drug Profile - Salicylate,300,679.26,611.33,90% of total billed charges,N/A,not seperately reimbursable,543.41,80% of total billed charges,N/A,not seperately reimbursable,611.33,90% of total billed charges,8.5,100% of CMS fee schedule,658.88,97% of total billed charges,N/A,not seperately reimbursable,624.92,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,611.33,90% of total billed charges,N/A,not seperately reimbursable,475.48,70% of total billed charges,611.33,90% of total billed charges,645.3,95% of total billed charges,645.3,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,584.16,86% of total billed charges,543.41,80% of total billed charges,N/A,not seperately reimbursable,658.88,97% of total billed charges,611.33,90% of total billed charges,N/A,not seperately reimbursable,658.88,97% of total billed charges,631.71,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.73,100% of CMS fee schedule,658.88,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.73,658.88,339.63
Outpatient Medical Services,LAB,81001,Urinalysis w/ Reflexive Microscopic,300,18.82,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,4.77,150% of AETNA fee schedule,3.17,100% of CMS fee schedule,16.94,90% of total billed charges,3.3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,17.31,92% of total billed charges,3.17,100% of CMS fee schedule,12.85, 405.66% of CMS fee schedule,3.17,100% of CMS fee schedule,15.66,494.23% of CMS fee schedule,14.53, 458.54% of CMS fee schedule,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,13.17,70% of total billed charges,16.94,90% of total billed charges,17.88,95% of total billed charges,17.88,95% of total billed charges,3.17,100% of CMS fee schedule,6.34,200% of CMS fee schedule,16.19,86% of total billed charges,15.06,80% of total billed charges,3.51,111% of CMS fee schedule,18.26,97% of total billed charges,16.94,90% of total billed charges,N/A,not seperately reimbursable,18.26,97% of total billed charges,17.5,93% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,2.69,85% of CMS fee schedule,2.69,18.26,9.41
Outpatient Medical Services,LAB,81001,Urinalysis w/ Microscopic,300,18.82,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,4.77,150% of AETNA fee schedule,3.17,100% of CMS fee schedule,16.94,90% of total billed charges,3.3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,17.31,92% of total billed charges,3.17,100% of CMS fee schedule,12.85, 405.66% of CMS fee schedule,3.17,100% of CMS fee schedule,15.66,494.23% of CMS fee schedule,14.53, 458.54% of CMS fee schedule,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,13.17,70% of total billed charges,16.94,90% of total billed charges,17.88,95% of total billed charges,17.88,95% of total billed charges,3.17,100% of CMS fee schedule,6.34,200% of CMS fee schedule,16.19,86% of total billed charges,15.06,80% of total billed charges,3.51,111% of CMS fee schedule,18.26,97% of total billed charges,16.94,90% of total billed charges,N/A,not seperately reimbursable,18.26,97% of total billed charges,17.5,93% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,2.69,85% of CMS fee schedule,2.69,18.26,9.41
Outpatient Medical Services,LAB,81001,UA Microscopic?,300,18.82,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,4.77,150% of AETNA fee schedule,3.17,100% of CMS fee schedule,16.94,90% of total billed charges,3.3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,17.31,92% of total billed charges,3.17,100% of CMS fee schedule,12.85, 405.66% of CMS fee schedule,3.17,100% of CMS fee schedule,15.66,494.23% of CMS fee schedule,14.53, 458.54% of CMS fee schedule,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,13.17,70% of total billed charges,16.94,90% of total billed charges,17.88,95% of total billed charges,17.88,95% of total billed charges,3.17,100% of CMS fee schedule,6.34,200% of CMS fee schedule,16.19,86% of total billed charges,15.06,80% of total billed charges,3.51,111% of CMS fee schedule,18.26,97% of total billed charges,16.94,90% of total billed charges,N/A,not seperately reimbursable,18.26,97% of total billed charges,17.5,93% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,2.69,85% of CMS fee schedule,2.69,18.26,9.41
Outpatient Medical Services,LAB,81001,UA MICROSCOPIC YES,300,18.82,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,4.77,150% of AETNA fee schedule,3.17,100% of CMS fee schedule,16.94,90% of total billed charges,3.3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,17.31,92% of total billed charges,3.17,100% of CMS fee schedule,12.85, 405.66% of CMS fee schedule,3.17,100% of CMS fee schedule,15.66,494.23% of CMS fee schedule,14.53, 458.54% of CMS fee schedule,16.94,90% of total billed charges,3.17,100% of CMS fee schedule,13.17,70% of total billed charges,16.94,90% of total billed charges,17.88,95% of total billed charges,17.88,95% of total billed charges,3.17,100% of CMS fee schedule,6.34,200% of CMS fee schedule,16.19,86% of total billed charges,15.06,80% of total billed charges,3.51,111% of CMS fee schedule,18.26,97% of total billed charges,16.94,90% of total billed charges,N/A,not seperately reimbursable,18.26,97% of total billed charges,17.5,93% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,3,100% of CMS fee schedule,18.26,97% of total billed charges,3.17,100% of CMS fee schedule,3.17,100% of CMS fee schedule,2.69,85% of CMS fee schedule,2.69,18.26,9.41
Outpatient Medical Services,LAB,81002,Urinalysis Dipstick POC,300,20.66,18.59,90% of total billed charges,3.48,100% of CMS fee schedule,16.53,80% of total billed charges,3.48,100% of CMS fee schedule,18.59,90% of total billed charges,3.93,100% of CMS fee schedule,20.04,97% of total billed charges,3.48,100% of CMS fee schedule,19.01,92% of total billed charges,3.48,100% of CMS fee schedule,14.11, 405.66% of CMS fee schedule,3.48,100% of CMS fee schedule,17.19,494.23% of CMS fee schedule,15.95, 458.54% of CMS fee schedule,18.59,90% of total billed charges,3.48,100% of CMS fee schedule,14.46,70% of total billed charges,18.59,90% of total billed charges,19.63,95% of total billed charges,19.63,95% of total billed charges,3.48,100% of CMS fee schedule,6.96,200% of CMS fee schedule,17.77,86% of total billed charges,16.53,80% of total billed charges,3.86,111% of CMS fee schedule,20.04,97% of total billed charges,18.59,90% of total billed charges,N/A,not seperately reimbursable,20.04,97% of total billed charges,19.21,93% of total billed charges,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,3.57,100% of CMS fee schedule,20.04,97% of total billed charges,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,2.95,85% of CMS fee schedule,2.95,20.04,10.33
Outpatient Medical Services,LAB,81002,81002 - Urinalysis Dipstick,300,20.66,18.59,90% of total billed charges,3.48,100% of CMS fee schedule,16.53,80% of total billed charges,3.48,100% of CMS fee schedule,18.59,90% of total billed charges,3.93,100% of CMS fee schedule,20.04,97% of total billed charges,3.48,100% of CMS fee schedule,19.01,92% of total billed charges,3.48,100% of CMS fee schedule,14.11, 405.66% of CMS fee schedule,3.48,100% of CMS fee schedule,17.19,494.23% of CMS fee schedule,15.95, 458.54% of CMS fee schedule,18.59,90% of total billed charges,3.48,100% of CMS fee schedule,14.46,70% of total billed charges,18.59,90% of total billed charges,19.63,95% of total billed charges,19.63,95% of total billed charges,3.48,100% of CMS fee schedule,6.96,200% of CMS fee schedule,17.77,86% of total billed charges,16.53,80% of total billed charges,3.86,111% of CMS fee schedule,20.04,97% of total billed charges,18.59,90% of total billed charges,N/A,not seperately reimbursable,20.04,97% of total billed charges,19.21,93% of total billed charges,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,3.57,100% of CMS fee schedule,20.04,97% of total billed charges,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,2.95,85% of CMS fee schedule,2.95,20.04,10.33
Outpatient Medical Services,LAB,81003,Urinalysis w/o Microscopic,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urinalysis OB Screen,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urinalysis Dipstick,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urinalysis Dipstick MGH,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urine Dipstick 2GP POC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urine Dipstick 10 POC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,OB Urine Dipstick 2 GP POC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,81003- Urinalysis Dipstick POC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,Urinalysis Dipstick POC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,81003,UA w/o Micro MC,300,13.36,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,3.38,150% of AETNA fee schedule,2.25,100% of CMS fee schedule,12.02,90% of total billed charges,3.41,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,12.29,92% of total billed charges,2.25,100% of CMS fee schedule,9.12, 405.66% of CMS fee schedule,2.25,100% of CMS fee schedule,11.12,494.23% of CMS fee schedule,10.31, 458.54% of CMS fee schedule,12.02,90% of total billed charges,2.25,100% of CMS fee schedule,9.35,70% of total billed charges,12.02,90% of total billed charges,12.69,95% of total billed charges,12.69,95% of total billed charges,2.25,100% of CMS fee schedule,4.5,200% of CMS fee schedule,11.49,86% of total billed charges,10.69,80% of total billed charges,2.49,111% of CMS fee schedule,12.96,97% of total billed charges,12.02,90% of total billed charges,N/A,not seperately reimbursable,12.96,97% of total billed charges,12.42,93% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,3.1,100% of CMS fee schedule,12.96,97% of total billed charges,2.25,100% of CMS fee schedule,2.25,100% of CMS fee schedule,1.91,85% of CMS fee schedule,1.91,12.96,6.68
Outpatient Medical Services,LAB,82024,Adrenocorticotropic Hormone,300,229.25,206.33,90% of total billed charges,38.61,100% of CMS fee schedule,183.4,80% of total billed charges,38.61,100% of CMS fee schedule,206.33,90% of total billed charges,44,100% of CMS fee schedule,222.37,97% of total billed charges,38.61,100% of CMS fee schedule,210.91,92% of total billed charges,38.61,100% of CMS fee schedule,156.66, 405.66% of CMS fee schedule,38.61,100% of CMS fee schedule,190.87,494.23% of CMS fee schedule,177.08, 458.54% of CMS fee schedule,206.33,90% of total billed charges,38.61,100% of CMS fee schedule,160.48,70% of total billed charges,206.33,90% of total billed charges,217.79,95% of total billed charges,217.79,95% of total billed charges,38.61,100% of CMS fee schedule,77.24,200% of CMS fee schedule,197.16,86% of total billed charges,183.4,80% of total billed charges,42.86,111% of CMS fee schedule,222.37,97% of total billed charges,206.33,90% of total billed charges,N/A,not seperately reimbursable,222.37,97% of total billed charges,213.2,93% of total billed charges,38.61,100% of CMS fee schedule,38.61,100% of CMS fee schedule,40,100% of CMS fee schedule,222.37,97% of total billed charges,38.61,100% of CMS fee schedule,38.61,100% of CMS fee schedule,32.82,85% of CMS fee schedule,32.82,222.37,114.63
Outpatient Medical Services,LAB,82140,"Ammonia, Level",300,86.49,77.84,90% of total billed charges,14.57,100% of CMS fee schedule,69.19,80% of total billed charges,14.57,100% of CMS fee schedule,77.84,90% of total billed charges,5.5,100% of CMS fee schedule,83.9,97% of total billed charges,14.57,100% of CMS fee schedule,79.57,92% of total billed charges,14.57,100% of CMS fee schedule,59.1, 405.66% of CMS fee schedule,14.57,100% of CMS fee schedule,72,494.23% of CMS fee schedule,66.8, 458.54% of CMS fee schedule,77.84,90% of total billed charges,14.57,100% of CMS fee schedule,60.54,70% of total billed charges,77.84,90% of total billed charges,82.17,95% of total billed charges,82.17,95% of total billed charges,14.57,100% of CMS fee schedule,29.14,200% of CMS fee schedule,74.38,86% of total billed charges,69.19,80% of total billed charges,16.17,111% of CMS fee schedule,83.9,97% of total billed charges,77.84,90% of total billed charges,N/A,not seperately reimbursable,83.9,97% of total billed charges,80.44,93% of total billed charges,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,5,100% of CMS fee schedule,83.9,97% of total billed charges,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,12.38,85% of CMS fee schedule,5,83.9,43.25
Outpatient Medical Services,LAB,82140,"82140 - Kidney Stone, 24h Urine/Saturation LC - ADD-ON",300,46.87,42.18,90% of total billed charges,14.57,100% of CMS fee schedule,37.5,80% of total billed charges,14.57,100% of CMS fee schedule,42.18,90% of total billed charges,5.5,100% of CMS fee schedule,45.46,97% of total billed charges,14.57,100% of CMS fee schedule,43.12,92% of total billed charges,14.57,100% of CMS fee schedule,59.1, 405.66% of CMS fee schedule,14.57,100% of CMS fee schedule,72,494.23% of CMS fee schedule,66.8, 458.54% of CMS fee schedule,42.18,90% of total billed charges,14.57,100% of CMS fee schedule,32.81,70% of total billed charges,42.18,90% of total billed charges,44.53,95% of total billed charges,44.53,95% of total billed charges,14.57,100% of CMS fee schedule,29.14,200% of CMS fee schedule,40.31,86% of total billed charges,37.5,80% of total billed charges,16.17,111% of CMS fee schedule,45.46,97% of total billed charges,42.18,90% of total billed charges,N/A,not seperately reimbursable,45.46,97% of total billed charges,43.59,93% of total billed charges,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,5,100% of CMS fee schedule,45.46,97% of total billed charges,14.57,100% of CMS fee schedule,14.57,100% of CMS fee schedule,12.38,85% of CMS fee schedule,5,72,23.44
Outpatient Medical Services,LAB,82150,Amylase,300,38.47,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,30.78,80% of total billed charges,6.48,100% of CMS fee schedule,34.62,90% of total billed charges,5.5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,35.39,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,26.93,70% of total billed charges,34.62,90% of total billed charges,36.55,95% of total billed charges,36.55,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,33.08,86% of total billed charges,30.78,80% of total billed charges,7.19,111% of CMS fee schedule,37.32,97% of total billed charges,34.62,90% of total billed charges,N/A,not seperately reimbursable,37.32,97% of total billed charges,35.78,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,37.32,19.24
Outpatient Medical Services,LAB,82150,Amylase Body Fluid,300,38.47,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,30.78,80% of total billed charges,6.48,100% of CMS fee schedule,34.62,90% of total billed charges,5.5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,35.39,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,26.93,70% of total billed charges,34.62,90% of total billed charges,36.55,95% of total billed charges,36.55,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,33.08,86% of total billed charges,30.78,80% of total billed charges,7.19,111% of CMS fee schedule,37.32,97% of total billed charges,34.62,90% of total billed charges,N/A,not seperately reimbursable,37.32,97% of total billed charges,35.78,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,37.32,19.24
Outpatient Medical Services,LAB,82150,Amylase Random Urine,300,10.31,9.28,90% of total billed charges,6.48,100% of CMS fee schedule,8.25,80% of total billed charges,6.48,100% of CMS fee schedule,9.28,90% of total billed charges,5.5,100% of CMS fee schedule,10,97% of total billed charges,6.48,100% of CMS fee schedule,9.49,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,9.28,90% of total billed charges,6.48,100% of CMS fee schedule,7.22,70% of total billed charges,9.28,90% of total billed charges,9.79,95% of total billed charges,9.79,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,8.87,86% of total billed charges,8.25,80% of total billed charges,7.19,111% of CMS fee schedule,10,97% of total billed charges,9.28,90% of total billed charges,N/A,not seperately reimbursable,10,97% of total billed charges,9.59,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,10,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,32.02,5.16
Outpatient Medical Services,LAB,82150,Amylase Isoenzymes,300,44.67,40.2,90% of total billed charges,6.48,100% of CMS fee schedule,35.74,80% of total billed charges,6.48,100% of CMS fee schedule,40.2,90% of total billed charges,5.5,100% of CMS fee schedule,43.33,97% of total billed charges,6.48,100% of CMS fee schedule,41.1,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,40.2,90% of total billed charges,6.48,100% of CMS fee schedule,31.27,70% of total billed charges,40.2,90% of total billed charges,42.44,95% of total billed charges,42.44,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,38.42,86% of total billed charges,35.74,80% of total billed charges,7.19,111% of CMS fee schedule,43.33,97% of total billed charges,40.2,90% of total billed charges,N/A,not seperately reimbursable,43.33,97% of total billed charges,41.54,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,43.33,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,43.33,22.34
Outpatient Medical Services,LAB,82150,82150 - Amylase Isoenzymes ADD-ON,300,44.67,40.2,90% of total billed charges,6.48,100% of CMS fee schedule,35.74,80% of total billed charges,6.48,100% of CMS fee schedule,40.2,90% of total billed charges,5.5,100% of CMS fee schedule,43.33,97% of total billed charges,6.48,100% of CMS fee schedule,41.1,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,40.2,90% of total billed charges,6.48,100% of CMS fee schedule,31.27,70% of total billed charges,40.2,90% of total billed charges,42.44,95% of total billed charges,42.44,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,38.42,86% of total billed charges,35.74,80% of total billed charges,7.19,111% of CMS fee schedule,43.33,97% of total billed charges,40.2,90% of total billed charges,N/A,not seperately reimbursable,43.33,97% of total billed charges,41.54,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,43.33,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,43.33,22.34
Outpatient Medical Services,LAB,82150,MC Amylase,300,38.47,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,30.78,80% of total billed charges,6.48,100% of CMS fee schedule,34.62,90% of total billed charges,5.5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,35.39,92% of total billed charges,6.48,100% of CMS fee schedule,26.28, 405.66% of CMS fee schedule,6.48,100% of CMS fee schedule,32.02,494.23% of CMS fee schedule,29.71, 458.54% of CMS fee schedule,34.62,90% of total billed charges,6.48,100% of CMS fee schedule,26.93,70% of total billed charges,34.62,90% of total billed charges,36.55,95% of total billed charges,36.55,95% of total billed charges,6.48,100% of CMS fee schedule,12.96,200% of CMS fee schedule,33.08,86% of total billed charges,30.78,80% of total billed charges,7.19,111% of CMS fee schedule,37.32,97% of total billed charges,34.62,90% of total billed charges,N/A,not seperately reimbursable,37.32,97% of total billed charges,35.78,93% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5,100% of CMS fee schedule,37.32,97% of total billed charges,6.48,100% of CMS fee schedule,6.48,100% of CMS fee schedule,5.5,85% of CMS fee schedule,5,37.32,19.24
Outpatient Medical Services,LAB,82232,Aldosterone,300,96.05,86.45,90% of total billed charges,16.18,100% of CMS fee schedule,76.84,80% of total billed charges,16.18,100% of CMS fee schedule,86.45,90% of total billed charges,20.9,100% of CMS fee schedule,93.17,97% of total billed charges,16.18,100% of CMS fee schedule,88.37,92% of total billed charges,16.18,100% of CMS fee schedule,65.63, 405.66% of CMS fee schedule,16.18,100% of CMS fee schedule,79.96,494.23% of CMS fee schedule,74.19, 458.54% of CMS fee schedule,86.45,90% of total billed charges,16.18,100% of CMS fee schedule,67.24,70% of total billed charges,86.45,90% of total billed charges,91.25,95% of total billed charges,91.25,95% of total billed charges,16.18,100% of CMS fee schedule,32.36,200% of CMS fee schedule,82.6,86% of total billed charges,76.84,80% of total billed charges,17.95,111% of CMS fee schedule,93.17,97% of total billed charges,86.45,90% of total billed charges,N/A,not seperately reimbursable,93.17,97% of total billed charges,89.33,93% of total billed charges,16.18,100% of CMS fee schedule,16.18,100% of CMS fee schedule,19,100% of CMS fee schedule,93.17,97% of total billed charges,16.18,100% of CMS fee schedule,16.18,100% of CMS fee schedule,13.75,85% of CMS fee schedule,13.75,93.17,48.03
Outpatient Medical Services,LAB,82232,"Beta-2 Microglobulin, Serum",300,96.05,86.45,90% of total billed charges,16.18,100% of CMS fee schedule,76.84,80% of total billed charges,16.18,100% of CMS fee schedule,86.45,90% of total billed charges,20.9,100% of CMS fee schedule,93.17,97% of total billed charges,16.18,100% of CMS fee schedule,88.37,92% of total billed charges,16.18,100% of CMS fee schedule,65.63, 405.66% of CMS fee schedule,16.18,100% of CMS fee schedule,79.96,494.23% of CMS fee schedule,74.19, 458.54% of CMS fee schedule,86.45,90% of total billed charges,16.18,100% of CMS fee schedule,67.24,70% of total billed charges,86.45,90% of total billed charges,91.25,95% of total billed charges,91.25,95% of total billed charges,16.18,100% of CMS fee schedule,32.36,200% of CMS fee schedule,82.6,86% of total billed charges,76.84,80% of total billed charges,17.95,111% of CMS fee schedule,93.17,97% of total billed charges,86.45,90% of total billed charges,N/A,not seperately reimbursable,93.17,97% of total billed charges,89.33,93% of total billed charges,16.18,100% of CMS fee schedule,16.18,100% of CMS fee schedule,19,100% of CMS fee schedule,93.17,97% of total billed charges,16.18,100% of CMS fee schedule,16.18,100% of CMS fee schedule,13.75,85% of CMS fee schedule,13.75,93.17,48.03
Outpatient Medical Services,LAB,82247,Bilirubin Total,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82247,Bilirubin Total Neonatal,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82247,Bilirubin Total,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82247,82247 add-on,300,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82248,Bilirubin Direct,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82248,Bilirubin Direct Neonatal,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82248,Bilirubin Indirect,301,29.8,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,23.84,80% of total billed charges,5.01,100% of CMS fee schedule,26.82,90% of total billed charges,7.62,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,27.42,92% of total billed charges,5.01,100% of CMS fee schedule,20.36, 405.66% of CMS fee schedule,5.01,100% of CMS fee schedule,24.81,494.23% of CMS fee schedule,23.01, 458.54% of CMS fee schedule,26.82,90% of total billed charges,5.01,100% of CMS fee schedule,20.86,70% of total billed charges,26.82,90% of total billed charges,28.31,95% of total billed charges,28.31,95% of total billed charges,5.01,100% of CMS fee schedule,10.04,200% of CMS fee schedule,25.63,86% of total billed charges,23.84,80% of total billed charges,5.57,111% of CMS fee schedule,28.91,97% of total billed charges,26.82,90% of total billed charges,N/A,not seperately reimbursable,28.91,97% of total billed charges,27.71,93% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,6.93,100% of CMS fee schedule,28.91,97% of total billed charges,5.01,100% of CMS fee schedule,5.01,100% of CMS fee schedule,4.26,85% of CMS fee schedule,4.26,28.91,14.90
Outpatient Medical Services,LAB,82274,Occult Blood Diagnostic,300,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82274,Occult Blood Diagnostic (FIT test),300,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82274,Occult Blood Diagnostic (FIT test) X 3,301,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82274,FIT POC,300,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82274,Occult Blood MC,300,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82274,Occult Blood Gastric MC,300,107.14,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,85.71,80% of total billed charges,15.92,100% of CMS fee schedule,96.43,90% of total billed charges,3.08,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,98.57,92% of total billed charges,15.92,100% of CMS fee schedule,64.58, 405.66% of CMS fee schedule,15.92,100% of CMS fee schedule,78.68,494.23% of CMS fee schedule,72.99, 458.54% of CMS fee schedule,96.43,90% of total billed charges,15.92,100% of CMS fee schedule,75,70% of total billed charges,96.43,90% of total billed charges,101.78,95% of total billed charges,101.78,95% of total billed charges,15.92,100% of CMS fee schedule,31.84,200% of CMS fee schedule,92.14,86% of total billed charges,85.71,80% of total billed charges,17.67,111% of CMS fee schedule,103.93,97% of total billed charges,96.43,90% of total billed charges,N/A,not seperately reimbursable,103.93,97% of total billed charges,99.64,93% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,2.8,100% of CMS fee schedule,103.93,97% of total billed charges,15.92,100% of CMS fee schedule,15.92,100% of CMS fee schedule,13.53,85% of CMS fee schedule,2.8,103.93,53.57
Outpatient Medical Services,LAB,82330,Calcium Level Ionized,300,9.28,8.35,90% of total billed charges,13.68,100% of CMS fee schedule,7.42,80% of total billed charges,13.68,100% of CMS fee schedule,8.35,90% of total billed charges,9.74,100% of CMS fee schedule,9,97% of total billed charges,13.68,100% of CMS fee schedule,8.54,92% of total billed charges,13.68,100% of CMS fee schedule,55.49, 405.66% of CMS fee schedule,13.68,100% of CMS fee schedule,67.61,494.23% of CMS fee schedule,62.72, 458.54% of CMS fee schedule,8.35,90% of total billed charges,13.68,100% of CMS fee schedule,6.5,70% of total billed charges,8.35,90% of total billed charges,8.82,95% of total billed charges,8.82,95% of total billed charges,13.68,100% of CMS fee schedule,27.36,200% of CMS fee schedule,7.98,86% of total billed charges,7.42,80% of total billed charges,15.18,111% of CMS fee schedule,9,97% of total billed charges,8.35,90% of total billed charges,N/A,not seperately reimbursable,9,97% of total billed charges,8.63,93% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,8.85,100% of CMS fee schedule,9,97% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,11.62,85% of CMS fee schedule,6.5,67.61,4.64
Outpatient Medical Services,LAB,82330,Calcium Level Ionized by Respiratory,300,81.21,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,64.97,80% of total billed charges,13.68,100% of CMS fee schedule,73.09,90% of total billed charges,9.74,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,74.71,92% of total billed charges,13.68,100% of CMS fee schedule,55.49, 405.66% of CMS fee schedule,13.68,100% of CMS fee schedule,67.61,494.23% of CMS fee schedule,62.72, 458.54% of CMS fee schedule,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,56.85,70% of total billed charges,73.09,90% of total billed charges,77.15,95% of total billed charges,77.15,95% of total billed charges,13.68,100% of CMS fee schedule,27.36,200% of CMS fee schedule,69.84,86% of total billed charges,64.97,80% of total billed charges,15.18,111% of CMS fee schedule,78.77,97% of total billed charges,73.09,90% of total billed charges,N/A,not seperately reimbursable,78.77,97% of total billed charges,75.53,93% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,8.85,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,11.62,85% of CMS fee schedule,8.85,78.77,40.61
Outpatient Medical Services,LAB,82330,"Ionized Calcium, POC",300,81.21,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,64.97,80% of total billed charges,13.68,100% of CMS fee schedule,73.09,90% of total billed charges,9.74,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,74.71,92% of total billed charges,13.68,100% of CMS fee schedule,55.49, 405.66% of CMS fee schedule,13.68,100% of CMS fee schedule,67.61,494.23% of CMS fee schedule,62.72, 458.54% of CMS fee schedule,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,56.85,70% of total billed charges,73.09,90% of total billed charges,77.15,95% of total billed charges,77.15,95% of total billed charges,13.68,100% of CMS fee schedule,27.36,200% of CMS fee schedule,69.84,86% of total billed charges,64.97,80% of total billed charges,15.18,111% of CMS fee schedule,78.77,97% of total billed charges,73.09,90% of total billed charges,N/A,not seperately reimbursable,78.77,97% of total billed charges,75.53,93% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,8.85,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,11.62,85% of CMS fee schedule,8.85,78.77,40.61
Outpatient Medical Services,LAB,82330,Electrolytes Venous by RT,300,81.21,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,64.97,80% of total billed charges,13.68,100% of CMS fee schedule,73.09,90% of total billed charges,9.74,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,74.71,92% of total billed charges,13.68,100% of CMS fee schedule,55.49, 405.66% of CMS fee schedule,13.68,100% of CMS fee schedule,67.61,494.23% of CMS fee schedule,62.72, 458.54% of CMS fee schedule,73.09,90% of total billed charges,13.68,100% of CMS fee schedule,56.85,70% of total billed charges,73.09,90% of total billed charges,77.15,95% of total billed charges,77.15,95% of total billed charges,13.68,100% of CMS fee schedule,27.36,200% of CMS fee schedule,69.84,86% of total billed charges,64.97,80% of total billed charges,15.18,111% of CMS fee schedule,78.77,97% of total billed charges,73.09,90% of total billed charges,N/A,not seperately reimbursable,78.77,97% of total billed charges,75.53,93% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,8.85,100% of CMS fee schedule,78.77,97% of total billed charges,13.68,100% of CMS fee schedule,13.68,100% of CMS fee schedule,11.62,85% of CMS fee schedule,8.85,78.77,40.61
Outpatient Medical Services,LAB,82530,zzzCortisol,301,93.58,84.22,90% of total billed charges,16.71,100% of CMS fee schedule,74.86,80% of total billed charges,16.71,100% of CMS fee schedule,84.22,90% of total billed charges,25.69,100% of CMS fee schedule,90.77,97% of total billed charges,16.71,100% of CMS fee schedule,86.09,92% of total billed charges,16.71,100% of CMS fee schedule,67.78, 405.66% of CMS fee schedule,16.71,100% of CMS fee schedule,82.58,494.23% of CMS fee schedule,76.62, 458.54% of CMS fee schedule,84.22,90% of total billed charges,16.71,100% of CMS fee schedule,65.51,70% of total billed charges,84.22,90% of total billed charges,88.9,95% of total billed charges,88.9,95% of total billed charges,16.71,100% of CMS fee schedule,33.42,200% of CMS fee schedule,80.48,86% of total billed charges,74.86,80% of total billed charges,18.54,111% of CMS fee schedule,90.77,97% of total billed charges,84.22,90% of total billed charges,N/A,not seperately reimbursable,90.77,97% of total billed charges,87.03,93% of total billed charges,16.71,100% of CMS fee schedule,16.71,100% of CMS fee schedule,23.35,100% of CMS fee schedule,90.77,97% of total billed charges,16.71,100% of CMS fee schedule,16.71,100% of CMS fee schedule,14.2,85% of CMS fee schedule,14.2,90.77,46.79
Outpatient Medical Services,LAB,82550,Creatine Kinase,300,38.65,34.79,90% of total billed charges,6.51,100% of CMS fee schedule,30.92,80% of total billed charges,6.51,100% of CMS fee schedule,34.79,90% of total billed charges,7.91,100% of CMS fee schedule,37.49,97% of total billed charges,6.51,100% of CMS fee schedule,35.56,92% of total billed charges,6.51,100% of CMS fee schedule,26.4, 405.66% of CMS fee schedule,6.51,100% of CMS fee schedule,32.17,494.23% of CMS fee schedule,29.85, 458.54% of CMS fee schedule,34.79,90% of total billed charges,6.51,100% of CMS fee schedule,27.06,70% of total billed charges,34.79,90% of total billed charges,36.72,95% of total billed charges,36.72,95% of total billed charges,6.51,100% of CMS fee schedule,13.02,200% of CMS fee schedule,33.24,86% of total billed charges,30.92,80% of total billed charges,7.22,111% of CMS fee schedule,37.49,97% of total billed charges,34.79,90% of total billed charges,N/A,not seperately reimbursable,37.49,97% of total billed charges,35.94,93% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,7.19,100% of CMS fee schedule,37.49,97% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,5.53,85% of CMS fee schedule,5.53,37.49,19.33
Outpatient Medical Services,LAB,82550,CK and Mass CKMB,300,38.65,34.79,90% of total billed charges,6.51,100% of CMS fee schedule,30.92,80% of total billed charges,6.51,100% of CMS fee schedule,34.79,90% of total billed charges,7.91,100% of CMS fee schedule,37.49,97% of total billed charges,6.51,100% of CMS fee schedule,35.56,92% of total billed charges,6.51,100% of CMS fee schedule,26.4, 405.66% of CMS fee schedule,6.51,100% of CMS fee schedule,32.17,494.23% of CMS fee schedule,29.85, 458.54% of CMS fee schedule,34.79,90% of total billed charges,6.51,100% of CMS fee schedule,27.06,70% of total billed charges,34.79,90% of total billed charges,36.72,95% of total billed charges,36.72,95% of total billed charges,6.51,100% of CMS fee schedule,13.02,200% of CMS fee schedule,33.24,86% of total billed charges,30.92,80% of total billed charges,7.22,111% of CMS fee schedule,37.49,97% of total billed charges,34.79,90% of total billed charges,N/A,not seperately reimbursable,37.49,97% of total billed charges,35.94,93% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,7.19,100% of CMS fee schedule,37.49,97% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,5.53,85% of CMS fee schedule,5.53,37.49,19.33
Outpatient Medical Services,LAB,82550,"CK, Total+Isoenzymes, Serum LC",300,10.58,9.52,90% of total billed charges,6.51,100% of CMS fee schedule,8.46,80% of total billed charges,6.51,100% of CMS fee schedule,9.52,90% of total billed charges,7.91,100% of CMS fee schedule,10.26,97% of total billed charges,6.51,100% of CMS fee schedule,9.73,92% of total billed charges,6.51,100% of CMS fee schedule,26.4, 405.66% of CMS fee schedule,6.51,100% of CMS fee schedule,32.17,494.23% of CMS fee schedule,29.85, 458.54% of CMS fee schedule,9.52,90% of total billed charges,6.51,100% of CMS fee schedule,7.41,70% of total billed charges,9.52,90% of total billed charges,10.05,95% of total billed charges,10.05,95% of total billed charges,6.51,100% of CMS fee schedule,13.02,200% of CMS fee schedule,9.1,86% of total billed charges,8.46,80% of total billed charges,7.22,111% of CMS fee schedule,10.26,97% of total billed charges,9.52,90% of total billed charges,N/A,not seperately reimbursable,10.26,97% of total billed charges,9.84,93% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,7.19,100% of CMS fee schedule,10.26,97% of total billed charges,6.51,100% of CMS fee schedule,6.51,100% of CMS fee schedule,5.53,85% of CMS fee schedule,5.53,32.17,5.29
Outpatient Medical Services,LAB,82565,Creatinine Serum,300,30.39,27.35,90% of total billed charges,5.12,100% of CMS fee schedule,7.71,150% of AETNA fee schedule,5.12,100% of CMS fee schedule,27.35,90% of total billed charges,7.05,100% of CMS fee schedule,29.48,97% of total billed charges,5.12,100% of CMS fee schedule,27.96,92% of total billed charges,5.12,100% of CMS fee schedule,20.77, 405.66% of CMS fee schedule,5.12,100% of CMS fee schedule,25.3,494.23% of CMS fee schedule,23.47, 458.54% of CMS fee schedule,27.35,90% of total billed charges,5.12,100% of CMS fee schedule,21.27,70% of total billed charges,27.35,90% of total billed charges,28.87,95% of total billed charges,28.87,95% of total billed charges,5.12,100% of CMS fee schedule,10.24,200% of CMS fee schedule,26.14,86% of total billed charges,24.31,80% of total billed charges,5.68,111% of CMS fee schedule,29.48,97% of total billed charges,27.35,90% of total billed charges,N/A,not seperately reimbursable,29.48,97% of total billed charges,28.26,93% of total billed charges,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,6.41,100% of CMS fee schedule,29.48,97% of total billed charges,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,4.35,85% of CMS fee schedule,4.35,29.48,15.20
Outpatient Medical Services,LAB,82565,Creatinine POC,300,30.39,27.35,90% of total billed charges,5.12,100% of CMS fee schedule,7.71,150% of AETNA fee schedule,5.12,100% of CMS fee schedule,27.35,90% of total billed charges,7.05,100% of CMS fee schedule,29.48,97% of total billed charges,5.12,100% of CMS fee schedule,27.96,92% of total billed charges,5.12,100% of CMS fee schedule,20.77, 405.66% of CMS fee schedule,5.12,100% of CMS fee schedule,25.3,494.23% of CMS fee schedule,23.47, 458.54% of CMS fee schedule,27.35,90% of total billed charges,5.12,100% of CMS fee schedule,21.27,70% of total billed charges,27.35,90% of total billed charges,28.87,95% of total billed charges,28.87,95% of total billed charges,5.12,100% of CMS fee schedule,10.24,200% of CMS fee schedule,26.14,86% of total billed charges,24.31,80% of total billed charges,5.68,111% of CMS fee schedule,29.48,97% of total billed charges,27.35,90% of total billed charges,N/A,not seperately reimbursable,29.48,97% of total billed charges,28.26,93% of total billed charges,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,6.41,100% of CMS fee schedule,29.48,97% of total billed charges,5.12,100% of CMS fee schedule,5.12,100% of CMS fee schedule,4.35,85% of CMS fee schedule,4.35,29.48,15.20
Outpatient Medical Services,LAB,82570,Creatinine 24 Hour Urine,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82570,Creatinine Random Urine,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82570,Lead Random Urine,300,17.31,15.58,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,15.58,90% of total billed charges,7.87,100% of CMS fee schedule,16.79,97% of total billed charges,5.18,100% of CMS fee schedule,15.93,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,15.58,90% of total billed charges,5.18,100% of CMS fee schedule,12.12,70% of total billed charges,15.58,90% of total billed charges,16.44,95% of total billed charges,16.44,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,14.89,86% of total billed charges,13.85,80% of total billed charges,5.74,111% of CMS fee schedule,16.79,97% of total billed charges,15.58,90% of total billed charges,N/A,not seperately reimbursable,16.79,97% of total billed charges,16.1,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,16.79,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,25.6,8.66
Outpatient Medical Services,LAB,82570,Creatinine Urine-Send Out,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82570,Microalb/Creat Ratio-Urine Creatinine,301,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82570,82570 add-on,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82570,"Mercury, Urine LC",300,44.4,39.96,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,39.96,90% of total billed charges,7.87,100% of CMS fee schedule,43.07,97% of total billed charges,5.18,100% of CMS fee schedule,40.85,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,39.96,90% of total billed charges,5.18,100% of CMS fee schedule,31.08,70% of total billed charges,39.96,90% of total billed charges,42.18,95% of total billed charges,42.18,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,38.18,86% of total billed charges,35.52,80% of total billed charges,5.74,111% of CMS fee schedule,43.07,97% of total billed charges,39.96,90% of total billed charges,N/A,not seperately reimbursable,43.07,97% of total billed charges,41.29,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,43.07,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,43.07,22.20
Outpatient Medical Services,LAB,82570,82570 - Calcium/Creatinine Ratio LC ADD-ON,300,13.85,12.47,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,12.47,90% of total billed charges,7.87,100% of CMS fee schedule,13.43,97% of total billed charges,5.18,100% of CMS fee schedule,12.74,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,12.47,90% of total billed charges,5.18,100% of CMS fee schedule,9.7,70% of total billed charges,12.47,90% of total billed charges,13.16,95% of total billed charges,13.16,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,11.91,86% of total billed charges,11.08,80% of total billed charges,5.74,111% of CMS fee schedule,13.43,97% of total billed charges,12.47,90% of total billed charges,N/A,not seperately reimbursable,13.43,97% of total billed charges,12.88,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,13.43,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,25.6,6.93
Outpatient Medical Services,LAB,82570,"82570 - Kidney Stone, 24h Urine/Saturation LC - ADD-ON",300,46.87,42.18,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,42.18,90% of total billed charges,7.87,100% of CMS fee schedule,45.46,97% of total billed charges,5.18,100% of CMS fee schedule,43.12,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,42.18,90% of total billed charges,5.18,100% of CMS fee schedule,32.81,70% of total billed charges,42.18,90% of total billed charges,44.53,95% of total billed charges,44.53,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,40.31,86% of total billed charges,37.5,80% of total billed charges,5.74,111% of CMS fee schedule,45.46,97% of total billed charges,42.18,90% of total billed charges,N/A,not seperately reimbursable,45.46,97% of total billed charges,43.59,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,45.46,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,45.46,23.44
Outpatient Medical Services,LAB,82570,"Creatinine, Random Urine",300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.47,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,82607,zzVitamin B12 Level,300,84.45,76.01,90% of total billed charges,15.08,100% of CMS fee schedule,22.67,150% of AETNA fee schedule,15.08,100% of CMS fee schedule,76.01,90% of total billed charges,14.3,100% of CMS fee schedule,81.92,97% of total billed charges,15.08,100% of CMS fee schedule,77.69,92% of total billed charges,15.08,100% of CMS fee schedule,61.17, 405.66% of CMS fee schedule,15.08,100% of CMS fee schedule,74.53,494.23% of CMS fee schedule,69.14, 458.54% of CMS fee schedule,76.01,90% of total billed charges,15.08,100% of CMS fee schedule,59.12,70% of total billed charges,76.01,90% of total billed charges,80.23,95% of total billed charges,80.23,95% of total billed charges,15.08,100% of CMS fee schedule,30.16,200% of CMS fee schedule,72.63,86% of total billed charges,67.56,80% of total billed charges,16.73,111% of CMS fee schedule,81.92,97% of total billed charges,76.01,90% of total billed charges,N/A,not seperately reimbursable,81.92,97% of total billed charges,78.54,93% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,13,100% of CMS fee schedule,81.92,97% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,12.81,85% of CMS fee schedule,12.81,81.92,42.23
Outpatient Medical Services,LAB,82607,"Vitamin B12, Level",300,89.52,80.57,90% of total billed charges,15.08,100% of CMS fee schedule,22.67,150% of AETNA fee schedule,15.08,100% of CMS fee schedule,80.57,90% of total billed charges,14.3,100% of CMS fee schedule,86.83,97% of total billed charges,15.08,100% of CMS fee schedule,82.36,92% of total billed charges,15.08,100% of CMS fee schedule,61.17, 405.66% of CMS fee schedule,15.08,100% of CMS fee schedule,74.53,494.23% of CMS fee schedule,69.14, 458.54% of CMS fee schedule,80.57,90% of total billed charges,15.08,100% of CMS fee schedule,62.66,70% of total billed charges,80.57,90% of total billed charges,85.04,95% of total billed charges,85.04,95% of total billed charges,15.08,100% of CMS fee schedule,30.16,200% of CMS fee schedule,76.99,86% of total billed charges,71.62,80% of total billed charges,16.73,111% of CMS fee schedule,86.83,97% of total billed charges,80.57,90% of total billed charges,N/A,not seperately reimbursable,86.83,97% of total billed charges,83.25,93% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,13,100% of CMS fee schedule,86.83,97% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,12.81,85% of CMS fee schedule,12.81,86.83,44.76
Outpatient Medical Services,LAB,82607,Direct Access Lab Vitamin B12,300,10.6,9.54,90% of total billed charges,15.08,100% of CMS fee schedule,22.67,150% of AETNA fee schedule,15.08,100% of CMS fee schedule,9.54,90% of total billed charges,14.3,100% of CMS fee schedule,10.28,97% of total billed charges,15.08,100% of CMS fee schedule,9.75,92% of total billed charges,15.08,100% of CMS fee schedule,61.17, 405.66% of CMS fee schedule,15.08,100% of CMS fee schedule,74.53,494.23% of CMS fee schedule,69.14, 458.54% of CMS fee schedule,9.54,90% of total billed charges,15.08,100% of CMS fee schedule,7.42,70% of total billed charges,9.54,90% of total billed charges,10.07,95% of total billed charges,10.07,95% of total billed charges,15.08,100% of CMS fee schedule,30.16,200% of CMS fee schedule,9.12,86% of total billed charges,8.48,80% of total billed charges,16.73,111% of CMS fee schedule,10.28,97% of total billed charges,9.54,90% of total billed charges,N/A,not seperately reimbursable,10.28,97% of total billed charges,9.86,93% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,13,100% of CMS fee schedule,10.28,97% of total billed charges,15.08,100% of CMS fee schedule,15.08,100% of CMS fee schedule,12.81,85% of CMS fee schedule,7.42,74.53,5.30
Outpatient Medical Services,LAB,82728,Ferritin,300,80.91,72.82,90% of total billed charges,13.63,100% of CMS fee schedule,20.49,150% of AETNA fee schedule,13.63,100% of CMS fee schedule,72.82,90% of total billed charges,13.2,100% of CMS fee schedule,78.48,97% of total billed charges,13.63,100% of CMS fee schedule,74.44,92% of total billed charges,13.63,100% of CMS fee schedule,55.29, 405.66% of CMS fee schedule,13.63,100% of CMS fee schedule,67.36,494.23% of CMS fee schedule,62.49, 458.54% of CMS fee schedule,72.82,90% of total billed charges,13.63,100% of CMS fee schedule,56.64,70% of total billed charges,72.82,90% of total billed charges,76.86,95% of total billed charges,76.86,95% of total billed charges,13.63,100% of CMS fee schedule,27.26,200% of CMS fee schedule,69.58,86% of total billed charges,64.73,80% of total billed charges,15.12,111% of CMS fee schedule,78.48,97% of total billed charges,72.82,90% of total billed charges,N/A,not seperately reimbursable,78.48,97% of total billed charges,75.25,93% of total billed charges,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,12,100% of CMS fee schedule,78.48,97% of total billed charges,13.63,100% of CMS fee schedule,13.63,100% of CMS fee schedule,11.58,85% of CMS fee schedule,11.58,78.48,40.46
Outpatient Medical Services,LAB,82746,"Folate, Level",300,87.26,78.53,90% of total billed charges,14.7,100% of CMS fee schedule,21.23,150% of AETNA fee schedule,14.7,100% of CMS fee schedule,78.53,90% of total billed charges,13.2,100% of CMS fee schedule,84.64,97% of total billed charges,14.7,100% of CMS fee schedule,80.28,92% of total billed charges,14.7,100% of CMS fee schedule,59.63, 405.66% of CMS fee schedule,14.7,100% of CMS fee schedule,72.65,494.23% of CMS fee schedule,67.4, 458.54% of CMS fee schedule,78.53,90% of total billed charges,14.7,100% of CMS fee schedule,61.08,70% of total billed charges,78.53,90% of total billed charges,82.9,95% of total billed charges,82.9,95% of total billed charges,14.7,100% of CMS fee schedule,29.4,200% of CMS fee schedule,75.04,86% of total billed charges,69.81,80% of total billed charges,16.31,111% of CMS fee schedule,84.64,97% of total billed charges,78.53,90% of total billed charges,N/A,not seperately reimbursable,84.64,97% of total billed charges,81.15,93% of total billed charges,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,12,100% of CMS fee schedule,84.64,97% of total billed charges,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,12.49,85% of CMS fee schedule,12,84.64,43.63
Outpatient Medical Services,LAB,82746,Direct Access Lab Folate,300,15.9,14.31,90% of total billed charges,14.7,100% of CMS fee schedule,21.23,150% of AETNA fee schedule,14.7,100% of CMS fee schedule,14.31,90% of total billed charges,13.2,100% of CMS fee schedule,15.42,97% of total billed charges,14.7,100% of CMS fee schedule,14.63,92% of total billed charges,14.7,100% of CMS fee schedule,59.63, 405.66% of CMS fee schedule,14.7,100% of CMS fee schedule,72.65,494.23% of CMS fee schedule,67.4, 458.54% of CMS fee schedule,14.31,90% of total billed charges,14.7,100% of CMS fee schedule,11.13,70% of total billed charges,14.31,90% of total billed charges,15.11,95% of total billed charges,15.11,95% of total billed charges,14.7,100% of CMS fee schedule,29.4,200% of CMS fee schedule,13.67,86% of total billed charges,12.72,80% of total billed charges,16.31,111% of CMS fee schedule,15.42,97% of total billed charges,14.31,90% of total billed charges,N/A,not seperately reimbursable,15.42,97% of total billed charges,14.79,93% of total billed charges,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,12,100% of CMS fee schedule,15.42,97% of total billed charges,14.7,100% of CMS fee schedule,14.7,100% of CMS fee schedule,12.49,85% of CMS fee schedule,11.13,72.65,7.95
Outpatient Medical Services,LAB,82784,Immunoglobulin A,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunoglobulin IgG Subclasses,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunoglobulin M,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunofixation Serum LC,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunoglobulins G/A/M/E,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunoglobulins G/A/M,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Immunoglobulin G,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"Immunoglobulin, G, QN, S",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"Immunoglobulin, A, QN, S",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"Immunoglobulin, M, QN, S",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"Celiac Ab, IgA Quantitative",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"MS, Gammaglobulin, Each",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,"IFE/PE S-Gammaglob, Ea",300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Celiac Profile-Total IgA,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,Celiac Disease Comprehensive LC,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,82784 add-on,300,55.2,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,49.68,90% of total billed charges,14.14,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,50.78,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,49.68,90% of total billed charges,9.3,100% of CMS fee schedule,38.64,70% of total billed charges,49.68,90% of total billed charges,52.44,95% of total billed charges,52.44,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,47.47,86% of total billed charges,44.16,80% of total billed charges,10.32,111% of CMS fee schedule,53.54,97% of total billed charges,49.68,90% of total billed charges,N/A,not seperately reimbursable,53.54,97% of total billed charges,51.34,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,53.54,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,53.54,27.60
Outpatient Medical Services,LAB,82784,82784 - Immunoglobulin G Index LC ADD-ON,300,20.03,18.03,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,18.03,90% of total billed charges,14.14,100% of CMS fee schedule,19.43,97% of total billed charges,9.3,100% of CMS fee schedule,18.43,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,18.03,90% of total billed charges,9.3,100% of CMS fee schedule,14.02,70% of total billed charges,18.03,90% of total billed charges,19.03,95% of total billed charges,19.03,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,17.23,86% of total billed charges,16.02,80% of total billed charges,10.32,111% of CMS fee schedule,19.43,97% of total billed charges,18.03,90% of total billed charges,N/A,not seperately reimbursable,19.43,97% of total billed charges,18.63,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,19.43,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,45.96,10.02
Outpatient Medical Services,LAB,82784,82784 - Multiple Sclerosis(MS) Profile Lc ADD-ON,300,27.08,24.37,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,24.37,90% of total billed charges,14.14,100% of CMS fee schedule,26.27,97% of total billed charges,9.3,100% of CMS fee schedule,24.91,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,24.37,90% of total billed charges,9.3,100% of CMS fee schedule,18.96,70% of total billed charges,24.37,90% of total billed charges,25.73,95% of total billed charges,25.73,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,23.29,86% of total billed charges,21.66,80% of total billed charges,10.32,111% of CMS fee schedule,26.27,97% of total billed charges,24.37,90% of total billed charges,N/A,not seperately reimbursable,26.27,97% of total billed charges,25.18,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,26.27,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,45.96,13.54
Outpatient Medical Services,LAB,82784,"82784 - IFE, Dara-Specific, Serum Lc ADD-ON",300,236.35,212.72,90% of total billed charges,9.3,100% of CMS fee schedule,13.98,150% of AETNA fee schedule,9.3,100% of CMS fee schedule,212.72,90% of total billed charges,14.14,100% of CMS fee schedule,229.26,97% of total billed charges,9.3,100% of CMS fee schedule,217.44,92% of total billed charges,9.3,100% of CMS fee schedule,37.72, 405.66% of CMS fee schedule,9.3,100% of CMS fee schedule,45.96,494.23% of CMS fee schedule,42.64, 458.54% of CMS fee schedule,212.72,90% of total billed charges,9.3,100% of CMS fee schedule,165.45,70% of total billed charges,212.72,90% of total billed charges,224.53,95% of total billed charges,224.53,95% of total billed charges,9.3,100% of CMS fee schedule,18.6,200% of CMS fee schedule,203.26,86% of total billed charges,189.08,80% of total billed charges,10.32,111% of CMS fee schedule,229.26,97% of total billed charges,212.72,90% of total billed charges,N/A,not seperately reimbursable,229.26,97% of total billed charges,219.81,93% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,12.85,100% of CMS fee schedule,229.26,97% of total billed charges,9.3,100% of CMS fee schedule,9.3,100% of CMS fee schedule,7.9,85% of CMS fee schedule,7.9,229.26,118.18
Outpatient Medical Services,LAB,82803,Blood Gas,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas CODE BLUE,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas Arterial POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas Venous POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas Cord Venous,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas Cord Arterial,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,MC Blood Gas Arterial POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,MC Blood Gas Venous POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,MC Creatinine POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas (Art) CG4 POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas (Ven) CG4 POC,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82803,Blood Gas Venous,300,154.75,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,123.8,80% of total billed charges,26.07,100% of CMS fee schedule,139.28,90% of total billed charges,29.41,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,142.37,92% of total billed charges,26.07,100% of CMS fee schedule,105.75, 405.66% of CMS fee schedule,26.07,100% of CMS fee schedule,128.84,494.23% of CMS fee schedule,119.54, 458.54% of CMS fee schedule,139.28,90% of total billed charges,26.07,100% of CMS fee schedule,108.33,70% of total billed charges,139.28,90% of total billed charges,147.01,95% of total billed charges,147.01,95% of total billed charges,26.07,100% of CMS fee schedule,52.14,200% of CMS fee schedule,133.09,86% of total billed charges,123.8,80% of total billed charges,28.93,111% of CMS fee schedule,150.11,97% of total billed charges,139.28,90% of total billed charges,N/A,not seperately reimbursable,150.11,97% of total billed charges,143.92,93% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,26.74,100% of CMS fee schedule,150.11,97% of total billed charges,26.07,100% of CMS fee schedule,26.07,100% of CMS fee schedule,22.15,85% of CMS fee schedule,22.15,150.11,77.38
Outpatient Medical Services,LAB,82945,Glucose Body Fluid,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.77,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4.34,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82945,Glucose Cerebrospinal Fluid,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.77,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4.34,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 30 Minutesz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 1 Hourz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 2 Hourz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 3 Hourz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose Fastingz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,Glucose Level Serum,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 5 Hourz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,zGlucose 4 Hourz,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,Glucose Level Serum,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,"Glucose, 2-Hour Post Challenge",300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,"Glucose, 1-Hour Post Challenge",300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,"Glucose, POC",300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,"Glucose Level, Random",300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,Glucose POC,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,MC Glucose Capillary,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82947,82947 add-on,300,23.33,21,90% of total billed charges,3.93,100% of CMS fee schedule,18.66,80% of total billed charges,3.93,100% of CMS fee schedule,21,90% of total billed charges,4.4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,21.46,92% of total billed charges,3.93,100% of CMS fee schedule,15.94, 405.66% of CMS fee schedule,3.93,100% of CMS fee schedule,19.42,494.23% of CMS fee schedule,18.02, 458.54% of CMS fee schedule,21,90% of total billed charges,3.93,100% of CMS fee schedule,16.33,70% of total billed charges,21,90% of total billed charges,22.16,95% of total billed charges,22.16,95% of total billed charges,3.93,100% of CMS fee schedule,7.86,200% of CMS fee schedule,20.06,86% of total billed charges,18.66,80% of total billed charges,4.36,111% of CMS fee schedule,22.63,97% of total billed charges,21,90% of total billed charges,N/A,not seperately reimbursable,22.63,97% of total billed charges,21.7,93% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,4,100% of CMS fee schedule,22.63,97% of total billed charges,3.93,100% of CMS fee schedule,3.93,100% of CMS fee schedule,3.34,85% of CMS fee schedule,3.34,22.63,11.67
Outpatient Medical Services,LAB,82962,Glucose Capillary,300,19.47,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,15.58,80% of total billed charges,3.28,100% of CMS fee schedule,17.52,90% of total billed charges,2.2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,17.91,92% of total billed charges,3.28,100% of CMS fee schedule,13.3, 405.66% of CMS fee schedule,3.28,100% of CMS fee schedule,16.21,494.23% of CMS fee schedule,15.04, 458.54% of CMS fee schedule,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,13.63,70% of total billed charges,17.52,90% of total billed charges,18.5,95% of total billed charges,18.5,95% of total billed charges,3.28,100% of CMS fee schedule,6.56,200% of CMS fee schedule,16.74,86% of total billed charges,15.58,80% of total billed charges,3.64,111% of CMS fee schedule,18.89,97% of total billed charges,17.52,90% of total billed charges,N/A,not seperately reimbursable,18.89,97% of total billed charges,18.11,93% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2.78,85% of CMS fee schedule,2,18.89,9.74
Outpatient Medical Services,LAB,82962,Capillary Glucose Pre/Post Unit,301,19.47,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,15.58,80% of total billed charges,3.28,100% of CMS fee schedule,17.52,90% of total billed charges,2.2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,17.91,92% of total billed charges,3.28,100% of CMS fee schedule,13.3, 405.66% of CMS fee schedule,3.28,100% of CMS fee schedule,16.21,494.23% of CMS fee schedule,15.04, 458.54% of CMS fee schedule,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,13.63,70% of total billed charges,17.52,90% of total billed charges,18.5,95% of total billed charges,18.5,95% of total billed charges,3.28,100% of CMS fee schedule,6.56,200% of CMS fee schedule,16.74,86% of total billed charges,15.58,80% of total billed charges,3.64,111% of CMS fee schedule,18.89,97% of total billed charges,17.52,90% of total billed charges,N/A,not seperately reimbursable,18.89,97% of total billed charges,18.11,93% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2.78,85% of CMS fee schedule,2,18.89,9.74
Outpatient Medical Services,LAB,82962,Glucose Capillary IPU,300,19.47,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,15.58,80% of total billed charges,3.28,100% of CMS fee schedule,17.52,90% of total billed charges,2.2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,17.91,92% of total billed charges,3.28,100% of CMS fee schedule,13.3, 405.66% of CMS fee schedule,3.28,100% of CMS fee schedule,16.21,494.23% of CMS fee schedule,15.04, 458.54% of CMS fee schedule,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,13.63,70% of total billed charges,17.52,90% of total billed charges,18.5,95% of total billed charges,18.5,95% of total billed charges,3.28,100% of CMS fee schedule,6.56,200% of CMS fee schedule,16.74,86% of total billed charges,15.58,80% of total billed charges,3.64,111% of CMS fee schedule,18.89,97% of total billed charges,17.52,90% of total billed charges,N/A,not seperately reimbursable,18.89,97% of total billed charges,18.11,93% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2.78,85% of CMS fee schedule,2,18.89,9.74
Outpatient Medical Services,LAB,82962,POC Glucose Capillary,300,19.47,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,15.58,80% of total billed charges,3.28,100% of CMS fee schedule,17.52,90% of total billed charges,2.2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,17.91,92% of total billed charges,3.28,100% of CMS fee schedule,13.3, 405.66% of CMS fee schedule,3.28,100% of CMS fee schedule,16.21,494.23% of CMS fee schedule,15.04, 458.54% of CMS fee schedule,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,13.63,70% of total billed charges,17.52,90% of total billed charges,18.5,95% of total billed charges,18.5,95% of total billed charges,3.28,100% of CMS fee schedule,6.56,200% of CMS fee schedule,16.74,86% of total billed charges,15.58,80% of total billed charges,3.64,111% of CMS fee schedule,18.89,97% of total billed charges,17.52,90% of total billed charges,N/A,not seperately reimbursable,18.89,97% of total billed charges,18.11,93% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2.78,85% of CMS fee schedule,2,18.89,9.74
Outpatient Medical Services,LAB,82962,82962-CAPILLARY GLUCOSE(PRE/POST UNIT),300,19.47,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,15.58,80% of total billed charges,3.28,100% of CMS fee schedule,17.52,90% of total billed charges,2.2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,17.91,92% of total billed charges,3.28,100% of CMS fee schedule,13.3, 405.66% of CMS fee schedule,3.28,100% of CMS fee schedule,16.21,494.23% of CMS fee schedule,15.04, 458.54% of CMS fee schedule,17.52,90% of total billed charges,3.28,100% of CMS fee schedule,13.63,70% of total billed charges,17.52,90% of total billed charges,18.5,95% of total billed charges,18.5,95% of total billed charges,3.28,100% of CMS fee schedule,6.56,200% of CMS fee schedule,16.74,86% of total billed charges,15.58,80% of total billed charges,3.64,111% of CMS fee schedule,18.89,97% of total billed charges,17.52,90% of total billed charges,N/A,not seperately reimbursable,18.89,97% of total billed charges,18.11,93% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2,100% of CMS fee schedule,18.89,97% of total billed charges,3.28,100% of CMS fee schedule,3.28,100% of CMS fee schedule,2.78,85% of CMS fee schedule,2,18.89,9.74
Outpatient Medical Services,LAB,83036,"Hemoglobin, A1C",300,57.64,51.88,90% of total billed charges,9.71,100% of CMS fee schedule,14.6,150% of AETNA fee schedule,9.71,100% of CMS fee schedule,51.88,90% of total billed charges,7.7,100% of CMS fee schedule,55.91,97% of total billed charges,9.71,100% of CMS fee schedule,53.03,92% of total billed charges,9.71,100% of CMS fee schedule,39.38, 405.66% of CMS fee schedule,9.71,100% of CMS fee schedule,47.98,494.23% of CMS fee schedule,44.52, 458.54% of CMS fee schedule,51.88,90% of total billed charges,9.71,100% of CMS fee schedule,40.35,70% of total billed charges,51.88,90% of total billed charges,54.76,95% of total billed charges,54.76,95% of total billed charges,9.71,100% of CMS fee schedule,19.42,200% of CMS fee schedule,49.57,86% of total billed charges,46.11,80% of total billed charges,10.77,111% of CMS fee schedule,55.91,97% of total billed charges,51.88,90% of total billed charges,N/A,not seperately reimbursable,55.91,97% of total billed charges,53.61,93% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,7,100% of CMS fee schedule,55.91,97% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,8.25,85% of CMS fee schedule,7,55.91,28.82
Outpatient Medical Services,LAB,83036,"Health Fair Hemoglobin, A1C",300,23.74,21.37,90% of total billed charges,9.71,100% of CMS fee schedule,14.6,150% of AETNA fee schedule,9.71,100% of CMS fee schedule,21.37,90% of total billed charges,7.7,100% of CMS fee schedule,23.03,97% of total billed charges,9.71,100% of CMS fee schedule,21.84,92% of total billed charges,9.71,100% of CMS fee schedule,39.38, 405.66% of CMS fee schedule,9.71,100% of CMS fee schedule,47.98,494.23% of CMS fee schedule,44.52, 458.54% of CMS fee schedule,21.37,90% of total billed charges,9.71,100% of CMS fee schedule,16.62,70% of total billed charges,21.37,90% of total billed charges,22.55,95% of total billed charges,22.55,95% of total billed charges,9.71,100% of CMS fee schedule,19.42,200% of CMS fee schedule,20.42,86% of total billed charges,18.99,80% of total billed charges,10.77,111% of CMS fee schedule,23.03,97% of total billed charges,21.37,90% of total billed charges,N/A,not seperately reimbursable,23.03,97% of total billed charges,22.08,93% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,7,100% of CMS fee schedule,23.03,97% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,8.25,85% of CMS fee schedule,7,47.98,11.87
Outpatient Medical Services,LAB,83036,Direct Access Lab HgbA1C,300,21.2,19.08,90% of total billed charges,9.71,100% of CMS fee schedule,14.6,150% of AETNA fee schedule,9.71,100% of CMS fee schedule,19.08,90% of total billed charges,7.7,100% of CMS fee schedule,20.56,97% of total billed charges,9.71,100% of CMS fee schedule,19.5,92% of total billed charges,9.71,100% of CMS fee schedule,39.38, 405.66% of CMS fee schedule,9.71,100% of CMS fee schedule,47.98,494.23% of CMS fee schedule,44.52, 458.54% of CMS fee schedule,19.08,90% of total billed charges,9.71,100% of CMS fee schedule,14.84,70% of total billed charges,19.08,90% of total billed charges,20.14,95% of total billed charges,20.14,95% of total billed charges,9.71,100% of CMS fee schedule,19.42,200% of CMS fee schedule,18.23,86% of total billed charges,16.96,80% of total billed charges,10.77,111% of CMS fee schedule,20.56,97% of total billed charges,19.08,90% of total billed charges,N/A,not seperately reimbursable,20.56,97% of total billed charges,19.72,93% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,7,100% of CMS fee schedule,20.56,97% of total billed charges,9.71,100% of CMS fee schedule,9.71,100% of CMS fee schedule,8.25,85% of CMS fee schedule,7,47.98,10.60
Outpatient Medical Services,LAB,83605,Lactic  Acid,300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,8.8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,8,66.62,34.34
Outpatient Medical Services,LAB,83605,Lactic Acid by Respiratory Therapy,300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,8.8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,8,66.62,34.34
Outpatient Medical Services,LAB,83605,MC Lactic Acid,300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,8.8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,8,66.62,34.34
Outpatient Medical Services,LAB,83605,MC Lactic Acid (Art),300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,8.8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,8,66.62,34.34
Outpatient Medical Services,LAB,83605,"Lactic Acid by RT, Venous",300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,8.8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,8,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,8,66.62,34.34
Outpatient Medical Services,LAB,83615,Lactate Dehydrogenase,300,35.85,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,9.08,150% of AETNA fee schedule,6.04,100% of CMS fee schedule,32.27,90% of total billed charges,7.91,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,32.98,92% of total billed charges,6.04,100% of CMS fee schedule,24.5, 405.66% of CMS fee schedule,6.04,100% of CMS fee schedule,29.85,494.23% of CMS fee schedule,27.69, 458.54% of CMS fee schedule,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,25.1,70% of total billed charges,32.27,90% of total billed charges,34.06,95% of total billed charges,34.06,95% of total billed charges,6.04,100% of CMS fee schedule,12.08,200% of CMS fee schedule,30.83,86% of total billed charges,28.68,80% of total billed charges,6.7,111% of CMS fee schedule,34.77,97% of total billed charges,32.27,90% of total billed charges,N/A,not seperately reimbursable,34.77,97% of total billed charges,33.34,93% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,7.19,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,5.13,85% of CMS fee schedule,5.13,34.77,17.93
Outpatient Medical Services,LAB,83615,Lactate Dehydrogenase Body Fluid,300,35.85,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,9.08,150% of AETNA fee schedule,6.04,100% of CMS fee schedule,32.27,90% of total billed charges,7.91,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,32.98,92% of total billed charges,6.04,100% of CMS fee schedule,24.5, 405.66% of CMS fee schedule,6.04,100% of CMS fee schedule,29.85,494.23% of CMS fee schedule,27.69, 458.54% of CMS fee schedule,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,25.1,70% of total billed charges,32.27,90% of total billed charges,34.06,95% of total billed charges,34.06,95% of total billed charges,6.04,100% of CMS fee schedule,12.08,200% of CMS fee schedule,30.83,86% of total billed charges,28.68,80% of total billed charges,6.7,111% of CMS fee schedule,34.77,97% of total billed charges,32.27,90% of total billed charges,N/A,not seperately reimbursable,34.77,97% of total billed charges,33.34,93% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,7.19,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,5.13,85% of CMS fee schedule,5.13,34.77,17.93
Outpatient Medical Services,LAB,83615,"Lactate Dehydrogenase, SO",300,35.85,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,9.08,150% of AETNA fee schedule,6.04,100% of CMS fee schedule,32.27,90% of total billed charges,7.91,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,32.98,92% of total billed charges,6.04,100% of CMS fee schedule,24.5, 405.66% of CMS fee schedule,6.04,100% of CMS fee schedule,29.85,494.23% of CMS fee schedule,27.69, 458.54% of CMS fee schedule,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,25.1,70% of total billed charges,32.27,90% of total billed charges,34.06,95% of total billed charges,34.06,95% of total billed charges,6.04,100% of CMS fee schedule,12.08,200% of CMS fee schedule,30.83,86% of total billed charges,28.68,80% of total billed charges,6.7,111% of CMS fee schedule,34.77,97% of total billed charges,32.27,90% of total billed charges,N/A,not seperately reimbursable,34.77,97% of total billed charges,33.34,93% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,7.19,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,5.13,85% of CMS fee schedule,5.13,34.77,17.93
Outpatient Medical Services,LAB,83615,Lactate Dehydrogenase CSF,300,35.85,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,9.08,150% of AETNA fee schedule,6.04,100% of CMS fee schedule,32.27,90% of total billed charges,7.91,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,32.98,92% of total billed charges,6.04,100% of CMS fee schedule,24.5, 405.66% of CMS fee schedule,6.04,100% of CMS fee schedule,29.85,494.23% of CMS fee schedule,27.69, 458.54% of CMS fee schedule,32.27,90% of total billed charges,6.04,100% of CMS fee schedule,25.1,70% of total billed charges,32.27,90% of total billed charges,34.06,95% of total billed charges,34.06,95% of total billed charges,6.04,100% of CMS fee schedule,12.08,200% of CMS fee schedule,30.83,86% of total billed charges,28.68,80% of total billed charges,6.7,111% of CMS fee schedule,34.77,97% of total billed charges,32.27,90% of total billed charges,N/A,not seperately reimbursable,34.77,97% of total billed charges,33.34,93% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,7.19,100% of CMS fee schedule,34.77,97% of total billed charges,6.04,100% of CMS fee schedule,6.04,100% of CMS fee schedule,5.13,85% of CMS fee schedule,5.13,34.77,17.93
Outpatient Medical Services,LAB,83690,Lipase,300,40.89,36.8,90% of total billed charges,6.89,100% of CMS fee schedule,32.71,80% of total billed charges,6.89,100% of CMS fee schedule,36.8,90% of total billed charges,5.5,100% of CMS fee schedule,39.66,97% of total billed charges,6.89,100% of CMS fee schedule,37.62,92% of total billed charges,6.89,100% of CMS fee schedule,27.95, 405.66% of CMS fee schedule,6.89,100% of CMS fee schedule,34.05,494.23% of CMS fee schedule,31.59, 458.54% of CMS fee schedule,36.8,90% of total billed charges,6.89,100% of CMS fee schedule,28.62,70% of total billed charges,36.8,90% of total billed charges,38.85,95% of total billed charges,38.85,95% of total billed charges,6.89,100% of CMS fee schedule,13.78,200% of CMS fee schedule,35.17,86% of total billed charges,32.71,80% of total billed charges,7.64,111% of CMS fee schedule,39.66,97% of total billed charges,36.8,90% of total billed charges,N/A,not seperately reimbursable,39.66,97% of total billed charges,38.03,93% of total billed charges,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,5,100% of CMS fee schedule,39.66,97% of total billed charges,6.89,100% of CMS fee schedule,6.89,100% of CMS fee schedule,5.85,85% of CMS fee schedule,5,39.66,20.45
Outpatient Medical Services,LAB,83735,Magnesium Level,300,39.77,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,35.79,90% of total billed charges,7.98,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,36.59,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,27.84,70% of total billed charges,35.79,90% of total billed charges,37.78,95% of total billed charges,37.78,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,34.2,86% of total billed charges,31.82,80% of total billed charges,7.43,111% of CMS fee schedule,38.58,97% of total billed charges,35.79,90% of total billed charges,N/A,not seperately reimbursable,38.58,97% of total billed charges,36.99,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,38.58,19.89
Outpatient Medical Services,LAB,83735,Magnesium Level 24 Hour Urine,300,39.77,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,35.79,90% of total billed charges,7.98,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,36.59,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,27.84,70% of total billed charges,35.79,90% of total billed charges,37.78,95% of total billed charges,37.78,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,34.2,86% of total billed charges,31.82,80% of total billed charges,7.43,111% of CMS fee schedule,38.58,97% of total billed charges,35.79,90% of total billed charges,N/A,not seperately reimbursable,38.58,97% of total billed charges,36.99,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,38.58,19.89
Outpatient Medical Services,LAB,83735,"Magnesium, Urine-MUA",300,39.77,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,35.79,90% of total billed charges,7.98,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,36.59,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,27.84,70% of total billed charges,35.79,90% of total billed charges,37.78,95% of total billed charges,37.78,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,34.2,86% of total billed charges,31.82,80% of total billed charges,7.43,111% of CMS fee schedule,38.58,97% of total billed charges,35.79,90% of total billed charges,N/A,not seperately reimbursable,38.58,97% of total billed charges,36.99,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,38.58,19.89
Outpatient Medical Services,LAB,83735,Magnesium-RBC,300,39.77,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,35.79,90% of total billed charges,7.98,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,36.59,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,27.84,70% of total billed charges,35.79,90% of total billed charges,37.78,95% of total billed charges,37.78,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,34.2,86% of total billed charges,31.82,80% of total billed charges,7.43,111% of CMS fee schedule,38.58,97% of total billed charges,35.79,90% of total billed charges,N/A,not seperately reimbursable,38.58,97% of total billed charges,36.99,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,38.58,19.89
Outpatient Medical Services,LAB,83735,Direct Access Lab Magnesium,300,39.77,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,35.79,90% of total billed charges,7.98,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,36.59,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,35.79,90% of total billed charges,6.7,100% of CMS fee schedule,27.84,70% of total billed charges,35.79,90% of total billed charges,37.78,95% of total billed charges,37.78,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,34.2,86% of total billed charges,31.82,80% of total billed charges,7.43,111% of CMS fee schedule,38.58,97% of total billed charges,35.79,90% of total billed charges,N/A,not seperately reimbursable,38.58,97% of total billed charges,36.99,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,38.58,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,38.58,19.89
Outpatient Medical Services,LAB,83735,"83735 - Kidney Stone, 24h Urine/Saturation LC - ADD-ON",300,46.87,42.18,90% of total billed charges,6.7,100% of CMS fee schedule,10.08,150% of AETNA fee schedule,6.7,100% of CMS fee schedule,42.18,90% of total billed charges,7.98,100% of CMS fee schedule,45.46,97% of total billed charges,6.7,100% of CMS fee schedule,43.12,92% of total billed charges,6.7,100% of CMS fee schedule,27.17, 405.66% of CMS fee schedule,6.7,100% of CMS fee schedule,33.11,494.23% of CMS fee schedule,30.72, 458.54% of CMS fee schedule,42.18,90% of total billed charges,6.7,100% of CMS fee schedule,32.81,70% of total billed charges,42.18,90% of total billed charges,44.53,95% of total billed charges,44.53,95% of total billed charges,6.7,100% of CMS fee schedule,13.4,200% of CMS fee schedule,40.31,86% of total billed charges,37.5,80% of total billed charges,7.43,111% of CMS fee schedule,45.46,97% of total billed charges,42.18,90% of total billed charges,N/A,not seperately reimbursable,45.46,97% of total billed charges,43.59,93% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,7.25,100% of CMS fee schedule,45.46,97% of total billed charges,6.7,100% of CMS fee schedule,6.7,100% of CMS fee schedule,5.69,85% of CMS fee schedule,5.69,45.46,23.44
Outpatient Medical Services,LAB,83880,B-type Natriuretic Peptide,300,233.05,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,48.99,150% of AETNA fee schedule,39.26,100% of CMS fee schedule,209.75,90% of total billed charges,41.73,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,214.41,92% of total billed charges,39.26,100% of CMS fee schedule,159.26, 405.66% of CMS fee schedule,39.26,100% of CMS fee schedule,194.03,494.23% of CMS fee schedule,180.02, 458.54% of CMS fee schedule,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,163.14,70% of total billed charges,209.75,90% of total billed charges,221.4,95% of total billed charges,221.4,95% of total billed charges,39.26,100% of CMS fee schedule,78.52,200% of CMS fee schedule,200.42,86% of total billed charges,186.44,80% of total billed charges,43.57,111% of CMS fee schedule,226.06,97% of total billed charges,209.75,90% of total billed charges,N/A,not seperately reimbursable,226.06,97% of total billed charges,216.74,93% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,37.94,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,33.37,85% of CMS fee schedule,33.37,226.06,116.53
Outpatient Medical Services,LAB,83880,B-type Natriuretic Peptide POC,300,233.05,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,48.99,150% of AETNA fee schedule,39.26,100% of CMS fee schedule,209.75,90% of total billed charges,41.73,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,214.41,92% of total billed charges,39.26,100% of CMS fee schedule,159.26, 405.66% of CMS fee schedule,39.26,100% of CMS fee schedule,194.03,494.23% of CMS fee schedule,180.02, 458.54% of CMS fee schedule,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,163.14,70% of total billed charges,209.75,90% of total billed charges,221.4,95% of total billed charges,221.4,95% of total billed charges,39.26,100% of CMS fee schedule,78.52,200% of CMS fee schedule,200.42,86% of total billed charges,186.44,80% of total billed charges,43.57,111% of CMS fee schedule,226.06,97% of total billed charges,209.75,90% of total billed charges,N/A,not seperately reimbursable,226.06,97% of total billed charges,216.74,93% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,37.94,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,33.37,85% of CMS fee schedule,33.37,226.06,116.53
Outpatient Medical Services,LAB,83880,BNP POC MC,300,233.05,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,48.99,150% of AETNA fee schedule,39.26,100% of CMS fee schedule,209.75,90% of total billed charges,41.73,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,214.41,92% of total billed charges,39.26,100% of CMS fee schedule,159.26, 405.66% of CMS fee schedule,39.26,100% of CMS fee schedule,194.03,494.23% of CMS fee schedule,180.02, 458.54% of CMS fee schedule,209.75,90% of total billed charges,39.26,100% of CMS fee schedule,163.14,70% of total billed charges,209.75,90% of total billed charges,221.4,95% of total billed charges,221.4,95% of total billed charges,39.26,100% of CMS fee schedule,78.52,200% of CMS fee schedule,200.42,86% of total billed charges,186.44,80% of total billed charges,43.57,111% of CMS fee schedule,226.06,97% of total billed charges,209.75,90% of total billed charges,N/A,not seperately reimbursable,226.06,97% of total billed charges,216.74,93% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,37.94,100% of CMS fee schedule,226.06,97% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,33.37,85% of CMS fee schedule,33.37,226.06,116.53
Outpatient Medical Services,LAB,83880,NT-proBNP LC,300,350.36,315.32,90% of total billed charges,39.26,100% of CMS fee schedule,48.99,150% of AETNA fee schedule,39.26,100% of CMS fee schedule,315.32,90% of total billed charges,41.73,100% of CMS fee schedule,339.85,97% of total billed charges,39.26,100% of CMS fee schedule,322.33,92% of total billed charges,39.26,100% of CMS fee schedule,159.26, 405.66% of CMS fee schedule,39.26,100% of CMS fee schedule,194.03,494.23% of CMS fee schedule,180.02, 458.54% of CMS fee schedule,315.32,90% of total billed charges,39.26,100% of CMS fee schedule,245.25,70% of total billed charges,315.32,90% of total billed charges,332.84,95% of total billed charges,332.84,95% of total billed charges,39.26,100% of CMS fee schedule,78.52,200% of CMS fee schedule,301.31,86% of total billed charges,280.29,80% of total billed charges,43.57,111% of CMS fee schedule,339.85,97% of total billed charges,315.32,90% of total billed charges,N/A,not seperately reimbursable,339.85,97% of total billed charges,325.83,93% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,37.94,100% of CMS fee schedule,339.85,97% of total billed charges,39.26,100% of CMS fee schedule,39.26,100% of CMS fee schedule,33.37,85% of CMS fee schedule,33.37,339.85,175.18
Outpatient Medical Services,LAB,83930,Osmolality Serum,300,39.24,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,31.39,80% of total billed charges,6.61,100% of CMS fee schedule,35.32,90% of total billed charges,3.3,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,36.1,92% of total billed charges,6.61,100% of CMS fee schedule,26.81, 405.66% of CMS fee schedule,6.61,100% of CMS fee schedule,32.66,494.23% of CMS fee schedule,30.3, 458.54% of CMS fee schedule,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,27.47,70% of total billed charges,35.32,90% of total billed charges,37.28,95% of total billed charges,37.28,95% of total billed charges,6.61,100% of CMS fee schedule,13.22,200% of CMS fee schedule,33.75,86% of total billed charges,31.39,80% of total billed charges,7.33,111% of CMS fee schedule,38.06,97% of total billed charges,35.32,90% of total billed charges,N/A,not seperately reimbursable,38.06,97% of total billed charges,36.49,93% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,3,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,5.61,85% of CMS fee schedule,3,38.06,19.62
Outpatient Medical Services,LAB,83930,"Osmolality-Serum, STAT to Ruby",300,39.24,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,31.39,80% of total billed charges,6.61,100% of CMS fee schedule,35.32,90% of total billed charges,3.3,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,36.1,92% of total billed charges,6.61,100% of CMS fee schedule,26.81, 405.66% of CMS fee schedule,6.61,100% of CMS fee schedule,32.66,494.23% of CMS fee schedule,30.3, 458.54% of CMS fee schedule,35.32,90% of total billed charges,6.61,100% of CMS fee schedule,27.47,70% of total billed charges,35.32,90% of total billed charges,37.28,95% of total billed charges,37.28,95% of total billed charges,6.61,100% of CMS fee schedule,13.22,200% of CMS fee schedule,33.75,86% of total billed charges,31.39,80% of total billed charges,7.33,111% of CMS fee schedule,38.06,97% of total billed charges,35.32,90% of total billed charges,N/A,not seperately reimbursable,38.06,97% of total billed charges,36.49,93% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,3,100% of CMS fee schedule,38.06,97% of total billed charges,6.61,100% of CMS fee schedule,6.61,100% of CMS fee schedule,5.61,85% of CMS fee schedule,3,38.06,19.62
Outpatient Medical Services,LAB,83935,Osmolality Random Urine,300,40.48,36.43,90% of total billed charges,6.82,100% of CMS fee schedule,32.38,80% of total billed charges,6.82,100% of CMS fee schedule,36.43,90% of total billed charges,3.3,100% of CMS fee schedule,39.27,97% of total billed charges,6.82,100% of CMS fee schedule,37.24,92% of total billed charges,6.82,100% of CMS fee schedule,27.66, 405.66% of CMS fee schedule,6.82,100% of CMS fee schedule,33.7,494.23% of CMS fee schedule,31.27, 458.54% of CMS fee schedule,36.43,90% of total billed charges,6.82,100% of CMS fee schedule,28.34,70% of total billed charges,36.43,90% of total billed charges,38.46,95% of total billed charges,38.46,95% of total billed charges,6.82,100% of CMS fee schedule,13.64,200% of CMS fee schedule,34.81,86% of total billed charges,32.38,80% of total billed charges,7.57,111% of CMS fee schedule,39.27,97% of total billed charges,36.43,90% of total billed charges,N/A,not seperately reimbursable,39.27,97% of total billed charges,37.65,93% of total billed charges,6.82,100% of CMS fee schedule,6.82,100% of CMS fee schedule,3,100% of CMS fee schedule,39.27,97% of total billed charges,6.82,100% of CMS fee schedule,6.82,100% of CMS fee schedule,5.79,85% of CMS fee schedule,3,39.27,20.24
Outpatient Medical Services,LAB,83935,"Osmolality-Urine, STAT to Ruby",300,40.48,36.43,90% of total billed charges,6.82,100% of CMS fee schedule,32.38,80% of total billed charges,6.82,100% of CMS fee schedule,36.43,90% of total billed charges,3.3,100% of CMS fee schedule,39.27,97% of total billed charges,6.82,100% of CMS fee schedule,37.24,92% of total billed charges,6.82,100% of CMS fee schedule,27.66, 405.66% of CMS fee schedule,6.82,100% of CMS fee schedule,33.7,494.23% of CMS fee schedule,31.27, 458.54% of CMS fee schedule,36.43,90% of total billed charges,6.82,100% of CMS fee schedule,28.34,70% of total billed charges,36.43,90% of total billed charges,38.46,95% of total billed charges,38.46,95% of total billed charges,6.82,100% of CMS fee schedule,13.64,200% of CMS fee schedule,34.81,86% of total billed charges,32.38,80% of total billed charges,7.57,111% of CMS fee schedule,39.27,97% of total billed charges,36.43,90% of total billed charges,N/A,not seperately reimbursable,39.27,97% of total billed charges,37.65,93% of total billed charges,6.82,100% of CMS fee schedule,6.82,100% of CMS fee schedule,3,100% of CMS fee schedule,39.27,97% of total billed charges,6.82,100% of CMS fee schedule,6.82,100% of CMS fee schedule,5.79,85% of CMS fee schedule,3,39.27,20.24
Outpatient Medical Services,LAB,84100,Phosphorus Level,300,28.13,25.32,90% of total billed charges,4.74,100% of CMS fee schedule,22.5,80% of total billed charges,4.74,100% of CMS fee schedule,25.32,90% of total billed charges,7.21,100% of CMS fee schedule,27.29,97% of total billed charges,4.74,100% of CMS fee schedule,25.88,92% of total billed charges,4.74,100% of CMS fee schedule,19.22, 405.66% of CMS fee schedule,4.74,100% of CMS fee schedule,23.42,494.23% of CMS fee schedule,21.73, 458.54% of CMS fee schedule,25.32,90% of total billed charges,4.74,100% of CMS fee schedule,19.69,70% of total billed charges,25.32,90% of total billed charges,26.72,95% of total billed charges,26.72,95% of total billed charges,4.74,100% of CMS fee schedule,9.48,200% of CMS fee schedule,24.19,86% of total billed charges,22.5,80% of total billed charges,5.26,111% of CMS fee schedule,27.29,97% of total billed charges,25.32,90% of total billed charges,N/A,not seperately reimbursable,27.29,97% of total billed charges,26.16,93% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,6.55,100% of CMS fee schedule,27.29,97% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,4.02,85% of CMS fee schedule,4.02,27.29,14.07
Outpatient Medical Services,LAB,84100,Direct Access Lab Phosphorus,300,5.3,4.77,90% of total billed charges,4.74,100% of CMS fee schedule,4.24,80% of total billed charges,4.74,100% of CMS fee schedule,4.77,90% of total billed charges,7.21,100% of CMS fee schedule,5.14,97% of total billed charges,4.74,100% of CMS fee schedule,4.88,92% of total billed charges,4.74,100% of CMS fee schedule,19.22, 405.66% of CMS fee schedule,4.74,100% of CMS fee schedule,23.42,494.23% of CMS fee schedule,21.73, 458.54% of CMS fee schedule,4.77,90% of total billed charges,4.74,100% of CMS fee schedule,3.71,70% of total billed charges,4.77,90% of total billed charges,5.04,95% of total billed charges,5.04,95% of total billed charges,4.74,100% of CMS fee schedule,9.48,200% of CMS fee schedule,4.56,86% of total billed charges,4.24,80% of total billed charges,5.26,111% of CMS fee schedule,5.14,97% of total billed charges,4.77,90% of total billed charges,N/A,not seperately reimbursable,5.14,97% of total billed charges,4.93,93% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,6.55,100% of CMS fee schedule,5.14,97% of total billed charges,4.74,100% of CMS fee schedule,4.74,100% of CMS fee schedule,4.02,85% of CMS fee schedule,3.71,23.42,2.65
Outpatient Medical Services,LAB,84132,Potassium Level,300,28.26,25.43,90% of total billed charges,4.76,100% of CMS fee schedule,22.61,80% of total billed charges,4.76,100% of CMS fee schedule,25.43,90% of total billed charges,6.97,100% of CMS fee schedule,27.41,97% of total billed charges,4.76,100% of CMS fee schedule,26,92% of total billed charges,4.76,100% of CMS fee schedule,19.3, 405.66% of CMS fee schedule,4.76,100% of CMS fee schedule,23.52,494.23% of CMS fee schedule,21.82, 458.54% of CMS fee schedule,25.43,90% of total billed charges,4.76,100% of CMS fee schedule,19.78,70% of total billed charges,25.43,90% of total billed charges,26.85,95% of total billed charges,26.85,95% of total billed charges,4.76,100% of CMS fee schedule,9.52,200% of CMS fee schedule,24.3,86% of total billed charges,22.61,80% of total billed charges,5.28,111% of CMS fee schedule,27.41,97% of total billed charges,25.43,90% of total billed charges,N/A,not seperately reimbursable,27.41,97% of total billed charges,26.28,93% of total billed charges,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,6.34,100% of CMS fee schedule,27.41,97% of total billed charges,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,4.04,85% of CMS fee schedule,4.04,27.41,14.13
Outpatient Medical Services,LAB,84132,"Potassium, POC",300,28.26,25.43,90% of total billed charges,4.76,100% of CMS fee schedule,22.61,80% of total billed charges,4.76,100% of CMS fee schedule,25.43,90% of total billed charges,6.97,100% of CMS fee schedule,27.41,97% of total billed charges,4.76,100% of CMS fee schedule,26,92% of total billed charges,4.76,100% of CMS fee schedule,19.3, 405.66% of CMS fee schedule,4.76,100% of CMS fee schedule,23.52,494.23% of CMS fee schedule,21.82, 458.54% of CMS fee schedule,25.43,90% of total billed charges,4.76,100% of CMS fee schedule,19.78,70% of total billed charges,25.43,90% of total billed charges,26.85,95% of total billed charges,26.85,95% of total billed charges,4.76,100% of CMS fee schedule,9.52,200% of CMS fee schedule,24.3,86% of total billed charges,22.61,80% of total billed charges,5.28,111% of CMS fee schedule,27.41,97% of total billed charges,25.43,90% of total billed charges,N/A,not seperately reimbursable,27.41,97% of total billed charges,26.28,93% of total billed charges,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,6.34,100% of CMS fee schedule,27.41,97% of total billed charges,4.76,100% of CMS fee schedule,4.76,100% of CMS fee schedule,4.04,85% of CMS fee schedule,4.04,27.41,14.13
Outpatient Medical Services,LAB,84153,Prostate Specific Antigen Diagnostic,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,27.66,150% of AETNA fee schedule,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,26.8,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,24.36,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84153,PSA (Diagnostic) SO,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,27.66,150% of AETNA fee schedule,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,26.8,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,24.36,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84153,PSA Total+% Free LC,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,27.66,150% of AETNA fee schedule,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,26.8,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,24.36,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84153,PSA Total (Reflex to Free) LC,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,27.66,150% of AETNA fee schedule,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,26.8,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,24.36,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84154,.%PSA Reflex LC,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,87.33,80% of total billed charges,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,22.37,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,20.34,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84154,PSA Total 84154 Add-On,300,109.16,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,87.33,80% of total billed charges,18.39,100% of CMS fee schedule,98.24,90% of total billed charges,22.37,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,100.43,92% of total billed charges,18.39,100% of CMS fee schedule,74.6, 405.66% of CMS fee schedule,18.39,100% of CMS fee schedule,90.88,494.23% of CMS fee schedule,84.32, 458.54% of CMS fee schedule,98.24,90% of total billed charges,18.39,100% of CMS fee schedule,76.41,70% of total billed charges,98.24,90% of total billed charges,103.7,95% of total billed charges,103.7,95% of total billed charges,18.39,100% of CMS fee schedule,36.78,200% of CMS fee schedule,93.88,86% of total billed charges,87.33,80% of total billed charges,20.41,111% of CMS fee schedule,105.89,97% of total billed charges,98.24,90% of total billed charges,N/A,not seperately reimbursable,105.89,97% of total billed charges,101.52,93% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,20.34,100% of CMS fee schedule,105.89,97% of total billed charges,18.39,100% of CMS fee schedule,18.39,100% of CMS fee schedule,15.63,85% of CMS fee schedule,15.63,105.89,54.58
Outpatient Medical Services,LAB,84156,Protein 24 Hour Urine,300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,Protein Random Urine,300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"Protein, Urine-MUA",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"Total Protein, Send Out",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"Protein Electro, Random Urine LC",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"IFE and PE, Random Urine LC",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"IFE+Protein Electro, 24-Hr Ur LC",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84156,"Prot Electro+Interp, 24-Hr Ur LC",300,21.78,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,17.42,80% of total billed charges,3.67,100% of CMS fee schedule,19.6,90% of total billed charges,4.51,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,20.04,92% of total billed charges,3.67,100% of CMS fee schedule,14.88, 405.66% of CMS fee schedule,3.67,100% of CMS fee schedule,18.13,494.23% of CMS fee schedule,16.82, 458.54% of CMS fee schedule,19.6,90% of total billed charges,3.67,100% of CMS fee schedule,15.25,70% of total billed charges,19.6,90% of total billed charges,20.69,95% of total billed charges,20.69,95% of total billed charges,3.67,100% of CMS fee schedule,7.34,200% of CMS fee schedule,18.73,86% of total billed charges,17.42,80% of total billed charges,4.07,111% of CMS fee schedule,21.13,97% of total billed charges,19.6,90% of total billed charges,N/A,not seperately reimbursable,21.13,97% of total billed charges,20.26,93% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,4.1,100% of CMS fee schedule,21.13,97% of total billed charges,3.67,100% of CMS fee schedule,3.67,100% of CMS fee schedule,3.11,85% of CMS fee schedule,3.11,21.13,10.89
Outpatient Medical Services,LAB,84157,Protein Body Fluid,300,23.74,21.37,90% of total billed charges,4,100% of CMS fee schedule,18.99,80% of total billed charges,4,100% of CMS fee schedule,21.37,90% of total billed charges,4.51,100% of CMS fee schedule,23.03,97% of total billed charges,4,100% of CMS fee schedule,21.84,92% of total billed charges,4,100% of CMS fee schedule,16.22, 405.66% of CMS fee schedule,4,100% of CMS fee schedule,19.76,494.23% of CMS fee schedule,18.34, 458.54% of CMS fee schedule,21.37,90% of total billed charges,4,100% of CMS fee schedule,16.62,70% of total billed charges,21.37,90% of total billed charges,22.55,95% of total billed charges,22.55,95% of total billed charges,4,100% of CMS fee schedule,8,200% of CMS fee schedule,20.42,86% of total billed charges,18.99,80% of total billed charges,4.44,111% of CMS fee schedule,23.03,97% of total billed charges,21.37,90% of total billed charges,N/A,not seperately reimbursable,23.03,97% of total billed charges,22.08,93% of total billed charges,4,100% of CMS fee schedule,4,100% of CMS fee schedule,4.1,100% of CMS fee schedule,23.03,97% of total billed charges,4,100% of CMS fee schedule,4,100% of CMS fee schedule,3.4,85% of CMS fee schedule,3.4,23.03,11.87
Outpatient Medical Services,LAB,84157,Protein Cerebrospinal Fluid,300,23.74,21.37,90% of total billed charges,4,100% of CMS fee schedule,18.99,80% of total billed charges,4,100% of CMS fee schedule,21.37,90% of total billed charges,4.51,100% of CMS fee schedule,23.03,97% of total billed charges,4,100% of CMS fee schedule,21.84,92% of total billed charges,4,100% of CMS fee schedule,16.22, 405.66% of CMS fee schedule,4,100% of CMS fee schedule,19.76,494.23% of CMS fee schedule,18.34, 458.54% of CMS fee schedule,21.37,90% of total billed charges,4,100% of CMS fee schedule,16.62,70% of total billed charges,21.37,90% of total billed charges,22.55,95% of total billed charges,22.55,95% of total billed charges,4,100% of CMS fee schedule,8,200% of CMS fee schedule,20.42,86% of total billed charges,18.99,80% of total billed charges,4.44,111% of CMS fee schedule,23.03,97% of total billed charges,21.37,90% of total billed charges,N/A,not seperately reimbursable,23.03,97% of total billed charges,22.08,93% of total billed charges,4,100% of CMS fee schedule,4,100% of CMS fee schedule,4.1,100% of CMS fee schedule,23.03,97% of total billed charges,4,100% of CMS fee schedule,4,100% of CMS fee schedule,3.4,85% of CMS fee schedule,3.4,23.03,11.87
Outpatient Medical Services,LAB,84165,IFE/PE S-Fraction/Quant,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,16.12,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,14.65,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,84165,"Protein Elec + Interp, Serum LC",300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,16.12,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,14.65,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,84165,84165 add-on,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,16.12,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,14.65,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,84244,Renin Plasma,300,130.53,117.48,90% of total billed charges,21.99,100% of CMS fee schedule,104.42,80% of total billed charges,21.99,100% of CMS fee schedule,117.48,90% of total billed charges,13.2,100% of CMS fee schedule,126.61,97% of total billed charges,21.99,100% of CMS fee schedule,120.09,92% of total billed charges,21.99,100% of CMS fee schedule,89.2, 405.66% of CMS fee schedule,21.99,100% of CMS fee schedule,108.68,494.23% of CMS fee schedule,100.83, 458.54% of CMS fee schedule,117.48,90% of total billed charges,21.99,100% of CMS fee schedule,91.37,70% of total billed charges,117.48,90% of total billed charges,124,95% of total billed charges,124,95% of total billed charges,21.99,100% of CMS fee schedule,43.98,200% of CMS fee schedule,112.26,86% of total billed charges,104.42,80% of total billed charges,24.4,111% of CMS fee schedule,126.61,97% of total billed charges,117.48,90% of total billed charges,N/A,not seperately reimbursable,126.61,97% of total billed charges,121.39,93% of total billed charges,21.99,100% of CMS fee schedule,21.99,100% of CMS fee schedule,12,100% of CMS fee schedule,126.61,97% of total billed charges,21.99,100% of CMS fee schedule,21.99,100% of CMS fee schedule,18.69,85% of CMS fee schedule,12,126.61,65.27
Outpatient Medical Services,LAB,84244,84244 - Aldosterone/Renin Ratio ADD-ON,300,32.01,28.81,90% of total billed charges,21.99,100% of CMS fee schedule,25.61,80% of total billed charges,21.99,100% of CMS fee schedule,28.81,90% of total billed charges,13.2,100% of CMS fee schedule,31.05,97% of total billed charges,21.99,100% of CMS fee schedule,29.45,92% of total billed charges,21.99,100% of CMS fee schedule,89.2, 405.66% of CMS fee schedule,21.99,100% of CMS fee schedule,108.68,494.23% of CMS fee schedule,100.83, 458.54% of CMS fee schedule,28.81,90% of total billed charges,21.99,100% of CMS fee schedule,22.41,70% of total billed charges,28.81,90% of total billed charges,30.41,95% of total billed charges,30.41,95% of total billed charges,21.99,100% of CMS fee schedule,43.98,200% of CMS fee schedule,27.53,86% of total billed charges,25.61,80% of total billed charges,24.4,111% of CMS fee schedule,31.05,97% of total billed charges,28.81,90% of total billed charges,N/A,not seperately reimbursable,31.05,97% of total billed charges,29.77,93% of total billed charges,21.99,100% of CMS fee schedule,21.99,100% of CMS fee schedule,12,100% of CMS fee schedule,31.05,97% of total billed charges,21.99,100% of CMS fee schedule,21.99,100% of CMS fee schedule,18.69,85% of CMS fee schedule,12,108.68,16.01
Outpatient Medical Services,LAB,84295,Sodium Level,300,28.56,25.7,90% of total billed charges,4.8,100% of CMS fee schedule,22.85,80% of total billed charges,4.8,100% of CMS fee schedule,25.7,90% of total billed charges,7.15,100% of CMS fee schedule,27.7,97% of total billed charges,4.8,100% of CMS fee schedule,26.28,92% of total billed charges,4.8,100% of CMS fee schedule,19.51, 405.66% of CMS fee schedule,4.8,100% of CMS fee schedule,23.77,494.23% of CMS fee schedule,22.05, 458.54% of CMS fee schedule,25.7,90% of total billed charges,4.8,100% of CMS fee schedule,19.99,70% of total billed charges,25.7,90% of total billed charges,27.13,95% of total billed charges,27.13,95% of total billed charges,4.8,100% of CMS fee schedule,9.62,200% of CMS fee schedule,24.56,86% of total billed charges,22.85,80% of total billed charges,5.33,111% of CMS fee schedule,27.7,97% of total billed charges,25.7,90% of total billed charges,N/A,not seperately reimbursable,27.7,97% of total billed charges,26.56,93% of total billed charges,4.8,100% of CMS fee schedule,4.8,100% of CMS fee schedule,6.5,100% of CMS fee schedule,27.7,97% of total billed charges,4.8,100% of CMS fee schedule,4.8,100% of CMS fee schedule,4.08,85% of CMS fee schedule,4.08,27.7,14.28
Outpatient Medical Services,LAB,84295,"Sodium, POC",300,28.56,25.7,90% of total billed charges,4.8,100% of CMS fee schedule,22.85,80% of total billed charges,4.8,100% of CMS fee schedule,25.7,90% of total billed charges,7.15,100% of CMS fee schedule,27.7,97% of total billed charges,4.8,100% of CMS fee schedule,26.28,92% of total billed charges,4.8,100% of CMS fee schedule,19.51, 405.66% of CMS fee schedule,4.8,100% of CMS fee schedule,23.77,494.23% of CMS fee schedule,22.05, 458.54% of CMS fee schedule,25.7,90% of total billed charges,4.8,100% of CMS fee schedule,19.99,70% of total billed charges,25.7,90% of total billed charges,27.13,95% of total billed charges,27.13,95% of total billed charges,4.8,100% of CMS fee schedule,9.62,200% of CMS fee schedule,24.56,86% of total billed charges,22.85,80% of total billed charges,5.33,111% of CMS fee schedule,27.7,97% of total billed charges,25.7,90% of total billed charges,N/A,not seperately reimbursable,27.7,97% of total billed charges,26.56,93% of total billed charges,4.8,100% of CMS fee schedule,4.8,100% of CMS fee schedule,6.5,100% of CMS fee schedule,27.7,97% of total billed charges,4.8,100% of CMS fee schedule,4.8,100% of CMS fee schedule,4.08,85% of CMS fee schedule,4.08,27.7,14.28
Outpatient Medical Services,LAB,84300,Sodium Level 24 Hour Urine,300,30.04,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,24.03,80% of total billed charges,5.05,100% of CMS fee schedule,27.04,90% of total billed charges,7.39,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,27.64,92% of total billed charges,5.05,100% of CMS fee schedule,20.52, 405.66% of CMS fee schedule,5.05,100% of CMS fee schedule,25,494.23% of CMS fee schedule,23.2, 458.54% of CMS fee schedule,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,21.03,70% of total billed charges,27.04,90% of total billed charges,28.54,95% of total billed charges,28.54,95% of total billed charges,5.05,100% of CMS fee schedule,10.12,200% of CMS fee schedule,25.83,86% of total billed charges,24.03,80% of total billed charges,5.61,111% of CMS fee schedule,29.14,97% of total billed charges,27.04,90% of total billed charges,N/A,not seperately reimbursable,29.14,97% of total billed charges,27.94,93% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,6.72,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,4.3,85% of CMS fee schedule,4.3,29.14,15.02
Outpatient Medical Services,LAB,84300,Sodium Level Random Urine,300,30.04,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,24.03,80% of total billed charges,5.05,100% of CMS fee schedule,27.04,90% of total billed charges,7.39,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,27.64,92% of total billed charges,5.05,100% of CMS fee schedule,20.52, 405.66% of CMS fee schedule,5.05,100% of CMS fee schedule,25,494.23% of CMS fee schedule,23.2, 458.54% of CMS fee schedule,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,21.03,70% of total billed charges,27.04,90% of total billed charges,28.54,95% of total billed charges,28.54,95% of total billed charges,5.05,100% of CMS fee schedule,10.12,200% of CMS fee schedule,25.83,86% of total billed charges,24.03,80% of total billed charges,5.61,111% of CMS fee schedule,29.14,97% of total billed charges,27.04,90% of total billed charges,N/A,not seperately reimbursable,29.14,97% of total billed charges,27.94,93% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,6.72,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,4.3,85% of CMS fee schedule,4.3,29.14,15.02
Outpatient Medical Services,LAB,84300,"Sodium, Urine-MUA",300,30.04,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,24.03,80% of total billed charges,5.05,100% of CMS fee schedule,27.04,90% of total billed charges,7.39,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,27.64,92% of total billed charges,5.05,100% of CMS fee schedule,20.52, 405.66% of CMS fee schedule,5.05,100% of CMS fee schedule,25,494.23% of CMS fee schedule,23.2, 458.54% of CMS fee schedule,27.04,90% of total billed charges,5.05,100% of CMS fee schedule,21.03,70% of total billed charges,27.04,90% of total billed charges,28.54,95% of total billed charges,28.54,95% of total billed charges,5.05,100% of CMS fee schedule,10.12,200% of CMS fee schedule,25.83,86% of total billed charges,24.03,80% of total billed charges,5.61,111% of CMS fee schedule,29.14,97% of total billed charges,27.04,90% of total billed charges,N/A,not seperately reimbursable,29.14,97% of total billed charges,27.94,93% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,6.72,100% of CMS fee schedule,29.14,97% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,4.3,85% of CMS fee schedule,4.3,29.14,15.02
Outpatient Medical Services,LAB,84300,"84300 - Kidney Stone, 24h Urine/Saturation LC - ADD-ON",300,46.87,42.18,90% of total billed charges,5.05,100% of CMS fee schedule,37.5,80% of total billed charges,5.05,100% of CMS fee schedule,42.18,90% of total billed charges,7.39,100% of CMS fee schedule,45.46,97% of total billed charges,5.05,100% of CMS fee schedule,43.12,92% of total billed charges,5.05,100% of CMS fee schedule,20.52, 405.66% of CMS fee schedule,5.05,100% of CMS fee schedule,25,494.23% of CMS fee schedule,23.2, 458.54% of CMS fee schedule,42.18,90% of total billed charges,5.05,100% of CMS fee schedule,32.81,70% of total billed charges,42.18,90% of total billed charges,44.53,95% of total billed charges,44.53,95% of total billed charges,5.05,100% of CMS fee schedule,10.12,200% of CMS fee schedule,40.31,86% of total billed charges,37.5,80% of total billed charges,5.61,111% of CMS fee schedule,45.46,97% of total billed charges,42.18,90% of total billed charges,N/A,not seperately reimbursable,45.46,97% of total billed charges,43.59,93% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,6.72,100% of CMS fee schedule,45.46,97% of total billed charges,5.05,100% of CMS fee schedule,5.05,100% of CMS fee schedule,4.3,85% of CMS fee schedule,4.3,45.46,23.44
Outpatient Medical Services,LAB,84425,"Vitamin B1, Whole Blood, SO",300,126.02,113.42,90% of total billed charges,21.23,100% of CMS fee schedule,100.82,80% of total billed charges,21.23,100% of CMS fee schedule,113.42,90% of total billed charges,7.7,100% of CMS fee schedule,122.24,97% of total billed charges,21.23,100% of CMS fee schedule,115.94,92% of total billed charges,21.23,100% of CMS fee schedule,86.12, 405.66% of CMS fee schedule,21.23,100% of CMS fee schedule,104.92,494.23% of CMS fee schedule,97.34, 458.54% of CMS fee schedule,113.42,90% of total billed charges,21.23,100% of CMS fee schedule,88.21,70% of total billed charges,113.42,90% of total billed charges,119.72,95% of total billed charges,119.72,95% of total billed charges,21.23,100% of CMS fee schedule,42.46,200% of CMS fee schedule,108.38,86% of total billed charges,100.82,80% of total billed charges,23.56,111% of CMS fee schedule,122.24,97% of total billed charges,113.42,90% of total billed charges,N/A,not seperately reimbursable,122.24,97% of total billed charges,117.2,93% of total billed charges,21.23,100% of CMS fee schedule,21.23,100% of CMS fee schedule,7,100% of CMS fee schedule,122.24,97% of total billed charges,21.23,100% of CMS fee schedule,21.23,100% of CMS fee schedule,18.04,85% of CMS fee schedule,7,122.24,63.01
Outpatient Medical Services,LAB,84436,Thyroxine,300,40.78,36.7,90% of total billed charges,6.87,100% of CMS fee schedule,32.62,80% of total billed charges,6.87,100% of CMS fee schedule,36.7,90% of total billed charges,10.45,100% of CMS fee schedule,39.56,97% of total billed charges,6.87,100% of CMS fee schedule,37.52,92% of total billed charges,6.87,100% of CMS fee schedule,27.86, 405.66% of CMS fee schedule,6.87,100% of CMS fee schedule,33.95,494.23% of CMS fee schedule,31.5, 458.54% of CMS fee schedule,36.7,90% of total billed charges,6.87,100% of CMS fee schedule,28.55,70% of total billed charges,36.7,90% of total billed charges,38.74,95% of total billed charges,38.74,95% of total billed charges,6.87,100% of CMS fee schedule,13.74,200% of CMS fee schedule,35.07,86% of total billed charges,32.62,80% of total billed charges,7.62,111% of CMS fee schedule,39.56,97% of total billed charges,36.7,90% of total billed charges,N/A,not seperately reimbursable,39.56,97% of total billed charges,37.93,93% of total billed charges,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,9.5,100% of CMS fee schedule,39.56,97% of total billed charges,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,5.83,85% of CMS fee schedule,5.83,39.56,20.39
Outpatient Medical Services,LAB,84436,Thyroxine T4,300,40.78,36.7,90% of total billed charges,6.87,100% of CMS fee schedule,32.62,80% of total billed charges,6.87,100% of CMS fee schedule,36.7,90% of total billed charges,10.45,100% of CMS fee schedule,39.56,97% of total billed charges,6.87,100% of CMS fee schedule,37.52,92% of total billed charges,6.87,100% of CMS fee schedule,27.86, 405.66% of CMS fee schedule,6.87,100% of CMS fee schedule,33.95,494.23% of CMS fee schedule,31.5, 458.54% of CMS fee schedule,36.7,90% of total billed charges,6.87,100% of CMS fee schedule,28.55,70% of total billed charges,36.7,90% of total billed charges,38.74,95% of total billed charges,38.74,95% of total billed charges,6.87,100% of CMS fee schedule,13.74,200% of CMS fee schedule,35.07,86% of total billed charges,32.62,80% of total billed charges,7.62,111% of CMS fee schedule,39.56,97% of total billed charges,36.7,90% of total billed charges,N/A,not seperately reimbursable,39.56,97% of total billed charges,37.93,93% of total billed charges,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,9.5,100% of CMS fee schedule,39.56,97% of total billed charges,6.87,100% of CMS fee schedule,6.87,100% of CMS fee schedule,5.83,85% of CMS fee schedule,5.83,39.56,20.39
Outpatient Medical Services,LAB,84439,zzThyroxine Free,300,50.51,45.46,90% of total billed charges,9.02,100% of CMS fee schedule,13.56,150% of AETNA fee schedule,9.02,100% of CMS fee schedule,45.46,90% of total billed charges,8.8,100% of CMS fee schedule,48.99,97% of total billed charges,9.02,100% of CMS fee schedule,46.47,92% of total billed charges,9.02,100% of CMS fee schedule,36.59, 405.66% of CMS fee schedule,9.02,100% of CMS fee schedule,44.57,494.23% of CMS fee schedule,41.36, 458.54% of CMS fee schedule,45.46,90% of total billed charges,9.02,100% of CMS fee schedule,35.36,70% of total billed charges,45.46,90% of total billed charges,47.98,95% of total billed charges,47.98,95% of total billed charges,9.02,100% of CMS fee schedule,18.04,200% of CMS fee schedule,43.44,86% of total billed charges,40.41,80% of total billed charges,10.01,111% of CMS fee schedule,48.99,97% of total billed charges,45.46,90% of total billed charges,N/A,not seperately reimbursable,48.99,97% of total billed charges,46.97,93% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,8,100% of CMS fee schedule,48.99,97% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,7.66,85% of CMS fee schedule,7.66,48.99,25.26
Outpatient Medical Services,LAB,84439,Free Thyroxine,300,53.54,48.19,90% of total billed charges,9.02,100% of CMS fee schedule,13.56,150% of AETNA fee schedule,9.02,100% of CMS fee schedule,48.19,90% of total billed charges,8.8,100% of CMS fee schedule,51.93,97% of total billed charges,9.02,100% of CMS fee schedule,49.26,92% of total billed charges,9.02,100% of CMS fee schedule,36.59, 405.66% of CMS fee schedule,9.02,100% of CMS fee schedule,44.57,494.23% of CMS fee schedule,41.36, 458.54% of CMS fee schedule,48.19,90% of total billed charges,9.02,100% of CMS fee schedule,37.48,70% of total billed charges,48.19,90% of total billed charges,50.86,95% of total billed charges,50.86,95% of total billed charges,9.02,100% of CMS fee schedule,18.04,200% of CMS fee schedule,46.04,86% of total billed charges,42.83,80% of total billed charges,10.01,111% of CMS fee schedule,51.93,97% of total billed charges,48.19,90% of total billed charges,N/A,not seperately reimbursable,51.93,97% of total billed charges,49.79,93% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,8,100% of CMS fee schedule,51.93,97% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,7.66,85% of CMS fee schedule,7.66,51.93,26.77
Outpatient Medical Services,LAB,84439,".Thyroxine (T4) Free, Direct, S LC",300,53.54,48.19,90% of total billed charges,9.02,100% of CMS fee schedule,13.56,150% of AETNA fee schedule,9.02,100% of CMS fee schedule,48.19,90% of total billed charges,8.8,100% of CMS fee schedule,51.93,97% of total billed charges,9.02,100% of CMS fee schedule,49.26,92% of total billed charges,9.02,100% of CMS fee schedule,36.59, 405.66% of CMS fee schedule,9.02,100% of CMS fee schedule,44.57,494.23% of CMS fee schedule,41.36, 458.54% of CMS fee schedule,48.19,90% of total billed charges,9.02,100% of CMS fee schedule,37.48,70% of total billed charges,48.19,90% of total billed charges,50.86,95% of total billed charges,50.86,95% of total billed charges,9.02,100% of CMS fee schedule,18.04,200% of CMS fee schedule,46.04,86% of total billed charges,42.83,80% of total billed charges,10.01,111% of CMS fee schedule,51.93,97% of total billed charges,48.19,90% of total billed charges,N/A,not seperately reimbursable,51.93,97% of total billed charges,49.79,93% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,8,100% of CMS fee schedule,51.93,97% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,7.66,85% of CMS fee schedule,7.66,51.93,26.77
Outpatient Medical Services,LAB,84439,".Thyroxine T4 Free, Direct, S LC",300,47.81,43.03,90% of total billed charges,9.02,100% of CMS fee schedule,13.56,150% of AETNA fee schedule,9.02,100% of CMS fee schedule,43.03,90% of total billed charges,8.8,100% of CMS fee schedule,46.38,97% of total billed charges,9.02,100% of CMS fee schedule,43.99,92% of total billed charges,9.02,100% of CMS fee schedule,36.59, 405.66% of CMS fee schedule,9.02,100% of CMS fee schedule,44.57,494.23% of CMS fee schedule,41.36, 458.54% of CMS fee schedule,43.03,90% of total billed charges,9.02,100% of CMS fee schedule,33.47,70% of total billed charges,43.03,90% of total billed charges,45.42,95% of total billed charges,45.42,95% of total billed charges,9.02,100% of CMS fee schedule,18.04,200% of CMS fee schedule,41.12,86% of total billed charges,38.25,80% of total billed charges,10.01,111% of CMS fee schedule,46.38,97% of total billed charges,43.03,90% of total billed charges,N/A,not seperately reimbursable,46.38,97% of total billed charges,44.46,93% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,8,100% of CMS fee schedule,46.38,97% of total billed charges,9.02,100% of CMS fee schedule,9.02,100% of CMS fee schedule,7.66,85% of CMS fee schedule,7.66,46.38,23.91
Outpatient Medical Services,LAB,84443,Thyroid Cascade Profile,300,99.72,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,25.26,150% of AETNA fee schedule,16.8,100% of CMS fee schedule,89.75,90% of total billed charges,25.53,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,91.74,92% of total billed charges,16.8,100% of CMS fee schedule,68.15, 405.66% of CMS fee schedule,16.8,100% of CMS fee schedule,83.03,494.23% of CMS fee schedule,77.03, 458.54% of CMS fee schedule,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,69.8,70% of total billed charges,89.75,90% of total billed charges,94.73,95% of total billed charges,94.73,95% of total billed charges,16.8,100% of CMS fee schedule,33.6,200% of CMS fee schedule,85.76,86% of total billed charges,79.78,80% of total billed charges,18.64,111% of CMS fee schedule,96.73,97% of total billed charges,89.75,90% of total billed charges,N/A,not seperately reimbursable,96.73,97% of total billed charges,92.74,93% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,23.21,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,14.28,85% of CMS fee schedule,14.28,96.73,49.86
Outpatient Medical Services,LAB,84443,"NB SCR, TSH",300,99.72,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,25.26,150% of AETNA fee schedule,16.8,100% of CMS fee schedule,89.75,90% of total billed charges,25.53,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,91.74,92% of total billed charges,16.8,100% of CMS fee schedule,68.15, 405.66% of CMS fee schedule,16.8,100% of CMS fee schedule,83.03,494.23% of CMS fee schedule,77.03, 458.54% of CMS fee schedule,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,69.8,70% of total billed charges,89.75,90% of total billed charges,94.73,95% of total billed charges,94.73,95% of total billed charges,16.8,100% of CMS fee schedule,33.6,200% of CMS fee schedule,85.76,86% of total billed charges,79.78,80% of total billed charges,18.64,111% of CMS fee schedule,96.73,97% of total billed charges,89.75,90% of total billed charges,N/A,not seperately reimbursable,96.73,97% of total billed charges,92.74,93% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,23.21,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,14.28,85% of CMS fee schedule,14.28,96.73,49.86
Outpatient Medical Services,LAB,84443,"Thyroid Stimulating Hormone, HS",300,99.72,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,25.26,150% of AETNA fee schedule,16.8,100% of CMS fee schedule,89.75,90% of total billed charges,25.53,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,91.74,92% of total billed charges,16.8,100% of CMS fee schedule,68.15, 405.66% of CMS fee schedule,16.8,100% of CMS fee schedule,83.03,494.23% of CMS fee schedule,77.03, 458.54% of CMS fee schedule,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,69.8,70% of total billed charges,89.75,90% of total billed charges,94.73,95% of total billed charges,94.73,95% of total billed charges,16.8,100% of CMS fee schedule,33.6,200% of CMS fee schedule,85.76,86% of total billed charges,79.78,80% of total billed charges,18.64,111% of CMS fee schedule,96.73,97% of total billed charges,89.75,90% of total billed charges,N/A,not seperately reimbursable,96.73,97% of total billed charges,92.74,93% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,23.21,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,14.28,85% of CMS fee schedule,14.28,96.73,49.86
Outpatient Medical Services,LAB,84443,Direct Access Lab TSH,300,15.9,14.31,90% of total billed charges,16.8,100% of CMS fee schedule,25.26,150% of AETNA fee schedule,16.8,100% of CMS fee schedule,14.31,90% of total billed charges,25.53,100% of CMS fee schedule,15.42,97% of total billed charges,16.8,100% of CMS fee schedule,14.63,92% of total billed charges,16.8,100% of CMS fee schedule,68.15, 405.66% of CMS fee schedule,16.8,100% of CMS fee schedule,83.03,494.23% of CMS fee schedule,77.03, 458.54% of CMS fee schedule,14.31,90% of total billed charges,16.8,100% of CMS fee schedule,11.13,70% of total billed charges,14.31,90% of total billed charges,15.11,95% of total billed charges,15.11,95% of total billed charges,16.8,100% of CMS fee schedule,33.6,200% of CMS fee schedule,13.67,86% of total billed charges,12.72,80% of total billed charges,18.64,111% of CMS fee schedule,15.42,97% of total billed charges,14.31,90% of total billed charges,N/A,not seperately reimbursable,15.42,97% of total billed charges,14.79,93% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,23.21,100% of CMS fee schedule,15.42,97% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,14.28,85% of CMS fee schedule,11.13,83.03,7.95
Outpatient Medical Services,LAB,84443,Thyroid Cascade Profile LC,300,99.72,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,25.26,150% of AETNA fee schedule,16.8,100% of CMS fee schedule,89.75,90% of total billed charges,25.53,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,91.74,92% of total billed charges,16.8,100% of CMS fee schedule,68.15, 405.66% of CMS fee schedule,16.8,100% of CMS fee schedule,83.03,494.23% of CMS fee schedule,77.03, 458.54% of CMS fee schedule,89.75,90% of total billed charges,16.8,100% of CMS fee schedule,69.8,70% of total billed charges,89.75,90% of total billed charges,94.73,95% of total billed charges,94.73,95% of total billed charges,16.8,100% of CMS fee schedule,33.6,200% of CMS fee schedule,85.76,86% of total billed charges,79.78,80% of total billed charges,18.64,111% of CMS fee schedule,96.73,97% of total billed charges,89.75,90% of total billed charges,N/A,not seperately reimbursable,96.73,97% of total billed charges,92.74,93% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,23.21,100% of CMS fee schedule,96.73,97% of total billed charges,16.8,100% of CMS fee schedule,16.8,100% of CMS fee schedule,14.28,85% of CMS fee schedule,14.28,96.73,49.86
Outpatient Medical Services,LAB,84481,Free Triiodothyronine,300,100.55,90.5,90% of total billed charges,16.94,100% of CMS fee schedule,80.44,80% of total billed charges,16.94,100% of CMS fee schedule,90.5,90% of total billed charges,25.75,100% of CMS fee schedule,97.53,97% of total billed charges,16.94,100% of CMS fee schedule,92.51,92% of total billed charges,16.94,100% of CMS fee schedule,68.71, 405.66% of CMS fee schedule,16.94,100% of CMS fee schedule,83.72,494.23% of CMS fee schedule,77.67, 458.54% of CMS fee schedule,90.5,90% of total billed charges,16.94,100% of CMS fee schedule,70.39,70% of total billed charges,90.5,90% of total billed charges,95.52,95% of total billed charges,95.52,95% of total billed charges,16.94,100% of CMS fee schedule,33.88,200% of CMS fee schedule,86.47,86% of total billed charges,80.44,80% of total billed charges,18.8,111% of CMS fee schedule,97.53,97% of total billed charges,90.5,90% of total billed charges,N/A,not seperately reimbursable,97.53,97% of total billed charges,93.51,93% of total billed charges,16.94,100% of CMS fee schedule,16.94,100% of CMS fee schedule,23.41,100% of CMS fee schedule,97.53,97% of total billed charges,16.94,100% of CMS fee schedule,16.94,100% of CMS fee schedule,14.39,85% of CMS fee schedule,14.39,97.53,50.28
Outpatient Medical Services,LAB,84481,.T3Free LC,300,89.78,80.8,90% of total billed charges,16.94,100% of CMS fee schedule,71.82,80% of total billed charges,16.94,100% of CMS fee schedule,80.8,90% of total billed charges,25.75,100% of CMS fee schedule,87.09,97% of total billed charges,16.94,100% of CMS fee schedule,82.6,92% of total billed charges,16.94,100% of CMS fee schedule,68.71, 405.66% of CMS fee schedule,16.94,100% of CMS fee schedule,83.72,494.23% of CMS fee schedule,77.67, 458.54% of CMS fee schedule,80.8,90% of total billed charges,16.94,100% of CMS fee schedule,62.85,70% of total billed charges,80.8,90% of total billed charges,85.29,95% of total billed charges,85.29,95% of total billed charges,16.94,100% of CMS fee schedule,33.88,200% of CMS fee schedule,77.21,86% of total billed charges,71.82,80% of total billed charges,18.8,111% of CMS fee schedule,87.09,97% of total billed charges,80.8,90% of total billed charges,N/A,not seperately reimbursable,87.09,97% of total billed charges,83.5,93% of total billed charges,16.94,100% of CMS fee schedule,16.94,100% of CMS fee schedule,23.41,100% of CMS fee schedule,87.09,97% of total billed charges,16.94,100% of CMS fee schedule,16.94,100% of CMS fee schedule,14.39,85% of CMS fee schedule,14.39,87.09,44.89
Outpatient Medical Services,LAB,84484,*Troponin I POC,510,74.02,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,59.22,80% of total billed charges,12.47,100% of CMS fee schedule,66.62,90% of total billed charges,10.86,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,68.1,92% of total billed charges,12.47,100% of CMS fee schedule,50.58, 405.66% of CMS fee schedule,12.47,100% of CMS fee schedule,61.63,494.23% of CMS fee schedule,57.18, 458.54% of CMS fee schedule,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,51.81,70% of total billed charges,66.62,90% of total billed charges,70.32,95% of total billed charges,70.32,95% of total billed charges,12.47,100% of CMS fee schedule,24.94,200% of CMS fee schedule,63.66,86% of total billed charges,59.22,80% of total billed charges,13.84,111% of CMS fee schedule,71.8,97% of total billed charges,66.62,90% of total billed charges,N/A,not seperately reimbursable,71.8,97% of total billed charges,68.84,93% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,9.87,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,10.59,85% of CMS fee schedule,9.87,71.8,37.01
Outpatient Medical Services,LAB,84484,"Cardiac Troponin I, HS",300,74.02,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,59.22,80% of total billed charges,12.47,100% of CMS fee schedule,66.62,90% of total billed charges,10.86,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,68.1,92% of total billed charges,12.47,100% of CMS fee schedule,50.58, 405.66% of CMS fee schedule,12.47,100% of CMS fee schedule,61.63,494.23% of CMS fee schedule,57.18, 458.54% of CMS fee schedule,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,51.81,70% of total billed charges,66.62,90% of total billed charges,70.32,95% of total billed charges,70.32,95% of total billed charges,12.47,100% of CMS fee schedule,24.94,200% of CMS fee schedule,63.66,86% of total billed charges,59.22,80% of total billed charges,13.84,111% of CMS fee schedule,71.8,97% of total billed charges,66.62,90% of total billed charges,N/A,not seperately reimbursable,71.8,97% of total billed charges,68.84,93% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,9.87,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,10.59,85% of CMS fee schedule,9.87,71.8,37.01
Outpatient Medical Services,LAB,84484,MC Troponin I POC,300,74.02,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,59.22,80% of total billed charges,12.47,100% of CMS fee schedule,66.62,90% of total billed charges,10.86,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,68.1,92% of total billed charges,12.47,100% of CMS fee schedule,50.58, 405.66% of CMS fee schedule,12.47,100% of CMS fee schedule,61.63,494.23% of CMS fee schedule,57.18, 458.54% of CMS fee schedule,66.62,90% of total billed charges,12.47,100% of CMS fee schedule,51.81,70% of total billed charges,66.62,90% of total billed charges,70.32,95% of total billed charges,70.32,95% of total billed charges,12.47,100% of CMS fee schedule,24.94,200% of CMS fee schedule,63.66,86% of total billed charges,59.22,80% of total billed charges,13.84,111% of CMS fee schedule,71.8,97% of total billed charges,66.62,90% of total billed charges,N/A,not seperately reimbursable,71.8,97% of total billed charges,68.84,93% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,9.87,100% of CMS fee schedule,71.8,97% of total billed charges,12.47,100% of CMS fee schedule,12.47,100% of CMS fee schedule,10.59,85% of CMS fee schedule,9.87,71.8,37.01
Outpatient Medical Services,LAB,84520,Blood Urea Nitrogen,300,23.45,21.11,90% of total billed charges,3.95,100% of CMS fee schedule,18.76,80% of total billed charges,3.95,100% of CMS fee schedule,21.11,90% of total billed charges,5.98,100% of CMS fee schedule,22.75,97% of total billed charges,3.95,100% of CMS fee schedule,21.57,92% of total billed charges,3.95,100% of CMS fee schedule,16.02, 405.66% of CMS fee schedule,3.95,100% of CMS fee schedule,19.52,494.23% of CMS fee schedule,18.11, 458.54% of CMS fee schedule,21.11,90% of total billed charges,3.95,100% of CMS fee schedule,16.42,70% of total billed charges,21.11,90% of total billed charges,22.28,95% of total billed charges,22.28,95% of total billed charges,3.95,100% of CMS fee schedule,7.9,200% of CMS fee schedule,20.17,86% of total billed charges,18.76,80% of total billed charges,4.38,111% of CMS fee schedule,22.75,97% of total billed charges,21.11,90% of total billed charges,N/A,not seperately reimbursable,22.75,97% of total billed charges,21.81,93% of total billed charges,3.95,100% of CMS fee schedule,3.95,100% of CMS fee schedule,5.44,100% of CMS fee schedule,22.75,97% of total billed charges,3.95,100% of CMS fee schedule,3.95,100% of CMS fee schedule,3.35,85% of CMS fee schedule,3.35,22.75,11.73
Outpatient Medical Services,LAB,84550,Uric Acid,300,26.83,24.15,90% of total billed charges,4.51,100% of CMS fee schedule,21.46,80% of total billed charges,4.51,100% of CMS fee schedule,24.15,90% of total billed charges,6.86,100% of CMS fee schedule,26.03,97% of total billed charges,4.51,100% of CMS fee schedule,24.68,92% of total billed charges,4.51,100% of CMS fee schedule,18.33, 405.66% of CMS fee schedule,4.51,100% of CMS fee schedule,22.33,494.23% of CMS fee schedule,20.72, 458.54% of CMS fee schedule,24.15,90% of total billed charges,4.51,100% of CMS fee schedule,18.78,70% of total billed charges,24.15,90% of total billed charges,25.49,95% of total billed charges,25.49,95% of total billed charges,4.51,100% of CMS fee schedule,9.04,200% of CMS fee schedule,23.07,86% of total billed charges,21.46,80% of total billed charges,5.01,111% of CMS fee schedule,26.03,97% of total billed charges,24.15,90% of total billed charges,N/A,not seperately reimbursable,26.03,97% of total billed charges,24.95,93% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,6.24,100% of CMS fee schedule,26.03,97% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,3.84,85% of CMS fee schedule,3.84,26.03,13.42
Outpatient Medical Services,LAB,84550,Direct Access Lab Uric Acid,300,26.83,24.15,90% of total billed charges,4.51,100% of CMS fee schedule,21.46,80% of total billed charges,4.51,100% of CMS fee schedule,24.15,90% of total billed charges,6.86,100% of CMS fee schedule,26.03,97% of total billed charges,4.51,100% of CMS fee schedule,24.68,92% of total billed charges,4.51,100% of CMS fee schedule,18.33, 405.66% of CMS fee schedule,4.51,100% of CMS fee schedule,22.33,494.23% of CMS fee schedule,20.72, 458.54% of CMS fee schedule,24.15,90% of total billed charges,4.51,100% of CMS fee schedule,18.78,70% of total billed charges,24.15,90% of total billed charges,25.49,95% of total billed charges,25.49,95% of total billed charges,4.51,100% of CMS fee schedule,9.04,200% of CMS fee schedule,23.07,86% of total billed charges,21.46,80% of total billed charges,5.01,111% of CMS fee schedule,26.03,97% of total billed charges,24.15,90% of total billed charges,N/A,not seperately reimbursable,26.03,97% of total billed charges,24.95,93% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,6.24,100% of CMS fee schedule,26.03,97% of total billed charges,4.51,100% of CMS fee schedule,4.51,100% of CMS fee schedule,3.84,85% of CMS fee schedule,3.84,26.03,13.42
Outpatient Medical Services,LAB,84681,C Peptide Serum,300,123.53,111.18,90% of total billed charges,20.81,100% of CMS fee schedule,98.82,80% of total billed charges,20.81,100% of CMS fee schedule,111.18,90% of total billed charges,31.63,100% of CMS fee schedule,119.82,97% of total billed charges,20.81,100% of CMS fee schedule,113.65,92% of total billed charges,20.81,100% of CMS fee schedule,84.41, 405.66% of CMS fee schedule,20.81,100% of CMS fee schedule,102.84,494.23% of CMS fee schedule,95.42, 458.54% of CMS fee schedule,111.18,90% of total billed charges,20.81,100% of CMS fee schedule,86.47,70% of total billed charges,111.18,90% of total billed charges,117.35,95% of total billed charges,117.35,95% of total billed charges,20.81,100% of CMS fee schedule,41.62,200% of CMS fee schedule,106.24,86% of total billed charges,98.82,80% of total billed charges,23.09,111% of CMS fee schedule,119.82,97% of total billed charges,111.18,90% of total billed charges,N/A,not seperately reimbursable,119.82,97% of total billed charges,114.88,93% of total billed charges,20.81,100% of CMS fee schedule,20.81,100% of CMS fee schedule,28.75,100% of CMS fee schedule,119.82,97% of total billed charges,20.81,100% of CMS fee schedule,20.81,100% of CMS fee schedule,17.68,85% of CMS fee schedule,17.68,119.82,61.77
Outpatient Medical Services,LAB,84681,"84681 - Insulin and C-peptide, Serum LC ADD-ON",300,10.99,9.89,90% of total billed charges,20.81,100% of CMS fee schedule,8.79,80% of total billed charges,20.81,100% of CMS fee schedule,9.89,90% of total billed charges,31.63,100% of CMS fee schedule,10.66,97% of total billed charges,20.81,100% of CMS fee schedule,10.11,92% of total billed charges,20.81,100% of CMS fee schedule,84.41, 405.66% of CMS fee schedule,20.81,100% of CMS fee schedule,102.84,494.23% of CMS fee schedule,95.42, 458.54% of CMS fee schedule,9.89,90% of total billed charges,20.81,100% of CMS fee schedule,7.69,70% of total billed charges,9.89,90% of total billed charges,10.44,95% of total billed charges,10.44,95% of total billed charges,20.81,100% of CMS fee schedule,41.62,200% of CMS fee schedule,9.45,86% of total billed charges,8.79,80% of total billed charges,23.09,111% of CMS fee schedule,10.66,97% of total billed charges,9.89,90% of total billed charges,N/A,not seperately reimbursable,10.66,97% of total billed charges,10.22,93% of total billed charges,20.81,100% of CMS fee schedule,20.81,100% of CMS fee schedule,28.75,100% of CMS fee schedule,10.66,97% of total billed charges,20.81,100% of CMS fee schedule,20.81,100% of CMS fee schedule,17.68,85% of CMS fee schedule,7.69,102.84,5.50
Outpatient Medical Services,LAB,84702,HCG Beta Subunit,300,89.34,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,22.64,150% of AETNA fee schedule,15.05,100% of CMS fee schedule,80.41,90% of total billed charges,18.06,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,82.19,92% of total billed charges,15.05,100% of CMS fee schedule,61.05, 405.66% of CMS fee schedule,15.05,100% of CMS fee schedule,74.38,494.23% of CMS fee schedule,69.01, 458.54% of CMS fee schedule,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,62.54,70% of total billed charges,80.41,90% of total billed charges,84.87,95% of total billed charges,84.87,95% of total billed charges,15.05,100% of CMS fee schedule,30.1,200% of CMS fee schedule,76.83,86% of total billed charges,71.47,80% of total billed charges,16.7,111% of CMS fee schedule,86.66,97% of total billed charges,80.41,90% of total billed charges,N/A,not seperately reimbursable,86.66,97% of total billed charges,83.09,93% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,16.42,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,12.79,85% of CMS fee schedule,12.79,86.66,44.67
Outpatient Medical Services,LAB,84702,HCG Quantitative,300,89.34,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,22.64,150% of AETNA fee schedule,15.05,100% of CMS fee schedule,80.41,90% of total billed charges,18.06,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,82.19,92% of total billed charges,15.05,100% of CMS fee schedule,61.05, 405.66% of CMS fee schedule,15.05,100% of CMS fee schedule,74.38,494.23% of CMS fee schedule,69.01, 458.54% of CMS fee schedule,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,62.54,70% of total billed charges,80.41,90% of total billed charges,84.87,95% of total billed charges,84.87,95% of total billed charges,15.05,100% of CMS fee schedule,30.1,200% of CMS fee schedule,76.83,86% of total billed charges,71.47,80% of total billed charges,16.7,111% of CMS fee schedule,86.66,97% of total billed charges,80.41,90% of total billed charges,N/A,not seperately reimbursable,86.66,97% of total billed charges,83.09,93% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,16.42,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,12.79,85% of CMS fee schedule,12.79,86.66,44.67
Outpatient Medical Services,LAB,84702,"HCG Quant, Send Out",300,89.34,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,22.64,150% of AETNA fee schedule,15.05,100% of CMS fee schedule,80.41,90% of total billed charges,18.06,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,82.19,92% of total billed charges,15.05,100% of CMS fee schedule,61.05, 405.66% of CMS fee schedule,15.05,100% of CMS fee schedule,74.38,494.23% of CMS fee schedule,69.01, 458.54% of CMS fee schedule,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,62.54,70% of total billed charges,80.41,90% of total billed charges,84.87,95% of total billed charges,84.87,95% of total billed charges,15.05,100% of CMS fee schedule,30.1,200% of CMS fee schedule,76.83,86% of total billed charges,71.47,80% of total billed charges,16.7,111% of CMS fee schedule,86.66,97% of total billed charges,80.41,90% of total billed charges,N/A,not seperately reimbursable,86.66,97% of total billed charges,83.09,93% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,16.42,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,12.79,85% of CMS fee schedule,12.79,86.66,44.67
Outpatient Medical Services,LAB,84702,HCG Quant MC,300,89.34,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,22.64,150% of AETNA fee schedule,15.05,100% of CMS fee schedule,80.41,90% of total billed charges,18.06,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,82.19,92% of total billed charges,15.05,100% of CMS fee schedule,61.05, 405.66% of CMS fee schedule,15.05,100% of CMS fee schedule,74.38,494.23% of CMS fee schedule,69.01, 458.54% of CMS fee schedule,80.41,90% of total billed charges,15.05,100% of CMS fee schedule,62.54,70% of total billed charges,80.41,90% of total billed charges,84.87,95% of total billed charges,84.87,95% of total billed charges,15.05,100% of CMS fee schedule,30.1,200% of CMS fee schedule,76.83,86% of total billed charges,71.47,80% of total billed charges,16.7,111% of CMS fee schedule,86.66,97% of total billed charges,80.41,90% of total billed charges,N/A,not seperately reimbursable,86.66,97% of total billed charges,83.09,93% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,16.42,100% of CMS fee schedule,86.66,97% of total billed charges,15.05,100% of CMS fee schedule,15.05,100% of CMS fee schedule,12.79,85% of CMS fee schedule,12.79,86.66,44.67
Outpatient Medical Services,LAB,84703,HCG-STAT Serum Qualitative,300,44.64,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,35.71,80% of total billed charges,7.52,100% of CMS fee schedule,40.18,90% of total billed charges,11.29,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,41.07,92% of total billed charges,7.52,100% of CMS fee schedule,30.5, 405.66% of CMS fee schedule,7.52,100% of CMS fee schedule,37.16,494.23% of CMS fee schedule,34.48, 458.54% of CMS fee schedule,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,31.25,70% of total billed charges,40.18,90% of total billed charges,42.41,95% of total billed charges,42.41,95% of total billed charges,7.52,100% of CMS fee schedule,15.04,200% of CMS fee schedule,38.39,86% of total billed charges,35.71,80% of total billed charges,8.34,111% of CMS fee schedule,43.3,97% of total billed charges,40.18,90% of total billed charges,N/A,not seperately reimbursable,43.3,97% of total billed charges,41.52,93% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.26,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,6.39,85% of CMS fee schedule,6.39,43.3,22.32
Outpatient Medical Services,LAB,84703,Urine Pregnancy Test,510,44.64,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,35.71,80% of total billed charges,7.52,100% of CMS fee schedule,40.18,90% of total billed charges,11.29,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,41.07,92% of total billed charges,7.52,100% of CMS fee schedule,30.5, 405.66% of CMS fee schedule,7.52,100% of CMS fee schedule,37.16,494.23% of CMS fee schedule,34.48, 458.54% of CMS fee schedule,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,31.25,70% of total billed charges,40.18,90% of total billed charges,42.41,95% of total billed charges,42.41,95% of total billed charges,7.52,100% of CMS fee schedule,15.04,200% of CMS fee schedule,38.39,86% of total billed charges,35.71,80% of total billed charges,8.34,111% of CMS fee schedule,43.3,97% of total billed charges,40.18,90% of total billed charges,N/A,not seperately reimbursable,43.3,97% of total billed charges,41.52,93% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.26,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,6.39,85% of CMS fee schedule,6.39,43.3,22.32
Outpatient Medical Services,LAB,84703,Urine Pregnancy Test MGH,300,44.64,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,35.71,80% of total billed charges,7.52,100% of CMS fee schedule,40.18,90% of total billed charges,11.29,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,41.07,92% of total billed charges,7.52,100% of CMS fee schedule,30.5, 405.66% of CMS fee schedule,7.52,100% of CMS fee schedule,37.16,494.23% of CMS fee schedule,34.48, 458.54% of CMS fee schedule,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,31.25,70% of total billed charges,40.18,90% of total billed charges,42.41,95% of total billed charges,42.41,95% of total billed charges,7.52,100% of CMS fee schedule,15.04,200% of CMS fee schedule,38.39,86% of total billed charges,35.71,80% of total billed charges,8.34,111% of CMS fee schedule,43.3,97% of total billed charges,40.18,90% of total billed charges,N/A,not seperately reimbursable,43.3,97% of total billed charges,41.52,93% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.26,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,6.39,85% of CMS fee schedule,6.39,43.3,22.32
Outpatient Medical Services,LAB,84703,HCG Qualitative Serum,300,44.64,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,35.71,80% of total billed charges,7.52,100% of CMS fee schedule,40.18,90% of total billed charges,11.29,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,41.07,92% of total billed charges,7.52,100% of CMS fee schedule,30.5, 405.66% of CMS fee schedule,7.52,100% of CMS fee schedule,37.16,494.23% of CMS fee schedule,34.48, 458.54% of CMS fee schedule,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,31.25,70% of total billed charges,40.18,90% of total billed charges,42.41,95% of total billed charges,42.41,95% of total billed charges,7.52,100% of CMS fee schedule,15.04,200% of CMS fee schedule,38.39,86% of total billed charges,35.71,80% of total billed charges,8.34,111% of CMS fee schedule,43.3,97% of total billed charges,40.18,90% of total billed charges,N/A,not seperately reimbursable,43.3,97% of total billed charges,41.52,93% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.26,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,6.39,85% of CMS fee schedule,6.39,43.3,22.32
Outpatient Medical Services,LAB,84703,MC POC Urine Pregnancy Test,300,44.64,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,35.71,80% of total billed charges,7.52,100% of CMS fee schedule,40.18,90% of total billed charges,11.29,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,41.07,92% of total billed charges,7.52,100% of CMS fee schedule,30.5, 405.66% of CMS fee schedule,7.52,100% of CMS fee schedule,37.16,494.23% of CMS fee schedule,34.48, 458.54% of CMS fee schedule,40.18,90% of total billed charges,7.52,100% of CMS fee schedule,31.25,70% of total billed charges,40.18,90% of total billed charges,42.41,95% of total billed charges,42.41,95% of total billed charges,7.52,100% of CMS fee schedule,15.04,200% of CMS fee schedule,38.39,86% of total billed charges,35.71,80% of total billed charges,8.34,111% of CMS fee schedule,43.3,97% of total billed charges,40.18,90% of total billed charges,N/A,not seperately reimbursable,43.3,97% of total billed charges,41.52,93% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.26,100% of CMS fee schedule,43.3,97% of total billed charges,7.52,100% of CMS fee schedule,7.52,100% of CMS fee schedule,6.39,85% of CMS fee schedule,6.39,43.3,22.32
Outpatient Medical Services,LAB,85007,Manual Differential,300,22.56,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,18.05,80% of total billed charges,3.8,100% of CMS fee schedule,20.3,90% of total billed charges,4.95,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,20.76,92% of total billed charges,3.8,100% of CMS fee schedule,15.41, 405.66% of CMS fee schedule,3.8,100% of CMS fee schedule,18.78,494.23% of CMS fee schedule,17.42, 458.54% of CMS fee schedule,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,15.79,70% of total billed charges,20.3,90% of total billed charges,21.43,95% of total billed charges,21.43,95% of total billed charges,3.8,100% of CMS fee schedule,7.6,200% of CMS fee schedule,19.4,86% of total billed charges,18.05,80% of total billed charges,4.21,111% of CMS fee schedule,21.88,97% of total billed charges,20.3,90% of total billed charges,N/A,not seperately reimbursable,21.88,97% of total billed charges,20.98,93% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,4.5,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,3.23,85% of CMS fee schedule,3.23,21.88,11.28
Outpatient Medical Services,LAB,85007,Manual Differential WBC,300,22.56,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,18.05,80% of total billed charges,3.8,100% of CMS fee schedule,20.3,90% of total billed charges,4.95,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,20.76,92% of total billed charges,3.8,100% of CMS fee schedule,15.41, 405.66% of CMS fee schedule,3.8,100% of CMS fee schedule,18.78,494.23% of CMS fee schedule,17.42, 458.54% of CMS fee schedule,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,15.79,70% of total billed charges,20.3,90% of total billed charges,21.43,95% of total billed charges,21.43,95% of total billed charges,3.8,100% of CMS fee schedule,7.6,200% of CMS fee schedule,19.4,86% of total billed charges,18.05,80% of total billed charges,4.21,111% of CMS fee schedule,21.88,97% of total billed charges,20.3,90% of total billed charges,N/A,not seperately reimbursable,21.88,97% of total billed charges,20.98,93% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,4.5,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,3.23,85% of CMS fee schedule,3.23,21.88,11.28
Outpatient Medical Services,LAB,85007,Manual Differential,300,22.56,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,18.05,80% of total billed charges,3.8,100% of CMS fee schedule,20.3,90% of total billed charges,4.95,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,20.76,92% of total billed charges,3.8,100% of CMS fee schedule,15.41, 405.66% of CMS fee schedule,3.8,100% of CMS fee schedule,18.78,494.23% of CMS fee schedule,17.42, 458.54% of CMS fee schedule,20.3,90% of total billed charges,3.8,100% of CMS fee schedule,15.79,70% of total billed charges,20.3,90% of total billed charges,21.43,95% of total billed charges,21.43,95% of total billed charges,3.8,100% of CMS fee schedule,7.6,200% of CMS fee schedule,19.4,86% of total billed charges,18.05,80% of total billed charges,4.21,111% of CMS fee schedule,21.88,97% of total billed charges,20.3,90% of total billed charges,N/A,not seperately reimbursable,21.88,97% of total billed charges,20.98,93% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,4.5,100% of CMS fee schedule,21.88,97% of total billed charges,3.8,100% of CMS fee schedule,3.8,100% of CMS fee schedule,3.23,85% of CMS fee schedule,3.23,21.88,11.28
Outpatient Medical Services,LAB,85014,Hematocrit,300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85014,Hematocrit,300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85014,"Folate, Hct",300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85014,"Hematocrit, POC",300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85014,85014 - POC Chem 8 - Add-On,300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85018,Hemoglobin/Hematocrit,300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85018,Hemoglobin,300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85018,"Hemoglobin, POC",300,14.07,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,11.26,80% of total billed charges,2.37,100% of CMS fee schedule,12.66,90% of total billed charges,3.55,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,12.94,92% of total billed charges,2.37,100% of CMS fee schedule,9.61, 405.66% of CMS fee schedule,2.37,100% of CMS fee schedule,11.71,494.23% of CMS fee schedule,10.86, 458.54% of CMS fee schedule,12.66,90% of total billed charges,2.37,100% of CMS fee schedule,9.85,70% of total billed charges,12.66,90% of total billed charges,13.37,95% of total billed charges,13.37,95% of total billed charges,2.37,100% of CMS fee schedule,4.74,200% of CMS fee schedule,12.1,86% of total billed charges,11.26,80% of total billed charges,2.63,111% of CMS fee schedule,13.65,97% of total billed charges,12.66,90% of total billed charges,N/A,not seperately reimbursable,13.65,97% of total billed charges,13.09,93% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,3.23,100% of CMS fee schedule,13.65,97% of total billed charges,2.37,100% of CMS fee schedule,2.37,100% of CMS fee schedule,2.01,85% of CMS fee schedule,2.01,13.65,7.04
Outpatient Medical Services,LAB,85025,CBC w/ Auto Diff,300,46.12,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,11.7,150% of AETNA fee schedule,7.77,100% of CMS fee schedule,41.51,90% of total billed charges,6.6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,42.43,92% of total billed charges,7.77,100% of CMS fee schedule,31.52, 405.66% of CMS fee schedule,7.77,100% of CMS fee schedule,38.4,494.23% of CMS fee schedule,35.62, 458.54% of CMS fee schedule,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,32.28,70% of total billed charges,41.51,90% of total billed charges,43.81,95% of total billed charges,43.81,95% of total billed charges,7.77,100% of CMS fee schedule,15.54,200% of CMS fee schedule,39.66,86% of total billed charges,36.9,80% of total billed charges,8.62,111% of CMS fee schedule,44.74,97% of total billed charges,41.51,90% of total billed charges,N/A,not seperately reimbursable,44.74,97% of total billed charges,42.89,93% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6.6,85% of CMS fee schedule,6,44.74,23.06
Outpatient Medical Services,LAB,85025,CBC + Diff,300,46.12,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,11.7,150% of AETNA fee schedule,7.77,100% of CMS fee schedule,41.51,90% of total billed charges,6.6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,42.43,92% of total billed charges,7.77,100% of CMS fee schedule,31.52, 405.66% of CMS fee schedule,7.77,100% of CMS fee schedule,38.4,494.23% of CMS fee schedule,35.62, 458.54% of CMS fee schedule,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,32.28,70% of total billed charges,41.51,90% of total billed charges,43.81,95% of total billed charges,43.81,95% of total billed charges,7.77,100% of CMS fee schedule,15.54,200% of CMS fee schedule,39.66,86% of total billed charges,36.9,80% of total billed charges,8.62,111% of CMS fee schedule,44.74,97% of total billed charges,41.51,90% of total billed charges,N/A,not seperately reimbursable,44.74,97% of total billed charges,42.89,93% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6.6,85% of CMS fee schedule,6,44.74,23.06
Outpatient Medical Services,LAB,85025,CBC + Diff,300,46.12,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,11.7,150% of AETNA fee schedule,7.77,100% of CMS fee schedule,41.51,90% of total billed charges,6.6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,42.43,92% of total billed charges,7.77,100% of CMS fee schedule,31.52, 405.66% of CMS fee schedule,7.77,100% of CMS fee schedule,38.4,494.23% of CMS fee schedule,35.62, 458.54% of CMS fee schedule,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,32.28,70% of total billed charges,41.51,90% of total billed charges,43.81,95% of total billed charges,43.81,95% of total billed charges,7.77,100% of CMS fee schedule,15.54,200% of CMS fee schedule,39.66,86% of total billed charges,36.9,80% of total billed charges,8.62,111% of CMS fee schedule,44.74,97% of total billed charges,41.51,90% of total billed charges,N/A,not seperately reimbursable,44.74,97% of total billed charges,42.89,93% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6.6,85% of CMS fee schedule,6,44.74,23.06
Outpatient Medical Services,LAB,85025,Complete Blood Count POC,300,46.12,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,11.7,150% of AETNA fee schedule,7.77,100% of CMS fee schedule,41.51,90% of total billed charges,6.6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,42.43,92% of total billed charges,7.77,100% of CMS fee schedule,31.52, 405.66% of CMS fee schedule,7.77,100% of CMS fee schedule,38.4,494.23% of CMS fee schedule,35.62, 458.54% of CMS fee schedule,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,32.28,70% of total billed charges,41.51,90% of total billed charges,43.81,95% of total billed charges,43.81,95% of total billed charges,7.77,100% of CMS fee schedule,15.54,200% of CMS fee schedule,39.66,86% of total billed charges,36.9,80% of total billed charges,8.62,111% of CMS fee schedule,44.74,97% of total billed charges,41.51,90% of total billed charges,N/A,not seperately reimbursable,44.74,97% of total billed charges,42.89,93% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6.6,85% of CMS fee schedule,6,44.74,23.06
Outpatient Medical Services,LAB,85025,MC CBC + Diff,300,46.12,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,11.7,150% of AETNA fee schedule,7.77,100% of CMS fee schedule,41.51,90% of total billed charges,6.6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,42.43,92% of total billed charges,7.77,100% of CMS fee schedule,31.52, 405.66% of CMS fee schedule,7.77,100% of CMS fee schedule,38.4,494.23% of CMS fee schedule,35.62, 458.54% of CMS fee schedule,41.51,90% of total billed charges,7.77,100% of CMS fee schedule,32.28,70% of total billed charges,41.51,90% of total billed charges,43.81,95% of total billed charges,43.81,95% of total billed charges,7.77,100% of CMS fee schedule,15.54,200% of CMS fee schedule,39.66,86% of total billed charges,36.9,80% of total billed charges,8.62,111% of CMS fee schedule,44.74,97% of total billed charges,41.51,90% of total billed charges,N/A,not seperately reimbursable,44.74,97% of total billed charges,42.89,93% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6,100% of CMS fee schedule,44.74,97% of total billed charges,7.77,100% of CMS fee schedule,7.77,100% of CMS fee schedule,6.6,85% of CMS fee schedule,6,44.74,23.06
Outpatient Medical Services,LAB,85027,zzZComplete Blood Count w/o Differential,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85027,CBC w/o Differential,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85027,CBC w/o Differential,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85027,Newborn CBC with Manual Diff,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85027,ANC - CBC,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85027,Direct Access Lab CBC,300,10.6,9.54,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,9.54,90% of total billed charges,8.27,100% of CMS fee schedule,10.28,97% of total billed charges,6.47,100% of CMS fee schedule,9.75,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,9.54,90% of total billed charges,6.47,100% of CMS fee schedule,7.42,70% of total billed charges,9.54,90% of total billed charges,10.07,95% of total billed charges,10.07,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,9.12,86% of total billed charges,8.48,80% of total billed charges,7.18,111% of CMS fee schedule,10.28,97% of total billed charges,9.54,90% of total billed charges,N/A,not seperately reimbursable,10.28,97% of total billed charges,9.86,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,10.28,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,31.97,5.30
Outpatient Medical Services,LAB,85027,MC CBC w/o Diff,300,38.4,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,9.74,150% of AETNA fee schedule,6.47,100% of CMS fee schedule,34.56,90% of total billed charges,8.27,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,35.33,92% of total billed charges,6.47,100% of CMS fee schedule,26.24, 405.66% of CMS fee schedule,6.47,100% of CMS fee schedule,31.97,494.23% of CMS fee schedule,29.66, 458.54% of CMS fee schedule,34.56,90% of total billed charges,6.47,100% of CMS fee schedule,26.88,70% of total billed charges,34.56,90% of total billed charges,36.48,95% of total billed charges,36.48,95% of total billed charges,6.47,100% of CMS fee schedule,12.94,200% of CMS fee schedule,33.02,86% of total billed charges,30.72,80% of total billed charges,7.18,111% of CMS fee schedule,37.25,97% of total billed charges,34.56,90% of total billed charges,N/A,not seperately reimbursable,37.25,97% of total billed charges,35.71,93% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,7.52,100% of CMS fee schedule,37.25,97% of total billed charges,6.47,100% of CMS fee schedule,6.47,100% of CMS fee schedule,5.49,85% of CMS fee schedule,5.49,37.25,19.20
Outpatient Medical Services,LAB,85045,Reticulocyte Count Automated,300,23.68,21.31,90% of total billed charges,3.99,100% of CMS fee schedule,18.94,80% of total billed charges,3.99,100% of CMS fee schedule,21.31,90% of total billed charges,4.95,100% of CMS fee schedule,22.97,97% of total billed charges,3.99,100% of CMS fee schedule,21.79,92% of total billed charges,3.99,100% of CMS fee schedule,16.18, 405.66% of CMS fee schedule,3.99,100% of CMS fee schedule,19.71,494.23% of CMS fee schedule,18.29, 458.54% of CMS fee schedule,21.31,90% of total billed charges,3.99,100% of CMS fee schedule,16.58,70% of total billed charges,21.31,90% of total billed charges,22.5,95% of total billed charges,22.5,95% of total billed charges,3.99,100% of CMS fee schedule,7.98,200% of CMS fee schedule,20.36,86% of total billed charges,18.94,80% of total billed charges,4.42,111% of CMS fee schedule,22.97,97% of total billed charges,21.31,90% of total billed charges,N/A,not seperately reimbursable,22.97,97% of total billed charges,22.02,93% of total billed charges,3.99,100% of CMS fee schedule,3.99,100% of CMS fee schedule,4.5,100% of CMS fee schedule,22.97,97% of total billed charges,3.99,100% of CMS fee schedule,3.99,100% of CMS fee schedule,3.39,85% of CMS fee schedule,3.39,22.97,11.84
Outpatient Medical Services,LAB,85049,Platelet Count,300,26.6,23.94,90% of total billed charges,4.48,100% of CMS fee schedule,21.28,80% of total billed charges,4.48,100% of CMS fee schedule,23.94,90% of total billed charges,3.3,100% of CMS fee schedule,25.8,97% of total billed charges,4.48,100% of CMS fee schedule,24.47,92% of total billed charges,4.48,100% of CMS fee schedule,18.17, 405.66% of CMS fee schedule,4.48,100% of CMS fee schedule,22.14,494.23% of CMS fee schedule,20.54, 458.54% of CMS fee schedule,23.94,90% of total billed charges,4.48,100% of CMS fee schedule,18.62,70% of total billed charges,23.94,90% of total billed charges,25.27,95% of total billed charges,25.27,95% of total billed charges,4.48,100% of CMS fee schedule,8.96,200% of CMS fee schedule,22.88,86% of total billed charges,21.28,80% of total billed charges,4.97,111% of CMS fee schedule,25.8,97% of total billed charges,23.94,90% of total billed charges,N/A,not seperately reimbursable,25.8,97% of total billed charges,24.74,93% of total billed charges,4.48,100% of CMS fee schedule,4.48,100% of CMS fee schedule,3,100% of CMS fee schedule,25.8,97% of total billed charges,4.48,100% of CMS fee schedule,4.48,100% of CMS fee schedule,3.8,85% of CMS fee schedule,3,25.8,13.30
Outpatient Medical Services,LAB,85049,DIC Profile LC,300,20.24,18.22,90% of total billed charges,4.48,100% of CMS fee schedule,16.19,80% of total billed charges,4.48,100% of CMS fee schedule,18.22,90% of total billed charges,3.3,100% of CMS fee schedule,19.63,97% of total billed charges,4.48,100% of CMS fee schedule,18.62,92% of total billed charges,4.48,100% of CMS fee schedule,18.17, 405.66% of CMS fee schedule,4.48,100% of CMS fee schedule,22.14,494.23% of CMS fee schedule,20.54, 458.54% of CMS fee schedule,18.22,90% of total billed charges,4.48,100% of CMS fee schedule,14.17,70% of total billed charges,18.22,90% of total billed charges,19.23,95% of total billed charges,19.23,95% of total billed charges,4.48,100% of CMS fee schedule,8.96,200% of CMS fee schedule,17.41,86% of total billed charges,16.19,80% of total billed charges,4.97,111% of CMS fee schedule,19.63,97% of total billed charges,18.22,90% of total billed charges,N/A,not seperately reimbursable,19.63,97% of total billed charges,18.82,93% of total billed charges,4.48,100% of CMS fee schedule,4.48,100% of CMS fee schedule,3,100% of CMS fee schedule,19.63,97% of total billed charges,4.48,100% of CMS fee schedule,4.48,100% of CMS fee schedule,3.8,85% of CMS fee schedule,3,22.14,10.12
Outpatient Medical Services,LAB,85379,DDimer,305,60.43,54.39,90% of total billed charges,10.18,100% of CMS fee schedule,48.34,80% of total billed charges,10.18,100% of CMS fee schedule,54.39,90% of total billed charges,11.66,100% of CMS fee schedule,58.62,97% of total billed charges,10.18,100% of CMS fee schedule,55.6,92% of total billed charges,10.18,100% of CMS fee schedule,41.29, 405.66% of CMS fee schedule,10.18,100% of CMS fee schedule,50.31,494.23% of CMS fee schedule,46.67, 458.54% of CMS fee schedule,54.39,90% of total billed charges,10.18,100% of CMS fee schedule,42.3,70% of total billed charges,54.39,90% of total billed charges,57.41,95% of total billed charges,57.41,95% of total billed charges,10.18,100% of CMS fee schedule,20.36,200% of CMS fee schedule,51.97,86% of total billed charges,48.34,80% of total billed charges,11.29,111% of CMS fee schedule,58.62,97% of total billed charges,54.39,90% of total billed charges,N/A,not seperately reimbursable,58.62,97% of total billed charges,56.2,93% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,10.6,100% of CMS fee schedule,58.62,97% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,8.65,85% of CMS fee schedule,8.65,58.62,30.22
Outpatient Medical Services,LAB,85379,MC D-Dimer,305,60.43,54.39,90% of total billed charges,10.18,100% of CMS fee schedule,48.34,80% of total billed charges,10.18,100% of CMS fee schedule,54.39,90% of total billed charges,11.66,100% of CMS fee schedule,58.62,97% of total billed charges,10.18,100% of CMS fee schedule,55.6,92% of total billed charges,10.18,100% of CMS fee schedule,41.29, 405.66% of CMS fee schedule,10.18,100% of CMS fee schedule,50.31,494.23% of CMS fee schedule,46.67, 458.54% of CMS fee schedule,54.39,90% of total billed charges,10.18,100% of CMS fee schedule,42.3,70% of total billed charges,54.39,90% of total billed charges,57.41,95% of total billed charges,57.41,95% of total billed charges,10.18,100% of CMS fee schedule,20.36,200% of CMS fee schedule,51.97,86% of total billed charges,48.34,80% of total billed charges,11.29,111% of CMS fee schedule,58.62,97% of total billed charges,54.39,90% of total billed charges,N/A,not seperately reimbursable,58.62,97% of total billed charges,56.2,93% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,10.6,100% of CMS fee schedule,58.62,97% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,8.65,85% of CMS fee schedule,8.65,58.62,30.22
Outpatient Medical Services,LAB,85379,85379 - DIC Profile LC ADD-ON,300,20.24,18.22,90% of total billed charges,10.18,100% of CMS fee schedule,16.19,80% of total billed charges,10.18,100% of CMS fee schedule,18.22,90% of total billed charges,11.66,100% of CMS fee schedule,19.63,97% of total billed charges,10.18,100% of CMS fee schedule,18.62,92% of total billed charges,10.18,100% of CMS fee schedule,41.29, 405.66% of CMS fee schedule,10.18,100% of CMS fee schedule,50.31,494.23% of CMS fee schedule,46.67, 458.54% of CMS fee schedule,18.22,90% of total billed charges,10.18,100% of CMS fee schedule,14.17,70% of total billed charges,18.22,90% of total billed charges,19.23,95% of total billed charges,19.23,95% of total billed charges,10.18,100% of CMS fee schedule,20.36,200% of CMS fee schedule,17.41,86% of total billed charges,16.19,80% of total billed charges,11.29,111% of CMS fee schedule,19.63,97% of total billed charges,18.22,90% of total billed charges,N/A,not seperately reimbursable,19.63,97% of total billed charges,18.82,93% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,10.6,100% of CMS fee schedule,19.63,97% of total billed charges,10.18,100% of CMS fee schedule,10.18,100% of CMS fee schedule,8.65,85% of CMS fee schedule,8.65,50.31,10.12
Outpatient Medical Services,LAB,85384,Fibrinogen,300,57.7,51.93,90% of total billed charges,9.72,100% of CMS fee schedule,46.16,80% of total billed charges,9.72,100% of CMS fee schedule,51.93,90% of total billed charges,10.9,100% of CMS fee schedule,55.97,97% of total billed charges,9.72,100% of CMS fee schedule,53.08,92% of total billed charges,9.72,100% of CMS fee schedule,39.43, 405.66% of CMS fee schedule,9.72,100% of CMS fee schedule,48.03,494.23% of CMS fee schedule,44.57, 458.54% of CMS fee schedule,51.93,90% of total billed charges,9.72,100% of CMS fee schedule,40.39,70% of total billed charges,51.93,90% of total billed charges,54.82,95% of total billed charges,54.82,95% of total billed charges,9.72,100% of CMS fee schedule,19.44,200% of CMS fee schedule,49.62,86% of total billed charges,46.16,80% of total billed charges,10.78,111% of CMS fee schedule,55.97,97% of total billed charges,51.93,90% of total billed charges,N/A,not seperately reimbursable,55.97,97% of total billed charges,53.66,93% of total billed charges,9.72,100% of CMS fee schedule,9.72,100% of CMS fee schedule,9.91,100% of CMS fee schedule,55.97,97% of total billed charges,9.72,100% of CMS fee schedule,9.72,100% of CMS fee schedule,8.26,85% of CMS fee schedule,8.26,55.97,28.85
Outpatient Medical Services,LAB,85384,85384 - DIC Profile LC ADD-ON,300,20.24,18.22,90% of total billed charges,9.72,100% of CMS fee schedule,16.19,80% of total billed charges,9.72,100% of CMS fee schedule,18.22,90% of total billed charges,10.9,100% of CMS fee schedule,19.63,97% of total billed charges,9.72,100% of CMS fee schedule,18.62,92% of total billed charges,9.72,100% of CMS fee schedule,39.43, 405.66% of CMS fee schedule,9.72,100% of CMS fee schedule,48.03,494.23% of CMS fee schedule,44.57, 458.54% of CMS fee schedule,18.22,90% of total billed charges,9.72,100% of CMS fee schedule,14.17,70% of total billed charges,18.22,90% of total billed charges,19.23,95% of total billed charges,19.23,95% of total billed charges,9.72,100% of CMS fee schedule,19.44,200% of CMS fee schedule,17.41,86% of total billed charges,16.19,80% of total billed charges,10.78,111% of CMS fee schedule,19.63,97% of total billed charges,18.22,90% of total billed charges,N/A,not seperately reimbursable,19.63,97% of total billed charges,18.82,93% of total billed charges,9.72,100% of CMS fee schedule,9.72,100% of CMS fee schedule,9.91,100% of CMS fee schedule,19.63,97% of total billed charges,9.72,100% of CMS fee schedule,9.72,100% of CMS fee schedule,8.26,85% of CMS fee schedule,8.26,48.03,10.12
Outpatient Medical Services,LAB,85610,Prothrombin Time/INR,300,25.46,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,5.9,150% of AETNA fee schedule,4.29,100% of CMS fee schedule,22.91,90% of total billed charges,4.4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,23.42,92% of total billed charges,4.29,100% of CMS fee schedule,17.4, 405.66% of CMS fee schedule,4.29,100% of CMS fee schedule,21.2,494.23% of CMS fee schedule,19.67, 458.54% of CMS fee schedule,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,17.82,70% of total billed charges,22.91,90% of total billed charges,24.19,95% of total billed charges,24.19,95% of total billed charges,4.29,100% of CMS fee schedule,8.58,200% of CMS fee schedule,21.9,86% of total billed charges,20.37,80% of total billed charges,4.76,111% of CMS fee schedule,24.7,97% of total billed charges,22.91,90% of total billed charges,N/A,not seperately reimbursable,24.7,97% of total billed charges,23.68,93% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,3.64,85% of CMS fee schedule,3.64,24.7,12.73
Outpatient Medical Services,LAB,85610,85610- Prothrombin time,300,25.46,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,5.9,150% of AETNA fee schedule,4.29,100% of CMS fee schedule,22.91,90% of total billed charges,4.4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,23.42,92% of total billed charges,4.29,100% of CMS fee schedule,17.4, 405.66% of CMS fee schedule,4.29,100% of CMS fee schedule,21.2,494.23% of CMS fee schedule,19.67, 458.54% of CMS fee schedule,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,17.82,70% of total billed charges,22.91,90% of total billed charges,24.19,95% of total billed charges,24.19,95% of total billed charges,4.29,100% of CMS fee schedule,8.58,200% of CMS fee schedule,21.9,86% of total billed charges,20.37,80% of total billed charges,4.76,111% of CMS fee schedule,24.7,97% of total billed charges,22.91,90% of total billed charges,N/A,not seperately reimbursable,24.7,97% of total billed charges,23.68,93% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,3.64,85% of CMS fee schedule,3.64,24.7,12.73
Outpatient Medical Services,LAB,85610,MC Prothrombin Time/INR (PT/INR),300,25.46,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,5.9,150% of AETNA fee schedule,4.29,100% of CMS fee schedule,22.91,90% of total billed charges,4.4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,23.42,92% of total billed charges,4.29,100% of CMS fee schedule,17.4, 405.66% of CMS fee schedule,4.29,100% of CMS fee schedule,21.2,494.23% of CMS fee schedule,19.67, 458.54% of CMS fee schedule,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,17.82,70% of total billed charges,22.91,90% of total billed charges,24.19,95% of total billed charges,24.19,95% of total billed charges,4.29,100% of CMS fee schedule,8.58,200% of CMS fee schedule,21.9,86% of total billed charges,20.37,80% of total billed charges,4.76,111% of CMS fee schedule,24.7,97% of total billed charges,22.91,90% of total billed charges,N/A,not seperately reimbursable,24.7,97% of total billed charges,23.68,93% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,3.64,85% of CMS fee schedule,3.64,24.7,12.73
Outpatient Medical Services,LAB,85610,85610 - Antiphospholipid Syndrome LC ADD-ON,300,205.28,184.75,90% of total billed charges,4.29,100% of CMS fee schedule,5.9,150% of AETNA fee schedule,4.29,100% of CMS fee schedule,184.75,90% of total billed charges,4.4,100% of CMS fee schedule,199.12,97% of total billed charges,4.29,100% of CMS fee schedule,188.86,92% of total billed charges,4.29,100% of CMS fee schedule,17.4, 405.66% of CMS fee schedule,4.29,100% of CMS fee schedule,21.2,494.23% of CMS fee schedule,19.67, 458.54% of CMS fee schedule,184.75,90% of total billed charges,4.29,100% of CMS fee schedule,143.7,70% of total billed charges,184.75,90% of total billed charges,195.02,95% of total billed charges,195.02,95% of total billed charges,4.29,100% of CMS fee schedule,8.58,200% of CMS fee schedule,176.54,86% of total billed charges,164.22,80% of total billed charges,4.76,111% of CMS fee schedule,199.12,97% of total billed charges,184.75,90% of total billed charges,N/A,not seperately reimbursable,199.12,97% of total billed charges,190.91,93% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4,100% of CMS fee schedule,199.12,97% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,3.64,85% of CMS fee schedule,3.64,199.12,102.64
Outpatient Medical Services,LAB,85610,85610 - DIC Profile LC ADD-ON,300,25.46,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,5.9,150% of AETNA fee schedule,4.29,100% of CMS fee schedule,22.91,90% of total billed charges,4.4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,23.42,92% of total billed charges,4.29,100% of CMS fee schedule,17.4, 405.66% of CMS fee schedule,4.29,100% of CMS fee schedule,21.2,494.23% of CMS fee schedule,19.67, 458.54% of CMS fee schedule,22.91,90% of total billed charges,4.29,100% of CMS fee schedule,17.82,70% of total billed charges,22.91,90% of total billed charges,24.19,95% of total billed charges,24.19,95% of total billed charges,4.29,100% of CMS fee schedule,8.58,200% of CMS fee schedule,21.9,86% of total billed charges,20.37,80% of total billed charges,4.76,111% of CMS fee schedule,24.7,97% of total billed charges,22.91,90% of total billed charges,N/A,not seperately reimbursable,24.7,97% of total billed charges,23.68,93% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,4,100% of CMS fee schedule,24.7,97% of total billed charges,4.29,100% of CMS fee schedule,4.29,100% of CMS fee schedule,3.64,85% of CMS fee schedule,3.64,24.7,12.73
Outpatient Medical Services,LAB,85652,Erythrocyte Sedimentation Rate,300,16.03,14.43,90% of total billed charges,2.7,100% of CMS fee schedule,12.82,80% of total billed charges,2.7,100% of CMS fee schedule,14.43,90% of total billed charges,3.3,100% of CMS fee schedule,15.55,97% of total billed charges,2.7,100% of CMS fee schedule,14.75,92% of total billed charges,2.7,100% of CMS fee schedule,10.95, 405.66% of CMS fee schedule,2.7,100% of CMS fee schedule,13.34,494.23% of CMS fee schedule,12.38, 458.54% of CMS fee schedule,14.43,90% of total billed charges,2.7,100% of CMS fee schedule,11.22,70% of total billed charges,14.43,90% of total billed charges,15.23,95% of total billed charges,15.23,95% of total billed charges,2.7,100% of CMS fee schedule,5.4,200% of CMS fee schedule,13.79,86% of total billed charges,12.82,80% of total billed charges,2.99,111% of CMS fee schedule,15.55,97% of total billed charges,14.43,90% of total billed charges,N/A,not seperately reimbursable,15.55,97% of total billed charges,14.91,93% of total billed charges,2.7,100% of CMS fee schedule,2.7,100% of CMS fee schedule,3,100% of CMS fee schedule,15.55,97% of total billed charges,2.7,100% of CMS fee schedule,2.7,100% of CMS fee schedule,2.29,85% of CMS fee schedule,2.29,15.55,8.02
Outpatient Medical Services,LAB,85730,Activated Partial Thromboplastin Time,300,35.68,32.11,90% of total billed charges,6.01,100% of CMS fee schedule,9.03,150% of AETNA fee schedule,6.01,100% of CMS fee schedule,32.11,90% of total billed charges,8.25,100% of CMS fee schedule,34.61,97% of total billed charges,6.01,100% of CMS fee schedule,32.83,92% of total billed charges,6.01,100% of CMS fee schedule,24.38, 405.66% of CMS fee schedule,6.01,100% of CMS fee schedule,29.7,494.23% of CMS fee schedule,27.55, 458.54% of CMS fee schedule,32.11,90% of total billed charges,6.01,100% of CMS fee schedule,24.98,70% of total billed charges,32.11,90% of total billed charges,33.9,95% of total billed charges,33.9,95% of total billed charges,6.01,100% of CMS fee schedule,12.02,200% of CMS fee schedule,30.68,86% of total billed charges,28.54,80% of total billed charges,6.67,111% of CMS fee schedule,34.61,97% of total billed charges,32.11,90% of total billed charges,N/A,not seperately reimbursable,34.61,97% of total billed charges,33.18,93% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.5,100% of CMS fee schedule,34.61,97% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,5.1,85% of CMS fee schedule,5.1,34.61,17.84
Outpatient Medical Services,LAB,85730,MC APTT,300,35.68,32.11,90% of total billed charges,6.01,100% of CMS fee schedule,9.03,150% of AETNA fee schedule,6.01,100% of CMS fee schedule,32.11,90% of total billed charges,8.25,100% of CMS fee schedule,34.61,97% of total billed charges,6.01,100% of CMS fee schedule,32.83,92% of total billed charges,6.01,100% of CMS fee schedule,24.38, 405.66% of CMS fee schedule,6.01,100% of CMS fee schedule,29.7,494.23% of CMS fee schedule,27.55, 458.54% of CMS fee schedule,32.11,90% of total billed charges,6.01,100% of CMS fee schedule,24.98,70% of total billed charges,32.11,90% of total billed charges,33.9,95% of total billed charges,33.9,95% of total billed charges,6.01,100% of CMS fee schedule,12.02,200% of CMS fee schedule,30.68,86% of total billed charges,28.54,80% of total billed charges,6.67,111% of CMS fee schedule,34.61,97% of total billed charges,32.11,90% of total billed charges,N/A,not seperately reimbursable,34.61,97% of total billed charges,33.18,93% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.5,100% of CMS fee schedule,34.61,97% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,5.1,85% of CMS fee schedule,5.1,34.61,17.84
Outpatient Medical Services,LAB,85730,85730 - Antiphospholipid Syndrome LC ADD-ON,300,205.28,184.75,90% of total billed charges,6.01,100% of CMS fee schedule,9.03,150% of AETNA fee schedule,6.01,100% of CMS fee schedule,184.75,90% of total billed charges,8.25,100% of CMS fee schedule,199.12,97% of total billed charges,6.01,100% of CMS fee schedule,188.86,92% of total billed charges,6.01,100% of CMS fee schedule,24.38, 405.66% of CMS fee schedule,6.01,100% of CMS fee schedule,29.7,494.23% of CMS fee schedule,27.55, 458.54% of CMS fee schedule,184.75,90% of total billed charges,6.01,100% of CMS fee schedule,143.7,70% of total billed charges,184.75,90% of total billed charges,195.02,95% of total billed charges,195.02,95% of total billed charges,6.01,100% of CMS fee schedule,12.02,200% of CMS fee schedule,176.54,86% of total billed charges,164.22,80% of total billed charges,6.67,111% of CMS fee schedule,199.12,97% of total billed charges,184.75,90% of total billed charges,N/A,not seperately reimbursable,199.12,97% of total billed charges,190.91,93% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.5,100% of CMS fee schedule,199.12,97% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,5.1,85% of CMS fee schedule,5.1,199.12,102.64
Outpatient Medical Services,LAB,85730,85730 - DIC Profile LC ADD-ON,300,20.24,18.22,90% of total billed charges,6.01,100% of CMS fee schedule,9.03,150% of AETNA fee schedule,6.01,100% of CMS fee schedule,18.22,90% of total billed charges,8.25,100% of CMS fee schedule,19.63,97% of total billed charges,6.01,100% of CMS fee schedule,18.62,92% of total billed charges,6.01,100% of CMS fee schedule,24.38, 405.66% of CMS fee schedule,6.01,100% of CMS fee schedule,29.7,494.23% of CMS fee schedule,27.55, 458.54% of CMS fee schedule,18.22,90% of total billed charges,6.01,100% of CMS fee schedule,14.17,70% of total billed charges,18.22,90% of total billed charges,19.23,95% of total billed charges,19.23,95% of total billed charges,6.01,100% of CMS fee schedule,12.02,200% of CMS fee schedule,17.41,86% of total billed charges,16.19,80% of total billed charges,6.67,111% of CMS fee schedule,19.63,97% of total billed charges,18.22,90% of total billed charges,N/A,not seperately reimbursable,19.63,97% of total billed charges,18.82,93% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,7.5,100% of CMS fee schedule,19.63,97% of total billed charges,6.01,100% of CMS fee schedule,6.01,100% of CMS fee schedule,5.1,85% of CMS fee schedule,5.1,29.7,10.12
Outpatient Medical Services,LAB,86140,C Reactive Protein,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,7.79,150% of AETNA fee schedule,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,3.3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,3,29.83,15.38
Outpatient Medical Services,LAB,86308,Mononucleosis Screen,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,24.6,80% of total billed charges,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,86308,Mono Screen,510,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,24.6,80% of total billed charges,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,86308,MC Monospot,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,24.6,80% of total billed charges,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,7.87,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,7.15,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,4.4,29.83,15.38
Outpatient Medical Services,LAB,86334,"Immuno Electro, Serum",300,132.61,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,106.09,80% of total billed charges,22.34,100% of CMS fee schedule,119.35,90% of total billed charges,30.8,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,122,92% of total billed charges,22.34,100% of CMS fee schedule,90.62, 405.66% of CMS fee schedule,22.34,100% of CMS fee schedule,110.41,494.23% of CMS fee schedule,102.43, 458.54% of CMS fee schedule,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,92.83,70% of total billed charges,119.35,90% of total billed charges,125.98,95% of total billed charges,125.98,95% of total billed charges,22.34,100% of CMS fee schedule,44.68,200% of CMS fee schedule,114.04,86% of total billed charges,106.09,80% of total billed charges,24.79,111% of CMS fee schedule,128.63,97% of total billed charges,119.35,90% of total billed charges,N/A,not seperately reimbursable,128.63,97% of total billed charges,123.33,93% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,28,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,18.98,85% of CMS fee schedule,18.98,128.63,66.31
Outpatient Medical Services,LAB,86334,IFE/PE S-Immunofix Electr,300,132.61,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,106.09,80% of total billed charges,22.34,100% of CMS fee schedule,119.35,90% of total billed charges,30.8,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,122,92% of total billed charges,22.34,100% of CMS fee schedule,90.62, 405.66% of CMS fee schedule,22.34,100% of CMS fee schedule,110.41,494.23% of CMS fee schedule,102.43, 458.54% of CMS fee schedule,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,92.83,70% of total billed charges,119.35,90% of total billed charges,125.98,95% of total billed charges,125.98,95% of total billed charges,22.34,100% of CMS fee schedule,44.68,200% of CMS fee schedule,114.04,86% of total billed charges,106.09,80% of total billed charges,24.79,111% of CMS fee schedule,128.63,97% of total billed charges,119.35,90% of total billed charges,N/A,not seperately reimbursable,128.63,97% of total billed charges,123.33,93% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,28,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,18.98,85% of CMS fee schedule,18.98,128.63,66.31
Outpatient Medical Services,LAB,86334,IFE and PE Serum LC,300,132.61,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,106.09,80% of total billed charges,22.34,100% of CMS fee schedule,119.35,90% of total billed charges,30.8,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,122,92% of total billed charges,22.34,100% of CMS fee schedule,90.62, 405.66% of CMS fee schedule,22.34,100% of CMS fee schedule,110.41,494.23% of CMS fee schedule,102.43, 458.54% of CMS fee schedule,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,92.83,70% of total billed charges,119.35,90% of total billed charges,125.98,95% of total billed charges,125.98,95% of total billed charges,22.34,100% of CMS fee schedule,44.68,200% of CMS fee schedule,114.04,86% of total billed charges,106.09,80% of total billed charges,24.79,111% of CMS fee schedule,128.63,97% of total billed charges,119.35,90% of total billed charges,N/A,not seperately reimbursable,128.63,97% of total billed charges,123.33,93% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,28,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,18.98,85% of CMS fee schedule,18.98,128.63,66.31
Outpatient Medical Services,LAB,86334,.Immunofixation Elect 001686 LC,300,132.61,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,106.09,80% of total billed charges,22.34,100% of CMS fee schedule,119.35,90% of total billed charges,30.8,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,122,92% of total billed charges,22.34,100% of CMS fee schedule,90.62, 405.66% of CMS fee schedule,22.34,100% of CMS fee schedule,110.41,494.23% of CMS fee schedule,102.43, 458.54% of CMS fee schedule,119.35,90% of total billed charges,22.34,100% of CMS fee schedule,92.83,70% of total billed charges,119.35,90% of total billed charges,125.98,95% of total billed charges,125.98,95% of total billed charges,22.34,100% of CMS fee schedule,44.68,200% of CMS fee schedule,114.04,86% of total billed charges,106.09,80% of total billed charges,24.79,111% of CMS fee schedule,128.63,97% of total billed charges,119.35,90% of total billed charges,N/A,not seperately reimbursable,128.63,97% of total billed charges,123.33,93% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,28,100% of CMS fee schedule,128.63,97% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,18.98,85% of CMS fee schedule,18.98,128.63,66.31
Outpatient Medical Services,LAB,86334,"IFE, Dara-Specific, Serum LC",300,236.35,212.72,90% of total billed charges,22.34,100% of CMS fee schedule,189.08,80% of total billed charges,22.34,100% of CMS fee schedule,212.72,90% of total billed charges,30.8,100% of CMS fee schedule,229.26,97% of total billed charges,22.34,100% of CMS fee schedule,217.44,92% of total billed charges,22.34,100% of CMS fee schedule,90.62, 405.66% of CMS fee schedule,22.34,100% of CMS fee schedule,110.41,494.23% of CMS fee schedule,102.43, 458.54% of CMS fee schedule,212.72,90% of total billed charges,22.34,100% of CMS fee schedule,165.45,70% of total billed charges,212.72,90% of total billed charges,224.53,95% of total billed charges,224.53,95% of total billed charges,22.34,100% of CMS fee schedule,44.68,200% of CMS fee schedule,203.26,86% of total billed charges,189.08,80% of total billed charges,24.79,111% of CMS fee schedule,229.26,97% of total billed charges,212.72,90% of total billed charges,N/A,not seperately reimbursable,229.26,97% of total billed charges,219.81,93% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,28,100% of CMS fee schedule,229.26,97% of total billed charges,22.34,100% of CMS fee schedule,22.34,100% of CMS fee schedule,18.98,85% of CMS fee schedule,18.98,229.26,118.18
Outpatient Medical Services,LAB,86617,"Lyme Disease, CSF",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme Disease, CSF, IgM Confirm",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme Disease-Serum, Western Blot",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme western Blot, IgM",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme, Western Blot, Serum LC",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme, Line Blot, CSF LC",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme, Line 86617 Add-On",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86617,"Lyme, Western Blot 86617 Add-On",300,91.94,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,73.55,80% of total billed charges,15.49,100% of CMS fee schedule,82.75,90% of total billed charges,23.54,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,84.58,92% of total billed charges,15.49,100% of CMS fee schedule,62.83, 405.66% of CMS fee schedule,15.49,100% of CMS fee schedule,76.55,494.23% of CMS fee schedule,71.02, 458.54% of CMS fee schedule,82.75,90% of total billed charges,15.49,100% of CMS fee schedule,64.36,70% of total billed charges,82.75,90% of total billed charges,87.34,95% of total billed charges,87.34,95% of total billed charges,15.49,100% of CMS fee schedule,30.98,200% of CMS fee schedule,79.07,86% of total billed charges,73.55,80% of total billed charges,17.19,111% of CMS fee schedule,89.18,97% of total billed charges,82.75,90% of total billed charges,N/A,not seperately reimbursable,89.18,97% of total billed charges,85.5,93% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,21.4,100% of CMS fee schedule,89.18,97% of total billed charges,15.49,100% of CMS fee schedule,15.49,100% of CMS fee schedule,13.16,85% of CMS fee schedule,13.16,89.18,45.97
Outpatient Medical Services,LAB,86618,zzLyme Antibody/Line Blot Reflex LC,300,95.37,85.83,90% of total billed charges,17.03,100% of CMS fee schedule,76.3,80% of total billed charges,17.03,100% of CMS fee schedule,85.83,90% of total billed charges,25.89,100% of CMS fee schedule,92.51,97% of total billed charges,17.03,100% of CMS fee schedule,87.74,92% of total billed charges,17.03,100% of CMS fee schedule,69.08, 405.66% of CMS fee schedule,17.03,100% of CMS fee schedule,84.16,494.23% of CMS fee schedule,78.08, 458.54% of CMS fee schedule,85.83,90% of total billed charges,17.03,100% of CMS fee schedule,66.76,70% of total billed charges,85.83,90% of total billed charges,90.6,95% of total billed charges,90.6,95% of total billed charges,17.03,100% of CMS fee schedule,34.06,200% of CMS fee schedule,82.02,86% of total billed charges,76.3,80% of total billed charges,18.9,111% of CMS fee schedule,92.51,97% of total billed charges,85.83,90% of total billed charges,N/A,not seperately reimbursable,92.51,97% of total billed charges,88.69,93% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,23.54,100% of CMS fee schedule,92.51,97% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,14.47,85% of CMS fee schedule,14.47,92.51,47.69
Outpatient Medical Services,LAB,86618,Lyme Disease Serology w/Reflex LC,300,95.37,85.83,90% of total billed charges,17.03,100% of CMS fee schedule,76.3,80% of total billed charges,17.03,100% of CMS fee schedule,85.83,90% of total billed charges,25.89,100% of CMS fee schedule,92.51,97% of total billed charges,17.03,100% of CMS fee schedule,87.74,92% of total billed charges,17.03,100% of CMS fee schedule,69.08, 405.66% of CMS fee schedule,17.03,100% of CMS fee schedule,84.16,494.23% of CMS fee schedule,78.08, 458.54% of CMS fee schedule,85.83,90% of total billed charges,17.03,100% of CMS fee schedule,66.76,70% of total billed charges,85.83,90% of total billed charges,90.6,95% of total billed charges,90.6,95% of total billed charges,17.03,100% of CMS fee schedule,34.06,200% of CMS fee schedule,82.02,86% of total billed charges,76.3,80% of total billed charges,18.9,111% of CMS fee schedule,92.51,97% of total billed charges,85.83,90% of total billed charges,N/A,not seperately reimbursable,92.51,97% of total billed charges,88.69,93% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,23.54,100% of CMS fee schedule,92.51,97% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,14.47,85% of CMS fee schedule,14.47,92.51,47.69
Outpatient Medical Services,LAB,86618,.Lyme IgG/IgM LC,300,192.52,173.27,90% of total billed charges,17.03,100% of CMS fee schedule,154.02,80% of total billed charges,17.03,100% of CMS fee schedule,173.27,90% of total billed charges,25.89,100% of CMS fee schedule,186.74,97% of total billed charges,17.03,100% of CMS fee schedule,177.12,92% of total billed charges,17.03,100% of CMS fee schedule,69.08, 405.66% of CMS fee schedule,17.03,100% of CMS fee schedule,84.16,494.23% of CMS fee schedule,78.08, 458.54% of CMS fee schedule,173.27,90% of total billed charges,17.03,100% of CMS fee schedule,134.76,70% of total billed charges,173.27,90% of total billed charges,182.89,95% of total billed charges,182.89,95% of total billed charges,17.03,100% of CMS fee schedule,34.06,200% of CMS fee schedule,165.57,86% of total billed charges,154.02,80% of total billed charges,18.9,111% of CMS fee schedule,186.74,97% of total billed charges,173.27,90% of total billed charges,N/A,not seperately reimbursable,186.74,97% of total billed charges,179.04,93% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,23.54,100% of CMS fee schedule,186.74,97% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,14.47,85% of CMS fee schedule,14.47,186.74,96.26
Outpatient Medical Services,LAB,86618,Lyme Antibody 86618 Add-On,300,101.09,90.98,90% of total billed charges,17.03,100% of CMS fee schedule,80.87,80% of total billed charges,17.03,100% of CMS fee schedule,90.98,90% of total billed charges,25.89,100% of CMS fee schedule,98.06,97% of total billed charges,17.03,100% of CMS fee schedule,93,92% of total billed charges,17.03,100% of CMS fee schedule,69.08, 405.66% of CMS fee schedule,17.03,100% of CMS fee schedule,84.16,494.23% of CMS fee schedule,78.08, 458.54% of CMS fee schedule,90.98,90% of total billed charges,17.03,100% of CMS fee schedule,70.76,70% of total billed charges,90.98,90% of total billed charges,96.04,95% of total billed charges,96.04,95% of total billed charges,17.03,100% of CMS fee schedule,34.06,200% of CMS fee schedule,86.94,86% of total billed charges,80.87,80% of total billed charges,18.9,111% of CMS fee schedule,98.06,97% of total billed charges,90.98,90% of total billed charges,N/A,not seperately reimbursable,98.06,97% of total billed charges,94.01,93% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,23.54,100% of CMS fee schedule,98.06,97% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,14.47,85% of CMS fee schedule,14.47,98.06,50.55
Outpatient Medical Services,LAB,86618,86618 - .Lyme IgG/IgM LC Add-on,300,192.52,173.27,90% of total billed charges,17.03,100% of CMS fee schedule,154.02,80% of total billed charges,17.03,100% of CMS fee schedule,173.27,90% of total billed charges,25.89,100% of CMS fee schedule,186.74,97% of total billed charges,17.03,100% of CMS fee schedule,177.12,92% of total billed charges,17.03,100% of CMS fee schedule,69.08, 405.66% of CMS fee schedule,17.03,100% of CMS fee schedule,84.16,494.23% of CMS fee schedule,78.08, 458.54% of CMS fee schedule,173.27,90% of total billed charges,17.03,100% of CMS fee schedule,134.76,70% of total billed charges,173.27,90% of total billed charges,182.89,95% of total billed charges,182.89,95% of total billed charges,17.03,100% of CMS fee schedule,34.06,200% of CMS fee schedule,165.57,86% of total billed charges,154.02,80% of total billed charges,18.9,111% of CMS fee schedule,186.74,97% of total billed charges,173.27,90% of total billed charges,N/A,not seperately reimbursable,186.74,97% of total billed charges,179.04,93% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,23.54,100% of CMS fee schedule,186.74,97% of total billed charges,17.03,100% of CMS fee schedule,17.03,100% of CMS fee schedule,14.47,85% of CMS fee schedule,14.47,186.74,96.26
Outpatient Medical Services,LAB,86703,HIV 1/2 Abs - Rapid,300,81.39,73.25,90% of total billed charges,13.71,100% of CMS fee schedule,20.63,150% of AETNA fee schedule,13.71,100% of CMS fee schedule,73.25,90% of total billed charges,20.57,100% of CMS fee schedule,78.95,97% of total billed charges,13.71,100% of CMS fee schedule,74.88,92% of total billed charges,13.71,100% of CMS fee schedule,55.61, 405.66% of CMS fee schedule,13.71,100% of CMS fee schedule,67.75,494.23% of CMS fee schedule,62.86, 458.54% of CMS fee schedule,73.25,90% of total billed charges,13.71,100% of CMS fee schedule,56.97,70% of total billed charges,73.25,90% of total billed charges,77.32,95% of total billed charges,77.32,95% of total billed charges,13.71,100% of CMS fee schedule,27.42,200% of CMS fee schedule,70,86% of total billed charges,65.11,80% of total billed charges,15.21,111% of CMS fee schedule,78.95,97% of total billed charges,73.25,90% of total billed charges,N/A,not seperately reimbursable,78.95,97% of total billed charges,75.69,93% of total billed charges,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,18.7,100% of CMS fee schedule,78.95,97% of total billed charges,13.71,100% of CMS fee schedule,13.71,100% of CMS fee schedule,11.65,85% of CMS fee schedule,11.65,78.95,40.70
Outpatient Medical Services,LAB,86704,Employee Health Hepatitis Panel,300,71.53,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,57.22,80% of total billed charges,12.05,100% of CMS fee schedule,64.38,90% of total billed charges,16.5,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,65.81,92% of total billed charges,12.05,100% of CMS fee schedule,48.88, 405.66% of CMS fee schedule,12.05,100% of CMS fee schedule,59.55,494.23% of CMS fee schedule,55.25, 458.54% of CMS fee schedule,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,50.07,70% of total billed charges,64.38,90% of total billed charges,67.95,95% of total billed charges,67.95,95% of total billed charges,12.05,100% of CMS fee schedule,24.1,200% of CMS fee schedule,61.52,86% of total billed charges,57.22,80% of total billed charges,13.37,111% of CMS fee schedule,69.38,97% of total billed charges,64.38,90% of total billed charges,N/A,not seperately reimbursable,69.38,97% of total billed charges,66.52,93% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,15,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,10.24,85% of CMS fee schedule,10.24,69.38,35.77
Outpatient Medical Services,LAB,86704,Hepatitis B Core - Antibody,300,71.53,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,57.22,80% of total billed charges,12.05,100% of CMS fee schedule,64.38,90% of total billed charges,16.5,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,65.81,92% of total billed charges,12.05,100% of CMS fee schedule,48.88, 405.66% of CMS fee schedule,12.05,100% of CMS fee schedule,59.55,494.23% of CMS fee schedule,55.25, 458.54% of CMS fee schedule,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,50.07,70% of total billed charges,64.38,90% of total billed charges,67.95,95% of total billed charges,67.95,95% of total billed charges,12.05,100% of CMS fee schedule,24.1,200% of CMS fee schedule,61.52,86% of total billed charges,57.22,80% of total billed charges,13.37,111% of CMS fee schedule,69.38,97% of total billed charges,64.38,90% of total billed charges,N/A,not seperately reimbursable,69.38,97% of total billed charges,66.52,93% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,15,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,10.24,85% of CMS fee schedule,10.24,69.38,35.77
Outpatient Medical Services,LAB,86704,"Viral Hepatitis HBV, HCV LC",300,71.53,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,57.22,80% of total billed charges,12.05,100% of CMS fee schedule,64.38,90% of total billed charges,16.5,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,65.81,92% of total billed charges,12.05,100% of CMS fee schedule,48.88, 405.66% of CMS fee schedule,12.05,100% of CMS fee schedule,59.55,494.23% of CMS fee schedule,55.25, 458.54% of CMS fee schedule,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,50.07,70% of total billed charges,64.38,90% of total billed charges,67.95,95% of total billed charges,67.95,95% of total billed charges,12.05,100% of CMS fee schedule,24.1,200% of CMS fee schedule,61.52,86% of total billed charges,57.22,80% of total billed charges,13.37,111% of CMS fee schedule,69.38,97% of total billed charges,64.38,90% of total billed charges,N/A,not seperately reimbursable,69.38,97% of total billed charges,66.52,93% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,15,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,10.24,85% of CMS fee schedule,10.24,69.38,35.77
Outpatient Medical Services,LAB,86704,HBcAb 86704 Add-On,300,71.53,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,57.22,80% of total billed charges,12.05,100% of CMS fee schedule,64.38,90% of total billed charges,16.5,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,65.81,92% of total billed charges,12.05,100% of CMS fee schedule,48.88, 405.66% of CMS fee schedule,12.05,100% of CMS fee schedule,59.55,494.23% of CMS fee schedule,55.25, 458.54% of CMS fee schedule,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,50.07,70% of total billed charges,64.38,90% of total billed charges,67.95,95% of total billed charges,67.95,95% of total billed charges,12.05,100% of CMS fee schedule,24.1,200% of CMS fee schedule,61.52,86% of total billed charges,57.22,80% of total billed charges,13.37,111% of CMS fee schedule,69.38,97% of total billed charges,64.38,90% of total billed charges,N/A,not seperately reimbursable,69.38,97% of total billed charges,66.52,93% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,15,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,10.24,85% of CMS fee schedule,10.24,69.38,35.77
Outpatient Medical Services,LAB,86704,Hepatitis B Core Antibody,300,71.53,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,57.22,80% of total billed charges,12.05,100% of CMS fee schedule,64.38,90% of total billed charges,16.5,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,65.81,92% of total billed charges,12.05,100% of CMS fee schedule,48.88, 405.66% of CMS fee schedule,12.05,100% of CMS fee schedule,59.55,494.23% of CMS fee schedule,55.25, 458.54% of CMS fee schedule,64.38,90% of total billed charges,12.05,100% of CMS fee schedule,50.07,70% of total billed charges,64.38,90% of total billed charges,67.95,95% of total billed charges,67.95,95% of total billed charges,12.05,100% of CMS fee schedule,24.1,200% of CMS fee schedule,61.52,86% of total billed charges,57.22,80% of total billed charges,13.37,111% of CMS fee schedule,69.38,97% of total billed charges,64.38,90% of total billed charges,N/A,not seperately reimbursable,69.38,97% of total billed charges,66.52,93% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,15,100% of CMS fee schedule,69.38,97% of total billed charges,12.05,100% of CMS fee schedule,12.05,100% of CMS fee schedule,10.24,85% of CMS fee schedule,10.24,69.38,35.77
Outpatient Medical Services,LAB,86705,"Hep VIII, HBcAb, IgM",300,69.86,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,55.89,80% of total billed charges,11.77,100% of CMS fee schedule,62.87,90% of total billed charges,17.88,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,64.27,92% of total billed charges,11.77,100% of CMS fee schedule,47.74, 405.66% of CMS fee schedule,11.77,100% of CMS fee schedule,58.17,494.23% of CMS fee schedule,53.97, 458.54% of CMS fee schedule,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,48.9,70% of total billed charges,62.87,90% of total billed charges,66.37,95% of total billed charges,66.37,95% of total billed charges,11.77,100% of CMS fee schedule,23.54,200% of CMS fee schedule,60.08,86% of total billed charges,55.89,80% of total billed charges,13.06,111% of CMS fee schedule,67.76,97% of total billed charges,62.87,90% of total billed charges,N/A,not seperately reimbursable,67.76,97% of total billed charges,64.97,93% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,16.25,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,10,85% of CMS fee schedule,10,67.76,34.93
Outpatient Medical Services,LAB,86705,Hepatitis B Core Antibody IgM,300,69.86,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,55.89,80% of total billed charges,11.77,100% of CMS fee schedule,62.87,90% of total billed charges,17.88,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,64.27,92% of total billed charges,11.77,100% of CMS fee schedule,47.74, 405.66% of CMS fee schedule,11.77,100% of CMS fee schedule,58.17,494.23% of CMS fee schedule,53.97, 458.54% of CMS fee schedule,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,48.9,70% of total billed charges,62.87,90% of total billed charges,66.37,95% of total billed charges,66.37,95% of total billed charges,11.77,100% of CMS fee schedule,23.54,200% of CMS fee schedule,60.08,86% of total billed charges,55.89,80% of total billed charges,13.06,111% of CMS fee schedule,67.76,97% of total billed charges,62.87,90% of total billed charges,N/A,not seperately reimbursable,67.76,97% of total billed charges,64.97,93% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,16.25,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,10,85% of CMS fee schedule,10,67.76,34.93
Outpatient Medical Services,LAB,86705,.HBcIgM LC,300,69.86,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,55.89,80% of total billed charges,11.77,100% of CMS fee schedule,62.87,90% of total billed charges,17.88,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,64.27,92% of total billed charges,11.77,100% of CMS fee schedule,47.74, 405.66% of CMS fee schedule,11.77,100% of CMS fee schedule,58.17,494.23% of CMS fee schedule,53.97, 458.54% of CMS fee schedule,62.87,90% of total billed charges,11.77,100% of CMS fee schedule,48.9,70% of total billed charges,62.87,90% of total billed charges,66.37,95% of total billed charges,66.37,95% of total billed charges,11.77,100% of CMS fee schedule,23.54,200% of CMS fee schedule,60.08,86% of total billed charges,55.89,80% of total billed charges,13.06,111% of CMS fee schedule,67.76,97% of total billed charges,62.87,90% of total billed charges,N/A,not seperately reimbursable,67.76,97% of total billed charges,64.97,93% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,16.25,100% of CMS fee schedule,67.76,97% of total billed charges,11.77,100% of CMS fee schedule,11.77,100% of CMS fee schedule,10,85% of CMS fee schedule,10,67.76,34.93
Outpatient Medical Services,LAB,86706,Hep B Surface Antibody,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,"EH Hepatitis Panel, HBsAB",300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,"Hep VIII, HBsAb",300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,Hepatitis B Surface - Antibody,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,"Hepatitis B Surface Antibody Qual, SO",300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,86706 add-on,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86706,Direct Access Lab Hep B Antibody Titer,300,20,18,90% of total billed charges,10.74,100% of CMS fee schedule,16,80% of total billed charges,10.74,100% of CMS fee schedule,18,90% of total billed charges,14.5,100% of CMS fee schedule,19.4,97% of total billed charges,10.74,100% of CMS fee schedule,18.4,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,18,90% of total billed charges,10.74,100% of CMS fee schedule,14,70% of total billed charges,18,90% of total billed charges,19,95% of total billed charges,19,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,17.2,86% of total billed charges,16,80% of total billed charges,11.92,111% of CMS fee schedule,19.4,97% of total billed charges,18,90% of total billed charges,N/A,not seperately reimbursable,19.4,97% of total billed charges,18.6,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,19.4,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,53.08,10.00
Outpatient Medical Services,LAB,86706,Hepatitis B Surface Antibody,300,63.75,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,51,80% of total billed charges,10.74,100% of CMS fee schedule,57.38,90% of total billed charges,14.5,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,58.65,92% of total billed charges,10.74,100% of CMS fee schedule,43.56, 405.66% of CMS fee schedule,10.74,100% of CMS fee schedule,53.08,494.23% of CMS fee schedule,49.24, 458.54% of CMS fee schedule,57.38,90% of total billed charges,10.74,100% of CMS fee schedule,44.63,70% of total billed charges,57.38,90% of total billed charges,60.56,95% of total billed charges,60.56,95% of total billed charges,10.74,100% of CMS fee schedule,21.48,200% of CMS fee schedule,54.83,86% of total billed charges,51,80% of total billed charges,11.92,111% of CMS fee schedule,61.84,97% of total billed charges,57.38,90% of total billed charges,N/A,not seperately reimbursable,61.84,97% of total billed charges,59.29,93% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,13.18,100% of CMS fee schedule,61.84,97% of total billed charges,10.74,100% of CMS fee schedule,10.74,100% of CMS fee schedule,9.12,85% of CMS fee schedule,9.12,61.84,31.88
Outpatient Medical Services,LAB,86707,Hepatitis Be Antibody,300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,16.5,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,15,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,9.83,66.62,34.34
Outpatient Medical Services,LAB,86707,"Hep VIII, HBeAb",300,68.68,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,54.94,80% of total billed charges,11.57,100% of CMS fee schedule,61.81,90% of total billed charges,16.5,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,63.19,92% of total billed charges,11.57,100% of CMS fee schedule,46.93, 405.66% of CMS fee schedule,11.57,100% of CMS fee schedule,57.18,494.23% of CMS fee schedule,53.05, 458.54% of CMS fee schedule,61.81,90% of total billed charges,11.57,100% of CMS fee schedule,48.08,70% of total billed charges,61.81,90% of total billed charges,65.25,95% of total billed charges,65.25,95% of total billed charges,11.57,100% of CMS fee schedule,23.14,200% of CMS fee schedule,59.06,86% of total billed charges,54.94,80% of total billed charges,12.84,111% of CMS fee schedule,66.62,97% of total billed charges,61.81,90% of total billed charges,N/A,not seperately reimbursable,66.62,97% of total billed charges,63.87,93% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,15,100% of CMS fee schedule,66.62,97% of total billed charges,11.57,100% of CMS fee schedule,11.57,100% of CMS fee schedule,9.83,85% of CMS fee schedule,9.83,66.62,34.34
Outpatient Medical Services,LAB,86709,Hepatitis A Antibody IgM,300,66.84,60.16,90% of total billed charges,11.26,100% of CMS fee schedule,53.47,80% of total billed charges,11.26,100% of CMS fee schedule,60.16,90% of total billed charges,16.72,100% of CMS fee schedule,64.83,97% of total billed charges,11.26,100% of CMS fee schedule,61.49,92% of total billed charges,11.26,100% of CMS fee schedule,45.67, 405.66% of CMS fee schedule,11.26,100% of CMS fee schedule,55.65,494.23% of CMS fee schedule,51.63, 458.54% of CMS fee schedule,60.16,90% of total billed charges,11.26,100% of CMS fee schedule,46.79,70% of total billed charges,60.16,90% of total billed charges,63.5,95% of total billed charges,63.5,95% of total billed charges,11.26,100% of CMS fee schedule,22.52,200% of CMS fee schedule,57.48,86% of total billed charges,53.47,80% of total billed charges,12.49,111% of CMS fee schedule,64.83,97% of total billed charges,60.16,90% of total billed charges,N/A,not seperately reimbursable,64.83,97% of total billed charges,62.16,93% of total billed charges,11.26,100% of CMS fee schedule,11.26,100% of CMS fee schedule,15.2,100% of CMS fee schedule,64.83,97% of total billed charges,11.26,100% of CMS fee schedule,11.26,100% of CMS fee schedule,9.57,85% of CMS fee schedule,9.57,64.83,33.42
Outpatient Medical Services,LAB,86709,"Hepatitis A Antibody, IgM",300,66.84,60.16,90% of total billed charges,11.26,100% of CMS fee schedule,53.47,80% of total billed charges,11.26,100% of CMS fee schedule,60.16,90% of total billed charges,16.72,100% of CMS fee schedule,64.83,97% of total billed charges,11.26,100% of CMS fee schedule,61.49,92% of total billed charges,11.26,100% of CMS fee schedule,45.67, 405.66% of CMS fee schedule,11.26,100% of CMS fee schedule,55.65,494.23% of CMS fee schedule,51.63, 458.54% of CMS fee schedule,60.16,90% of total billed charges,11.26,100% of CMS fee schedule,46.79,70% of total billed charges,60.16,90% of total billed charges,63.5,95% of total billed charges,63.5,95% of total billed charges,11.26,100% of CMS fee schedule,22.52,200% of CMS fee schedule,57.48,86% of total billed charges,53.47,80% of total billed charges,12.49,111% of CMS fee schedule,64.83,97% of total billed charges,60.16,90% of total billed charges,N/A,not seperately reimbursable,64.83,97% of total billed charges,62.16,93% of total billed charges,11.26,100% of CMS fee schedule,11.26,100% of CMS fee schedule,15.2,100% of CMS fee schedule,64.83,97% of total billed charges,11.26,100% of CMS fee schedule,11.26,100% of CMS fee schedule,9.57,85% of CMS fee schedule,9.57,64.83,33.42
Outpatient Medical Services,LAB,86735,Mumps Antibodies IgG,300,77.46,69.71,90% of total billed charges,13.05,100% of CMS fee schedule,61.97,80% of total billed charges,13.05,100% of CMS fee schedule,69.71,90% of total billed charges,N/A,not seperately reimbursable,75.14,97% of total billed charges,13.05,100% of CMS fee schedule,71.26,92% of total billed charges,13.05,100% of CMS fee schedule,52.93, 405.66% of CMS fee schedule,13.05,100% of CMS fee schedule,64.49,494.23% of CMS fee schedule,59.83, 458.54% of CMS fee schedule,69.71,90% of total billed charges,13.05,100% of CMS fee schedule,54.22,70% of total billed charges,69.71,90% of total billed charges,73.59,95% of total billed charges,73.59,95% of total billed charges,13.05,100% of CMS fee schedule,26.1,200% of CMS fee schedule,66.62,86% of total billed charges,61.97,80% of total billed charges,14.48,111% of CMS fee schedule,75.14,97% of total billed charges,69.71,90% of total billed charges,N/A,not seperately reimbursable,75.14,97% of total billed charges,72.04,93% of total billed charges,13.05,100% of CMS fee schedule,13.05,100% of CMS fee schedule,N/A,not seperately reimbursable,75.14,97% of total billed charges,13.05,100% of CMS fee schedule,13.05,100% of CMS fee schedule,11.09,85% of CMS fee schedule,11.09,75.14,38.73
Outpatient Medical Services,LAB,86735,Immunity Panel,300,77.46,69.71,90% of total billed charges,13.05,100% of CMS fee schedule,61.97,80% of total billed charges,13.05,100% of CMS fee schedule,69.71,90% of total billed charges,N/A,not seperately reimbursable,75.14,97% of total billed charges,13.05,100% of CMS fee schedule,71.26,92% of total billed charges,13.05,100% of CMS fee schedule,52.93, 405.66% of CMS fee schedule,13.05,100% of CMS fee schedule,64.49,494.23% of CMS fee schedule,59.83, 458.54% of CMS fee schedule,69.71,90% of total billed charges,13.05,100% of CMS fee schedule,54.22,70% of total billed charges,69.71,90% of total billed charges,73.59,95% of total billed charges,73.59,95% of total billed charges,13.05,100% of CMS fee schedule,26.1,200% of CMS fee schedule,66.62,86% of total billed charges,61.97,80% of total billed charges,14.48,111% of CMS fee schedule,75.14,97% of total billed charges,69.71,90% of total billed charges,N/A,not seperately reimbursable,75.14,97% of total billed charges,72.04,93% of total billed charges,13.05,100% of CMS fee schedule,13.05,100% of CMS fee schedule,N/A,not seperately reimbursable,75.14,97% of total billed charges,13.05,100% of CMS fee schedule,13.05,100% of CMS fee schedule,11.09,85% of CMS fee schedule,11.09,75.14,38.73
Outpatient Medical Services,LAB,86803,Hepatitis C Antibody,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,Hep C Virus Ab,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,"EH Hepatitis Panel, HCVAB",300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,"Hep VIII, Hep C Ab",300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,Hepatitis C - Antibody,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,zzzHCV Antibody reflex to NAA LC,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,86803 add-on,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,HBcAb 86803 Add-On,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,HCV Antibody RFX to Quant PCR LC,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86803,Hepatitis C Antibody,300,84.7,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,67.76,80% of total billed charges,14.27,100% of CMS fee schedule,76.23,90% of total billed charges,20.9,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,77.92,92% of total billed charges,14.27,100% of CMS fee schedule,57.88, 405.66% of CMS fee schedule,14.27,100% of CMS fee schedule,70.52,494.23% of CMS fee schedule,65.43, 458.54% of CMS fee schedule,76.23,90% of total billed charges,14.27,100% of CMS fee schedule,59.29,70% of total billed charges,76.23,90% of total billed charges,80.47,95% of total billed charges,80.47,95% of total billed charges,14.27,100% of CMS fee schedule,28.54,200% of CMS fee schedule,72.84,86% of total billed charges,67.76,80% of total billed charges,15.83,111% of CMS fee schedule,82.16,97% of total billed charges,76.23,90% of total billed charges,N/A,not seperately reimbursable,82.16,97% of total billed charges,78.77,93% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,19,100% of CMS fee schedule,82.16,97% of total billed charges,14.27,100% of CMS fee schedule,14.27,100% of CMS fee schedule,12.12,85% of CMS fee schedule,12.12,82.16,42.35
Outpatient Medical Services,LAB,86850,*Antibody Screen Pre Rx,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,*Antibody Screen Post Rx,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Antibody Screen,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Prenatal ABSC,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Pre Warm ABSC,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,PEG ABSC,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Antibody Screen Gel,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Prenatal ABSC Gel,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Antibody Screen Auto,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86850,Prenatal ABSC Auto,300,270.55,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,16.25,150% of AETNA fee schedule,50.81,100% of CMS IPPS rate,243.5,90% of total billed charges,9.3,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,248.91,92% of total billed charges,50.81,100% of CMS IPPS rate,124.64,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,198.71,100% of CMS IPPS rate,251.7,100% of CMS IPPS rate,243.5,90% of total billed charges,50.81,100% of CMS IPPS rate,189.39,70% of total billed charges,243.5,90% of total billed charges,257.02,95% of total billed charges,257.02,95% of total billed charges,50.81,100% of CMS IPPS rate,93.78,100% of CMS IPPS rate,232.67,86% of total billed charges,216.44,80% of total billed charges,51.14,100% of CMS IPPS rate,262.43,97% of total billed charges,243.5,90% of total billed charges,N/A,not seperately reimbursable,262.43,97% of total billed charges,251.61,93% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,262.43,97% of total billed charges,50.81,100% of CMS IPPS rate,50.81,100% of CMS IPPS rate,43.19,100% of CMS IPPS rate,8.45,262.43,135.28
Outpatient Medical Services,LAB,86870,Antibody Identification Interpretation,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,9.3,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,1696.56,874.52
Outpatient Medical Services,LAB,86870,ABID Additional Panel,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,9.3,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,1696.56,874.52
Outpatient Medical Services,LAB,86870,ABID Additional Panel,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,9.3,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,1696.56,874.52
Outpatient Medical Services,LAB,86870,ABID Additional Panel Billing -> 5,300,8745.16,7870.64,90% of total billed charges,342.12,100% of CMS IPPS rate,6996.13,80% of total billed charges,342.12,100% of CMS IPPS rate,7870.64,90% of total billed charges,9.3,100% of CMS fee schedule,8482.81,97% of total billed charges,342.12,100% of CMS IPPS rate,8045.55,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,7870.64,90% of total billed charges,342.12,100% of CMS IPPS rate,6121.61,70% of total billed charges,7870.64,90% of total billed charges,8307.9,95% of total billed charges,8307.9,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,7520.84,86% of total billed charges,6996.13,80% of total billed charges,293.01,100% of CMS IPPS rate,8482.81,97% of total billed charges,7870.64,90% of total billed charges,N/A,not seperately reimbursable,8482.81,97% of total billed charges,8133,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,8482.81,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,8482.81,4372.58
Outpatient Medical Services,LAB,86870,ABID Additional Panel Billing -> 4,300,6996.13,6296.52,90% of total billed charges,342.12,100% of CMS IPPS rate,5596.9,80% of total billed charges,342.12,100% of CMS IPPS rate,6296.52,90% of total billed charges,9.3,100% of CMS fee schedule,6786.25,97% of total billed charges,342.12,100% of CMS IPPS rate,6436.44,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,6296.52,90% of total billed charges,342.12,100% of CMS IPPS rate,4897.29,70% of total billed charges,6296.52,90% of total billed charges,6646.32,95% of total billed charges,6646.32,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,6016.67,86% of total billed charges,5596.9,80% of total billed charges,293.01,100% of CMS IPPS rate,6786.25,97% of total billed charges,6296.52,90% of total billed charges,N/A,not seperately reimbursable,6786.25,97% of total billed charges,6506.4,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,6786.25,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,6786.25,3498.07
Outpatient Medical Services,LAB,86870,ABID Additional Panel Billing -> 3,300,5247.1,4722.39,90% of total billed charges,342.12,100% of CMS IPPS rate,4197.68,80% of total billed charges,342.12,100% of CMS IPPS rate,4722.39,90% of total billed charges,9.3,100% of CMS fee schedule,5089.69,97% of total billed charges,342.12,100% of CMS IPPS rate,4827.33,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,4722.39,90% of total billed charges,342.12,100% of CMS IPPS rate,3672.97,70% of total billed charges,4722.39,90% of total billed charges,4984.75,95% of total billed charges,4984.75,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,4512.51,86% of total billed charges,4197.68,80% of total billed charges,293.01,100% of CMS IPPS rate,5089.69,97% of total billed charges,4722.39,90% of total billed charges,N/A,not seperately reimbursable,5089.69,97% of total billed charges,4879.8,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,5089.69,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,5089.69,2623.55
Outpatient Medical Services,LAB,86870,ABID Additional Panel Billing -> 2,300,3498.06,3148.25,90% of total billed charges,342.12,100% of CMS IPPS rate,2798.45,80% of total billed charges,342.12,100% of CMS IPPS rate,3148.25,90% of total billed charges,9.3,100% of CMS fee schedule,3393.12,97% of total billed charges,342.12,100% of CMS IPPS rate,3218.22,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,3148.25,90% of total billed charges,342.12,100% of CMS IPPS rate,2448.64,70% of total billed charges,3148.25,90% of total billed charges,3323.16,95% of total billed charges,3323.16,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,3008.33,86% of total billed charges,2798.45,80% of total billed charges,293.01,100% of CMS IPPS rate,3393.12,97% of total billed charges,3148.25,90% of total billed charges,N/A,not seperately reimbursable,3393.12,97% of total billed charges,3253.2,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,3393.12,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,3393.12,1749.03
Outpatient Medical Services,LAB,86870,ABID Additional Panel Billing -> 1,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,9.3,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,8.45,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,8.45,1696.56,874.52
Outpatient Medical Services,LAB,86880,*Cord Blood DAT,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,*Direct Coombs Pre Reaction,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,*Direct Coombs Post Reaction,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,* Direct Coombs Unit Trans Rx,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,DAT Interp,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,Direct Coombs,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,DAT Interp -> Neg,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86880,DAT Interp -> Pos,300,310.19,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,248.15,80% of total billed charges,56.49,100% of CMS IPPS rate,279.17,90% of total billed charges,8.17,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,285.37,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,279.17,90% of total billed charges,56.49,100% of CMS IPPS rate,217.13,70% of total billed charges,279.17,90% of total billed charges,294.68,95% of total billed charges,294.68,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,266.76,86% of total billed charges,248.15,80% of total billed charges,34.56,100% of CMS IPPS rate,300.88,97% of total billed charges,279.17,90% of total billed charges,N/A,not seperately reimbursable,300.88,97% of total billed charges,288.48,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,7.43,100% of CMS fee schedule,300.88,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,7.43,300.88,155.10
Outpatient Medical Services,LAB,86885,Antibody ID-each cell selected,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,8.69,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,823.14,424.30
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 7,300,5940.23,5346.21,90% of total billed charges,162.98,100% of CMS IPPS rate,4752.18,80% of total billed charges,162.98,100% of CMS IPPS rate,5346.21,90% of total billed charges,8.69,100% of CMS fee schedule,5762.02,97% of total billed charges,162.98,100% of CMS IPPS rate,5465.01,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,5346.21,90% of total billed charges,162.98,100% of CMS IPPS rate,4158.16,70% of total billed charges,5346.21,90% of total billed charges,5643.22,95% of total billed charges,5643.22,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,5108.6,86% of total billed charges,4752.18,80% of total billed charges,148.36,100% of CMS IPPS rate,5762.02,97% of total billed charges,5346.21,90% of total billed charges,N/A,not seperately reimbursable,5762.02,97% of total billed charges,5524.41,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,5762.02,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,5762.02,2970.12
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 6,300,5091.63,4582.47,90% of total billed charges,162.98,100% of CMS IPPS rate,4073.3,80% of total billed charges,162.98,100% of CMS IPPS rate,4582.47,90% of total billed charges,8.69,100% of CMS fee schedule,4938.88,97% of total billed charges,162.98,100% of CMS IPPS rate,4684.3,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,4582.47,90% of total billed charges,162.98,100% of CMS IPPS rate,3564.14,70% of total billed charges,4582.47,90% of total billed charges,4837.05,95% of total billed charges,4837.05,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,4378.8,86% of total billed charges,4073.3,80% of total billed charges,148.36,100% of CMS IPPS rate,4938.88,97% of total billed charges,4582.47,90% of total billed charges,N/A,not seperately reimbursable,4938.88,97% of total billed charges,4735.22,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,4938.88,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,4938.88,2545.82
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 5,300,4243.02,3818.72,90% of total billed charges,162.98,100% of CMS IPPS rate,3394.42,80% of total billed charges,162.98,100% of CMS IPPS rate,3818.72,90% of total billed charges,8.69,100% of CMS fee schedule,4115.73,97% of total billed charges,162.98,100% of CMS IPPS rate,3903.58,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,3818.72,90% of total billed charges,162.98,100% of CMS IPPS rate,2970.11,70% of total billed charges,3818.72,90% of total billed charges,4030.87,95% of total billed charges,4030.87,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,3649,86% of total billed charges,3394.42,80% of total billed charges,148.36,100% of CMS IPPS rate,4115.73,97% of total billed charges,3818.72,90% of total billed charges,N/A,not seperately reimbursable,4115.73,97% of total billed charges,3946.01,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,4115.73,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,4115.73,2121.51
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 4,300,3394.42,3054.98,90% of total billed charges,162.98,100% of CMS IPPS rate,2715.54,80% of total billed charges,162.98,100% of CMS IPPS rate,3054.98,90% of total billed charges,8.69,100% of CMS fee schedule,3292.59,97% of total billed charges,162.98,100% of CMS IPPS rate,3122.87,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,3054.98,90% of total billed charges,162.98,100% of CMS IPPS rate,2376.09,70% of total billed charges,3054.98,90% of total billed charges,3224.7,95% of total billed charges,3224.7,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,2919.2,86% of total billed charges,2715.54,80% of total billed charges,148.36,100% of CMS IPPS rate,3292.59,97% of total billed charges,3054.98,90% of total billed charges,N/A,not seperately reimbursable,3292.59,97% of total billed charges,3156.81,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,3292.59,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,3292.59,1697.21
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 3,300,2545.81,2291.23,90% of total billed charges,162.98,100% of CMS IPPS rate,2036.65,80% of total billed charges,162.98,100% of CMS IPPS rate,2291.23,90% of total billed charges,8.69,100% of CMS fee schedule,2469.44,97% of total billed charges,162.98,100% of CMS IPPS rate,2342.15,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,2291.23,90% of total billed charges,162.98,100% of CMS IPPS rate,1782.07,70% of total billed charges,2291.23,90% of total billed charges,2418.52,95% of total billed charges,2418.52,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,2189.4,86% of total billed charges,2036.65,80% of total billed charges,148.36,100% of CMS IPPS rate,2469.44,97% of total billed charges,2291.23,90% of total billed charges,N/A,not seperately reimbursable,2469.44,97% of total billed charges,2367.6,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,2469.44,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,2469.44,1272.91
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 2,300,1697.21,1527.49,90% of total billed charges,162.98,100% of CMS IPPS rate,1357.77,80% of total billed charges,162.98,100% of CMS IPPS rate,1527.49,90% of total billed charges,8.69,100% of CMS fee schedule,1646.29,97% of total billed charges,162.98,100% of CMS IPPS rate,1561.43,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,1527.49,90% of total billed charges,162.98,100% of CMS IPPS rate,1188.05,70% of total billed charges,1527.49,90% of total billed charges,1612.35,95% of total billed charges,1612.35,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,1459.6,86% of total billed charges,1357.77,80% of total billed charges,148.36,100% of CMS IPPS rate,1646.29,97% of total billed charges,1527.49,90% of total billed charges,N/A,not seperately reimbursable,1646.29,97% of total billed charges,1578.41,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,1646.29,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,1646.29,848.61
Outpatient Medical Services,LAB,86885,ABID each cell selected billing -> 1,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,8.69,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,7.9,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,7.9,823.14,424.30
Outpatient Medical Services,LAB,86900,ABO/Rh (dU) Pt,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,*ABO/Rh Cord,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,*ABO Rh Pre Transfusion Reaction,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,*ABO/Rh Post Transfusion Reaction,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,*ABO/Rh Unit Transfusion Rx,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,Prenatal ABORh,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,zzzPAT ABO/Rh Type,300,87.13,78.42,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,78.42,90% of total billed charges,4.53,100% of CMS fee schedule,84.52,97% of total billed charges,122.59,100% of CMS IPPS rate,80.16,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,78.42,90% of total billed charges,122.59,100% of CMS IPPS rate,60.99,70% of total billed charges,78.42,90% of total billed charges,82.77,95% of total billed charges,82.77,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,74.93,86% of total billed charges,69.7,80% of total billed charges,112.72,100% of CMS IPPS rate,84.52,97% of total billed charges,78.42,90% of total billed charges,N/A,not seperately reimbursable,84.52,97% of total billed charges,81.03,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,84.52,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,43.57
Outpatient Medical Services,LAB,86900,Prenatal ABO-Rh,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,ABO-Rh Pt,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,PAT ABO-Rh Type,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,ABO-Rh Auto,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,PAT ABO Rh Auto,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,Prenatal ABO-RH Auto,300,92.36,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,83.12,90% of total billed charges,4.53,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,84.97,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,83.12,90% of total billed charges,122.59,100% of CMS IPPS rate,64.65,70% of total billed charges,83.12,90% of total billed charges,87.74,95% of total billed charges,87.74,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,79.43,86% of total billed charges,73.89,80% of total billed charges,112.72,100% of CMS IPPS rate,89.59,97% of total billed charges,83.12,90% of total billed charges,N/A,not seperately reimbursable,89.59,97% of total billed charges,85.89,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,89.59,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,46.18
Outpatient Medical Services,LAB,86900,DAL Blood Type,300,10.6,9.54,90% of total billed charges,122.59,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,122.59,100% of CMS IPPS rate,9.54,90% of total billed charges,4.53,100% of CMS fee schedule,10.28,97% of total billed charges,122.59,100% of CMS IPPS rate,9.75,92% of total billed charges,122.59,100% of CMS IPPS rate,293.84,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,468.44,100% of CMS IPPS rate,593.35,100% of CMS IPPS rate,9.54,90% of total billed charges,122.59,100% of CMS IPPS rate,7.42,70% of total billed charges,9.54,90% of total billed charges,10.07,95% of total billed charges,10.07,95% of total billed charges,122.59,100% of CMS IPPS rate,221.08,100% of CMS IPPS rate,9.12,86% of total billed charges,8.48,80% of total billed charges,112.72,100% of CMS IPPS rate,10.28,97% of total billed charges,9.54,90% of total billed charges,N/A,not seperately reimbursable,10.28,97% of total billed charges,9.86,93% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,4.12,100% of CMS fee schedule,10.28,97% of total billed charges,122.59,100% of CMS IPPS rate,122.59,100% of CMS IPPS rate,104.2,100% of CMS IPPS rate,4.12,593.35,5.30
Outpatient Medical Services,LAB,86901,Rh Type,300,22.99,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,37.33,100% of CMS IPPS rate,20.69,90% of total billed charges,4.59,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,21.15,92% of total billed charges,37.33,100% of CMS IPPS rate,92.24,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,147.06,100% of CMS IPPS rate,186.27,100% of CMS IPPS rate,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,16.09,70% of total billed charges,20.69,90% of total billed charges,21.84,95% of total billed charges,21.84,95% of total billed charges,37.33,100% of CMS IPPS rate,69.4,100% of CMS IPPS rate,19.77,86% of total billed charges,18.39,80% of total billed charges,34.56,100% of CMS IPPS rate,22.3,97% of total billed charges,20.69,90% of total billed charges,N/A,not seperately reimbursable,22.3,97% of total billed charges,21.38,93% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,4.17,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,31.73,100% of CMS IPPS rate,4.17,186.27,11.50
Outpatient Medical Services,LAB,86901,Rh Type,300,22.99,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,37.33,100% of CMS IPPS rate,20.69,90% of total billed charges,4.59,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,21.15,92% of total billed charges,37.33,100% of CMS IPPS rate,92.24,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,147.06,100% of CMS IPPS rate,186.27,100% of CMS IPPS rate,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,16.09,70% of total billed charges,20.69,90% of total billed charges,21.84,95% of total billed charges,21.84,95% of total billed charges,37.33,100% of CMS IPPS rate,69.4,100% of CMS IPPS rate,19.77,86% of total billed charges,18.39,80% of total billed charges,34.56,100% of CMS IPPS rate,22.3,97% of total billed charges,20.69,90% of total billed charges,N/A,not seperately reimbursable,22.3,97% of total billed charges,21.38,93% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,4.17,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,31.73,100% of CMS IPPS rate,4.17,186.27,11.50
Outpatient Medical Services,LAB,86901,Rh-Type,300,22.99,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,37.33,100% of CMS IPPS rate,20.69,90% of total billed charges,4.59,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,21.15,92% of total billed charges,37.33,100% of CMS IPPS rate,92.24,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,147.06,100% of CMS IPPS rate,186.27,100% of CMS IPPS rate,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,16.09,70% of total billed charges,20.69,90% of total billed charges,21.84,95% of total billed charges,21.84,95% of total billed charges,37.33,100% of CMS IPPS rate,69.4,100% of CMS IPPS rate,19.77,86% of total billed charges,18.39,80% of total billed charges,34.56,100% of CMS IPPS rate,22.3,97% of total billed charges,20.69,90% of total billed charges,N/A,not seperately reimbursable,22.3,97% of total billed charges,21.38,93% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,4.17,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,31.73,100% of CMS IPPS rate,4.17,186.27,11.50
Outpatient Medical Services,LAB,86901,Rh Type Auto,300,22.99,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,37.33,100% of CMS IPPS rate,20.69,90% of total billed charges,4.59,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,21.15,92% of total billed charges,37.33,100% of CMS IPPS rate,92.24,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,147.06,100% of CMS IPPS rate,186.27,100% of CMS IPPS rate,20.69,90% of total billed charges,37.33,100% of CMS IPPS rate,16.09,70% of total billed charges,20.69,90% of total billed charges,21.84,95% of total billed charges,21.84,95% of total billed charges,37.33,100% of CMS IPPS rate,69.4,100% of CMS IPPS rate,19.77,86% of total billed charges,18.39,80% of total billed charges,34.56,100% of CMS IPPS rate,22.3,97% of total billed charges,20.69,90% of total billed charges,N/A,not seperately reimbursable,22.3,97% of total billed charges,21.38,93% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,4.17,100% of CMS fee schedule,22.3,97% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,31.73,100% of CMS IPPS rate,4.17,186.27,11.50
Outpatient Medical Services,LAB,86901,86901 Direct Access Lab Blood Typing add-on test,300,10.6,9.54,90% of total billed charges,37.33,100% of CMS IPPS rate,4.49,150% of AETNA fee schedule,37.33,100% of CMS IPPS rate,9.54,90% of total billed charges,4.59,100% of CMS fee schedule,10.28,97% of total billed charges,37.33,100% of CMS IPPS rate,9.75,92% of total billed charges,37.33,100% of CMS IPPS rate,92.24,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,147.06,100% of CMS IPPS rate,186.27,100% of CMS IPPS rate,9.54,90% of total billed charges,37.33,100% of CMS IPPS rate,7.42,70% of total billed charges,9.54,90% of total billed charges,10.07,95% of total billed charges,10.07,95% of total billed charges,37.33,100% of CMS IPPS rate,69.4,100% of CMS IPPS rate,9.12,86% of total billed charges,8.48,80% of total billed charges,34.56,100% of CMS IPPS rate,10.28,97% of total billed charges,9.54,90% of total billed charges,N/A,not seperately reimbursable,10.28,97% of total billed charges,9.86,93% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,4.17,100% of CMS fee schedule,10.28,97% of total billed charges,37.33,100% of CMS IPPS rate,37.33,100% of CMS IPPS rate,31.73,100% of CMS IPPS rate,4.17,186.27,5.30
Outpatient Medical Services,LAB,86902,Ag Type Billing,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,3.1,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1696.56,874.52
Outpatient Medical Services,LAB,86902,Hgb S-,300,1749.03,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1399.22,80% of total billed charges,342.12,100% of CMS IPPS rate,1574.13,90% of total billed charges,3.1,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,1609.11,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,1574.13,90% of total billed charges,342.12,100% of CMS IPPS rate,1224.32,70% of total billed charges,1574.13,90% of total billed charges,1661.58,95% of total billed charges,1661.58,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,1504.17,86% of total billed charges,1399.22,80% of total billed charges,293.01,100% of CMS IPPS rate,1696.56,97% of total billed charges,1574.13,90% of total billed charges,N/A,not seperately reimbursable,1696.56,97% of total billed charges,1626.6,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,1696.56,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1696.56,874.52
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 9,300,305.28,274.75,90% of total billed charges,342.12,100% of CMS IPPS rate,244.22,80% of total billed charges,342.12,100% of CMS IPPS rate,274.75,90% of total billed charges,3.1,100% of CMS fee schedule,296.12,97% of total billed charges,342.12,100% of CMS IPPS rate,280.86,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,274.75,90% of total billed charges,342.12,100% of CMS IPPS rate,213.7,70% of total billed charges,274.75,90% of total billed charges,290.02,95% of total billed charges,290.02,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,262.54,86% of total billed charges,244.22,80% of total billed charges,293.01,100% of CMS IPPS rate,296.12,97% of total billed charges,274.75,90% of total billed charges,N/A,not seperately reimbursable,296.12,97% of total billed charges,283.91,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,296.12,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,152.64
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 8,300,271.36,244.22,90% of total billed charges,342.12,100% of CMS IPPS rate,217.09,80% of total billed charges,342.12,100% of CMS IPPS rate,244.22,90% of total billed charges,3.1,100% of CMS fee schedule,263.22,97% of total billed charges,342.12,100% of CMS IPPS rate,249.65,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,244.22,90% of total billed charges,342.12,100% of CMS IPPS rate,189.95,70% of total billed charges,244.22,90% of total billed charges,257.79,95% of total billed charges,257.79,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,233.37,86% of total billed charges,217.09,80% of total billed charges,293.01,100% of CMS IPPS rate,263.22,97% of total billed charges,244.22,90% of total billed charges,N/A,not seperately reimbursable,263.22,97% of total billed charges,252.36,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,263.22,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,135.68
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 7,300,237.44,213.7,90% of total billed charges,342.12,100% of CMS IPPS rate,189.95,80% of total billed charges,342.12,100% of CMS IPPS rate,213.7,90% of total billed charges,3.1,100% of CMS fee schedule,230.32,97% of total billed charges,342.12,100% of CMS IPPS rate,218.44,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,213.7,90% of total billed charges,342.12,100% of CMS IPPS rate,166.21,70% of total billed charges,213.7,90% of total billed charges,225.57,95% of total billed charges,225.57,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,204.2,86% of total billed charges,189.95,80% of total billed charges,293.01,100% of CMS IPPS rate,230.32,97% of total billed charges,213.7,90% of total billed charges,N/A,not seperately reimbursable,230.32,97% of total billed charges,220.82,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,230.32,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,118.72
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 6,300,203.52,183.17,90% of total billed charges,342.12,100% of CMS IPPS rate,162.82,80% of total billed charges,342.12,100% of CMS IPPS rate,183.17,90% of total billed charges,3.1,100% of CMS fee schedule,197.41,97% of total billed charges,342.12,100% of CMS IPPS rate,187.24,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,183.17,90% of total billed charges,342.12,100% of CMS IPPS rate,142.46,70% of total billed charges,183.17,90% of total billed charges,193.34,95% of total billed charges,193.34,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,175.03,86% of total billed charges,162.82,80% of total billed charges,293.01,100% of CMS IPPS rate,197.41,97% of total billed charges,183.17,90% of total billed charges,N/A,not seperately reimbursable,197.41,97% of total billed charges,189.27,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,197.41,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,101.76
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 5,300,169.6,152.64,90% of total billed charges,342.12,100% of CMS IPPS rate,135.68,80% of total billed charges,342.12,100% of CMS IPPS rate,152.64,90% of total billed charges,3.1,100% of CMS fee schedule,164.51,97% of total billed charges,342.12,100% of CMS IPPS rate,156.03,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,152.64,90% of total billed charges,342.12,100% of CMS IPPS rate,118.72,70% of total billed charges,152.64,90% of total billed charges,161.12,95% of total billed charges,161.12,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,145.86,86% of total billed charges,135.68,80% of total billed charges,293.01,100% of CMS IPPS rate,164.51,97% of total billed charges,152.64,90% of total billed charges,N/A,not seperately reimbursable,164.51,97% of total billed charges,157.73,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,164.51,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,84.80
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 4,300,135.68,122.11,90% of total billed charges,342.12,100% of CMS IPPS rate,108.54,80% of total billed charges,342.12,100% of CMS IPPS rate,122.11,90% of total billed charges,3.1,100% of CMS fee schedule,131.61,97% of total billed charges,342.12,100% of CMS IPPS rate,124.83,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,122.11,90% of total billed charges,342.12,100% of CMS IPPS rate,94.98,70% of total billed charges,122.11,90% of total billed charges,128.9,95% of total billed charges,128.9,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,116.68,86% of total billed charges,108.54,80% of total billed charges,293.01,100% of CMS IPPS rate,131.61,97% of total billed charges,122.11,90% of total billed charges,N/A,not seperately reimbursable,131.61,97% of total billed charges,126.18,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,131.61,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,67.84
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 3,300,101.76,91.58,90% of total billed charges,342.12,100% of CMS IPPS rate,81.41,80% of total billed charges,342.12,100% of CMS IPPS rate,91.58,90% of total billed charges,3.1,100% of CMS fee schedule,98.71,97% of total billed charges,342.12,100% of CMS IPPS rate,93.62,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,91.58,90% of total billed charges,342.12,100% of CMS IPPS rate,71.23,70% of total billed charges,91.58,90% of total billed charges,96.67,95% of total billed charges,96.67,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,87.51,86% of total billed charges,81.41,80% of total billed charges,293.01,100% of CMS IPPS rate,98.71,97% of total billed charges,91.58,90% of total billed charges,N/A,not seperately reimbursable,98.71,97% of total billed charges,94.64,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,98.71,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,50.88
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 2,300,67.84,61.06,90% of total billed charges,342.12,100% of CMS IPPS rate,54.27,80% of total billed charges,342.12,100% of CMS IPPS rate,61.06,90% of total billed charges,3.1,100% of CMS fee schedule,65.8,97% of total billed charges,342.12,100% of CMS IPPS rate,62.41,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,61.06,90% of total billed charges,342.12,100% of CMS IPPS rate,47.49,70% of total billed charges,61.06,90% of total billed charges,64.45,95% of total billed charges,64.45,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,58.34,86% of total billed charges,54.27,80% of total billed charges,293.01,100% of CMS IPPS rate,65.8,97% of total billed charges,61.06,90% of total billed charges,N/A,not seperately reimbursable,65.8,97% of total billed charges,63.09,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,65.8,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,33.92
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 10,300,339.2,305.28,90% of total billed charges,342.12,100% of CMS IPPS rate,271.36,80% of total billed charges,342.12,100% of CMS IPPS rate,305.28,90% of total billed charges,3.1,100% of CMS fee schedule,329.02,97% of total billed charges,342.12,100% of CMS IPPS rate,312.06,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,305.28,90% of total billed charges,342.12,100% of CMS IPPS rate,237.44,70% of total billed charges,305.28,90% of total billed charges,322.24,95% of total billed charges,322.24,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,291.71,86% of total billed charges,271.36,80% of total billed charges,293.01,100% of CMS IPPS rate,329.02,97% of total billed charges,305.28,90% of total billed charges,N/A,not seperately reimbursable,329.02,97% of total billed charges,315.46,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,329.02,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,169.60
Outpatient Medical Services,LAB,86902,Unit Antigen Type Bill Quantity -> 1,300,33.92,30.53,90% of total billed charges,342.12,100% of CMS IPPS rate,27.14,80% of total billed charges,342.12,100% of CMS IPPS rate,30.53,90% of total billed charges,3.1,100% of CMS fee schedule,32.9,97% of total billed charges,342.12,100% of CMS IPPS rate,31.21,92% of total billed charges,342.12,100% of CMS IPPS rate,826.83,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,1318.14,100% of CMS IPPS rate,1669.63,100% of CMS IPPS rate,30.53,90% of total billed charges,342.12,100% of CMS IPPS rate,23.74,70% of total billed charges,30.53,90% of total billed charges,32.22,95% of total billed charges,32.22,95% of total billed charges,342.12,100% of CMS IPPS rate,622.12,100% of CMS IPPS rate,29.17,86% of total billed charges,27.14,80% of total billed charges,293.01,100% of CMS IPPS rate,32.9,97% of total billed charges,30.53,90% of total billed charges,N/A,not seperately reimbursable,32.9,97% of total billed charges,31.55,93% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,2.82,100% of CMS fee schedule,32.9,97% of total billed charges,342.12,100% of CMS IPPS rate,342.12,100% of CMS IPPS rate,290.81,100% of CMS IPPS rate,2.82,1669.63,16.96
Outpatient Medical Services,LAB,86922,Crossmatch Anti-Human Globulin Interpretation,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,XM PEG Interp,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,AHG XM Pre Rx,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,AHG XM Post Rx,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,Corssmatch Pre Warmed Interp,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,Crossmatch Anti-Human Globulin Interpretation,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,Antiglobulin Crossmatch,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,AHG Technique Crossmatch,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,AHG Technique Crossmatch Gel,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,86922,Peg Crossmatch,300,848.6,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,678.88,80% of total billed charges,162.98,100% of CMS IPPS rate,763.74,90% of total billed charges,23.1,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,780.71,92% of total billed charges,162.98,100% of CMS IPPS rate,392.89,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,626.35,100% of CMS IPPS rate,793.37,100% of CMS IPPS rate,763.74,90% of total billed charges,162.98,100% of CMS IPPS rate,594.02,70% of total billed charges,763.74,90% of total billed charges,806.17,95% of total billed charges,806.17,95% of total billed charges,162.98,100% of CMS IPPS rate,295.62,100% of CMS IPPS rate,729.8,86% of total billed charges,678.88,80% of total billed charges,148.36,100% of CMS IPPS rate,823.14,97% of total billed charges,763.74,90% of total billed charges,N/A,not seperately reimbursable,823.14,97% of total billed charges,789.2,93% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,21,100% of CMS fee schedule,823.14,97% of total billed charges,162.98,100% of CMS IPPS rate,162.98,100% of CMS IPPS rate,138.53,100% of CMS IPPS rate,21,823.14,424.30
Outpatient Medical Services,LAB,87015,"Concentration, For Infect",300,39.65,35.69,90% of total billed charges,6.68,100% of CMS fee schedule,31.72,80% of total billed charges,6.68,100% of CMS fee schedule,35.69,90% of total billed charges,8.25,100% of CMS fee schedule,38.46,97% of total billed charges,6.68,100% of CMS fee schedule,36.48,92% of total billed charges,6.68,100% of CMS fee schedule,27.09, 405.66% of CMS fee schedule,6.68,100% of CMS fee schedule,33.01,494.23% of CMS fee schedule,30.63, 458.54% of CMS fee schedule,35.69,90% of total billed charges,6.68,100% of CMS fee schedule,27.76,70% of total billed charges,35.69,90% of total billed charges,37.67,95% of total billed charges,37.67,95% of total billed charges,6.68,100% of CMS fee schedule,13.36,200% of CMS fee schedule,34.1,86% of total billed charges,31.72,80% of total billed charges,7.41,111% of CMS fee schedule,38.46,97% of total billed charges,35.69,90% of total billed charges,N/A,not seperately reimbursable,38.46,97% of total billed charges,36.87,93% of total billed charges,6.68,100% of CMS fee schedule,6.68,100% of CMS fee schedule,7.5,100% of CMS fee schedule,38.46,97% of total billed charges,6.68,100% of CMS fee schedule,6.68,100% of CMS fee schedule,5.67,85% of CMS fee schedule,5.67,38.46,19.83
Outpatient Medical Services,LAB,87015,"Malaria, Thick Smear (Conc)",300,39.65,35.69,90% of total billed charges,6.68,100% of CMS fee schedule,31.72,80% of total billed charges,6.68,100% of CMS fee schedule,35.69,90% of total billed charges,8.25,100% of CMS fee schedule,38.46,97% of total billed charges,6.68,100% of CMS fee schedule,36.48,92% of total billed charges,6.68,100% of CMS fee schedule,27.09, 405.66% of CMS fee schedule,6.68,100% of CMS fee schedule,33.01,494.23% of CMS fee schedule,30.63, 458.54% of CMS fee schedule,35.69,90% of total billed charges,6.68,100% of CMS fee schedule,27.76,70% of total billed charges,35.69,90% of total billed charges,37.67,95% of total billed charges,37.67,95% of total billed charges,6.68,100% of CMS fee schedule,13.36,200% of CMS fee schedule,34.1,86% of total billed charges,31.72,80% of total billed charges,7.41,111% of CMS fee schedule,38.46,97% of total billed charges,35.69,90% of total billed charges,N/A,not seperately reimbursable,38.46,97% of total billed charges,36.87,93% of total billed charges,6.68,100% of CMS fee schedule,6.68,100% of CMS fee schedule,7.5,100% of CMS fee schedule,38.46,97% of total billed charges,6.68,100% of CMS fee schedule,6.68,100% of CMS fee schedule,5.67,85% of CMS fee schedule,5.67,38.46,19.83
Outpatient Medical Services,LAB,87040,Culture Blood,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,15.4,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,14,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87040,Culture Blood Pediatric,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,15.4,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,14,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87040,Culture Blood - Extended,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,15.4,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,14,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87045,Culture Stool,300,56.03,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,44.82,80% of total billed charges,9.44,100% of CMS fee schedule,50.43,90% of total billed charges,7.59,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,51.55,92% of total billed charges,9.44,100% of CMS fee schedule,38.29, 405.66% of CMS fee schedule,9.44,100% of CMS fee schedule,46.65,494.23% of CMS fee schedule,43.28, 458.54% of CMS fee schedule,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,39.22,70% of total billed charges,50.43,90% of total billed charges,53.23,95% of total billed charges,53.23,95% of total billed charges,9.44,100% of CMS fee schedule,18.88,200% of CMS fee schedule,48.19,86% of total billed charges,44.82,80% of total billed charges,10.47,111% of CMS fee schedule,54.35,97% of total billed charges,50.43,90% of total billed charges,N/A,not seperately reimbursable,54.35,97% of total billed charges,52.11,93% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,6.9,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,8.02,85% of CMS fee schedule,6.9,54.35,28.02
Outpatient Medical Services,LAB,87046,Stool Cult. for Add'l Pathogens,300,56.03,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,44.82,80% of total billed charges,9.44,100% of CMS fee schedule,50.43,90% of total billed charges,2.87,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,51.55,92% of total billed charges,9.44,100% of CMS fee schedule,38.29, 405.66% of CMS fee schedule,9.44,100% of CMS fee schedule,46.65,494.23% of CMS fee schedule,43.28, 458.54% of CMS fee schedule,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,39.22,70% of total billed charges,50.43,90% of total billed charges,53.23,95% of total billed charges,53.23,95% of total billed charges,9.44,100% of CMS fee schedule,18.88,200% of CMS fee schedule,48.19,86% of total billed charges,44.82,80% of total billed charges,10.47,111% of CMS fee schedule,54.35,97% of total billed charges,50.43,90% of total billed charges,N/A,not seperately reimbursable,54.35,97% of total billed charges,52.11,93% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,2.61,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,8.02,85% of CMS fee schedule,2.61,54.35,28.02
Outpatient Medical Services,LAB,87046,"Culture, Campy",300,56.03,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,44.82,80% of total billed charges,9.44,100% of CMS fee schedule,50.43,90% of total billed charges,2.87,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,51.55,92% of total billed charges,9.44,100% of CMS fee schedule,38.29, 405.66% of CMS fee schedule,9.44,100% of CMS fee schedule,46.65,494.23% of CMS fee schedule,43.28, 458.54% of CMS fee schedule,50.43,90% of total billed charges,9.44,100% of CMS fee schedule,39.22,70% of total billed charges,50.43,90% of total billed charges,53.23,95% of total billed charges,53.23,95% of total billed charges,9.44,100% of CMS fee schedule,18.88,200% of CMS fee schedule,48.19,86% of total billed charges,44.82,80% of total billed charges,10.47,111% of CMS fee schedule,54.35,97% of total billed charges,50.43,90% of total billed charges,N/A,not seperately reimbursable,54.35,97% of total billed charges,52.11,93% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,2.61,100% of CMS fee schedule,54.35,97% of total billed charges,9.44,100% of CMS fee schedule,9.44,100% of CMS fee schedule,8.02,85% of CMS fee schedule,2.61,54.35,28.02
Outpatient Medical Services,LAB,87070,GC Culture,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Transfusion Unit,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Sterility Check,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Miscellaneous culture,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Environmental,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Body Fluid,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Bone Marrow,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Spinal Fluid,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Ear,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Eye,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Genital,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Respiratory,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Medical Device,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Tissue,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Wound_NonSurgical,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Sputum,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Surgical Swab,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Sinus,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Bronchial Washing,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Bronchial Brushing,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Bronchoalveolar Lavage,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87070,Culture Abscess,300,51.17,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,12.96,150% of AETNA fee schedule,8.61,100% of CMS fee schedule,46.05,90% of total billed charges,7.59,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,47.08,92% of total billed charges,8.61,100% of CMS fee schedule,34.96, 405.66% of CMS fee schedule,8.61,100% of CMS fee schedule,42.6,494.23% of CMS fee schedule,39.52, 458.54% of CMS fee schedule,46.05,90% of total billed charges,8.61,100% of CMS fee schedule,35.82,70% of total billed charges,46.05,90% of total billed charges,48.61,95% of total billed charges,48.61,95% of total billed charges,8.61,100% of CMS fee schedule,17.24,200% of CMS fee schedule,44.01,86% of total billed charges,40.94,80% of total billed charges,9.56,111% of CMS fee schedule,49.63,97% of total billed charges,46.05,90% of total billed charges,N/A,not seperately reimbursable,49.63,97% of total billed charges,47.59,93% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,6.9,100% of CMS fee schedule,49.63,97% of total billed charges,8.61,100% of CMS fee schedule,8.61,100% of CMS fee schedule,7.32,85% of CMS fee schedule,6.9,49.63,25.59
Outpatient Medical Services,LAB,87075,Culture Anaerobic,300,56.21,50.59,90% of total billed charges,9.47,100% of CMS fee schedule,44.97,80% of total billed charges,9.47,100% of CMS fee schedule,50.59,90% of total billed charges,11,100% of CMS fee schedule,54.52,97% of total billed charges,9.47,100% of CMS fee schedule,51.71,92% of total billed charges,9.47,100% of CMS fee schedule,38.41, 405.66% of CMS fee schedule,9.47,100% of CMS fee schedule,46.8,494.23% of CMS fee schedule,43.42, 458.54% of CMS fee schedule,50.59,90% of total billed charges,9.47,100% of CMS fee schedule,39.35,70% of total billed charges,50.59,90% of total billed charges,53.4,95% of total billed charges,53.4,95% of total billed charges,9.47,100% of CMS fee schedule,18.94,200% of CMS fee schedule,48.34,86% of total billed charges,44.97,80% of total billed charges,10.51,111% of CMS fee schedule,54.52,97% of total billed charges,50.59,90% of total billed charges,N/A,not seperately reimbursable,54.52,97% of total billed charges,52.28,93% of total billed charges,9.47,100% of CMS fee schedule,9.47,100% of CMS fee schedule,10,100% of CMS fee schedule,54.52,97% of total billed charges,9.47,100% of CMS fee schedule,9.47,100% of CMS fee schedule,8.04,85% of CMS fee schedule,8.04,54.52,28.11
Outpatient Medical Services,LAB,87075,"Anaerobic Cult, Extended Incub LC",300,352.59,317.33,90% of total billed charges,9.47,100% of CMS fee schedule,282.07,80% of total billed charges,9.47,100% of CMS fee schedule,317.33,90% of total billed charges,11,100% of CMS fee schedule,342.01,97% of total billed charges,9.47,100% of CMS fee schedule,324.38,92% of total billed charges,9.47,100% of CMS fee schedule,38.41, 405.66% of CMS fee schedule,9.47,100% of CMS fee schedule,46.8,494.23% of CMS fee schedule,43.42, 458.54% of CMS fee schedule,317.33,90% of total billed charges,9.47,100% of CMS fee schedule,246.81,70% of total billed charges,317.33,90% of total billed charges,334.96,95% of total billed charges,334.96,95% of total billed charges,9.47,100% of CMS fee schedule,18.94,200% of CMS fee schedule,303.23,86% of total billed charges,282.07,80% of total billed charges,10.51,111% of CMS fee schedule,342.01,97% of total billed charges,317.33,90% of total billed charges,N/A,not seperately reimbursable,342.01,97% of total billed charges,327.91,93% of total billed charges,9.47,100% of CMS fee schedule,9.47,100% of CMS fee schedule,10,100% of CMS fee schedule,342.01,97% of total billed charges,9.47,100% of CMS fee schedule,9.47,100% of CMS fee schedule,8.04,85% of CMS fee schedule,8.04,342.01,176.30
Outpatient Medical Services,LAB,87076,RapID ANA II,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,9.63,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,8.75,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87076,Maldi Anaerobic ID,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,9.63,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,8.75,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,RapID NH,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Oxidase,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Spot Indole,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Negative Breakpoint Panel 30,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Positive Breakpoint Panel 20,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Negative Urine Combo Panel 61,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Pos Combo Panel 33,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Maldi NH ID,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87077,Maldi Aerobe,300,47.97,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,38.38,80% of total billed charges,8.08,100% of CMS fee schedule,43.17,90% of total billed charges,7.81,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,44.13,92% of total billed charges,8.08,100% of CMS fee schedule,32.77, 405.66% of CMS fee schedule,8.08,100% of CMS fee schedule,39.93,494.23% of CMS fee schedule,37.05, 458.54% of CMS fee schedule,43.17,90% of total billed charges,8.08,100% of CMS fee schedule,33.58,70% of total billed charges,43.17,90% of total billed charges,45.57,95% of total billed charges,45.57,95% of total billed charges,8.08,100% of CMS fee schedule,16.16,200% of CMS fee schedule,41.25,86% of total billed charges,38.38,80% of total billed charges,8.96,111% of CMS fee schedule,46.53,97% of total billed charges,43.17,90% of total billed charges,N/A,not seperately reimbursable,46.53,97% of total billed charges,44.61,93% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,7.1,100% of CMS fee schedule,46.53,97% of total billed charges,8.08,100% of CMS fee schedule,8.08,100% of CMS fee schedule,6.86,85% of CMS fee schedule,6.86,46.53,23.99
Outpatient Medical Services,LAB,87081,Culture Beta Strep,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87081,Culture Beta Strep,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87081,Culture for yeast only,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87081,Culture VRE Screen,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87081,Culture Throat,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87081,Legionella Culture,300,39.36,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,31.49,80% of total billed charges,6.63,100% of CMS fee schedule,35.42,90% of total billed charges,5.72,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,36.21,92% of total billed charges,6.63,100% of CMS fee schedule,26.89, 405.66% of CMS fee schedule,6.63,100% of CMS fee schedule,32.76,494.23% of CMS fee schedule,30.4, 458.54% of CMS fee schedule,35.42,90% of total billed charges,6.63,100% of CMS fee schedule,27.55,70% of total billed charges,35.42,90% of total billed charges,37.39,95% of total billed charges,37.39,95% of total billed charges,6.63,100% of CMS fee schedule,13.26,200% of CMS fee schedule,33.85,86% of total billed charges,31.49,80% of total billed charges,7.35,111% of CMS fee schedule,38.18,97% of total billed charges,35.42,90% of total billed charges,N/A,not seperately reimbursable,38.18,97% of total billed charges,36.6,93% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.2,100% of CMS fee schedule,38.18,97% of total billed charges,6.63,100% of CMS fee schedule,6.63,100% of CMS fee schedule,5.63,85% of CMS fee schedule,5.2,38.18,19.68
Outpatient Medical Services,LAB,87086,Culture Urine Cysto,300,47.9,43.11,90% of total billed charges,8.07,100% of CMS fee schedule,12.15,150% of AETNA fee schedule,8.07,100% of CMS fee schedule,43.11,90% of total billed charges,8.8,100% of CMS fee schedule,46.46,97% of total billed charges,8.07,100% of CMS fee schedule,44.07,92% of total billed charges,8.07,100% of CMS fee schedule,32.73, 405.66% of CMS fee schedule,8.07,100% of CMS fee schedule,39.88,494.23% of CMS fee schedule,37, 458.54% of CMS fee schedule,43.11,90% of total billed charges,8.07,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,8.07,100% of CMS fee schedule,16.14,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,8.95,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,8.07,100% of CMS fee schedule,8.07,100% of CMS fee schedule,8,100% of CMS fee schedule,46.46,97% of total billed charges,8.07,100% of CMS fee schedule,8.07,100% of CMS fee schedule,6.85,85% of CMS fee schedule,6.85,46.46,23.95
Outpatient Medical Services,LAB,87086,Culture Urine,300,47.9,43.11,90% of total billed charges,8.07,100% of CMS fee schedule,12.15,150% of AETNA fee schedule,8.07,100% of CMS fee schedule,43.11,90% of total billed charges,8.8,100% of CMS fee schedule,46.46,97% of total billed charges,8.07,100% of CMS fee schedule,44.07,92% of total billed charges,8.07,100% of CMS fee schedule,32.73, 405.66% of CMS fee schedule,8.07,100% of CMS fee schedule,39.88,494.23% of CMS fee schedule,37, 458.54% of CMS fee schedule,43.11,90% of total billed charges,8.07,100% of CMS fee schedule,33.53,70% of total billed charges,43.11,90% of total billed charges,45.51,95% of total billed charges,45.51,95% of total billed charges,8.07,100% of CMS fee schedule,16.14,200% of CMS fee schedule,41.19,86% of total billed charges,38.32,80% of total billed charges,8.95,111% of CMS fee schedule,46.46,97% of total billed charges,43.11,90% of total billed charges,N/A,not seperately reimbursable,46.46,97% of total billed charges,44.55,93% of total billed charges,8.07,100% of CMS fee schedule,8.07,100% of CMS fee schedule,8,100% of CMS fee schedule,46.46,97% of total billed charges,8.07,100% of CMS fee schedule,8.07,100% of CMS fee schedule,6.85,85% of CMS fee schedule,6.85,46.46,23.95
Outpatient Medical Services,LAB,87088,Presumptive ID,300,48.02,43.22,90% of total billed charges,8.09,100% of CMS fee schedule,11.69,150% of AETNA fee schedule,8.09,100% of CMS fee schedule,43.22,90% of total billed charges,8.8,100% of CMS fee schedule,46.58,97% of total billed charges,8.09,100% of CMS fee schedule,44.18,92% of total billed charges,8.09,100% of CMS fee schedule,32.81, 405.66% of CMS fee schedule,8.09,100% of CMS fee schedule,39.98,494.23% of CMS fee schedule,37.09, 458.54% of CMS fee schedule,43.22,90% of total billed charges,8.09,100% of CMS fee schedule,33.61,70% of total billed charges,43.22,90% of total billed charges,45.62,95% of total billed charges,45.62,95% of total billed charges,8.09,100% of CMS fee schedule,16.18,200% of CMS fee schedule,41.3,86% of total billed charges,38.42,80% of total billed charges,8.97,111% of CMS fee schedule,46.58,97% of total billed charges,43.22,90% of total billed charges,N/A,not seperately reimbursable,46.58,97% of total billed charges,44.66,93% of total billed charges,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,8,100% of CMS fee schedule,46.58,97% of total billed charges,8.09,100% of CMS fee schedule,8.09,100% of CMS fee schedule,6.87,85% of CMS fee schedule,6.87,46.58,24.01
Outpatient Medical Services,LAB,87106,API Yeast Identification,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,10.67,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,9.7,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87106,Rapid trehalose assimilation,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,10.67,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,9.7,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87106,Maldi Yeast,300,61.26,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,49.01,80% of total billed charges,10.32,100% of CMS fee schedule,55.13,90% of total billed charges,10.67,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,56.36,92% of total billed charges,10.32,100% of CMS fee schedule,41.86, 405.66% of CMS fee schedule,10.32,100% of CMS fee schedule,51,494.23% of CMS fee schedule,47.32, 458.54% of CMS fee schedule,55.13,90% of total billed charges,10.32,100% of CMS fee schedule,42.88,70% of total billed charges,55.13,90% of total billed charges,58.2,95% of total billed charges,58.2,95% of total billed charges,10.32,100% of CMS fee schedule,20.64,200% of CMS fee schedule,52.68,86% of total billed charges,49.01,80% of total billed charges,11.45,111% of CMS fee schedule,59.42,97% of total billed charges,55.13,90% of total billed charges,N/A,not seperately reimbursable,59.42,97% of total billed charges,56.97,93% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,9.7,100% of CMS fee schedule,59.42,97% of total billed charges,10.32,100% of CMS fee schedule,10.32,100% of CMS fee schedule,8.77,85% of CMS fee schedule,8.77,59.42,30.63
Outpatient Medical Services,LAB,87147,Streptocard,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,24.6,80% of total billed charges,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,3.3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,3,29.83,15.38
Outpatient Medical Services,LAB,87147,Staphyloslide,300,30.75,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,24.6,80% of total billed charges,5.18,100% of CMS fee schedule,27.68,90% of total billed charges,3.3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,28.29,92% of total billed charges,5.18,100% of CMS fee schedule,21.01, 405.66% of CMS fee schedule,5.18,100% of CMS fee schedule,25.6,494.23% of CMS fee schedule,23.75, 458.54% of CMS fee schedule,27.68,90% of total billed charges,5.18,100% of CMS fee schedule,21.53,70% of total billed charges,27.68,90% of total billed charges,29.21,95% of total billed charges,29.21,95% of total billed charges,5.18,100% of CMS fee schedule,10.36,200% of CMS fee schedule,26.45,86% of total billed charges,24.6,80% of total billed charges,5.74,111% of CMS fee schedule,29.83,97% of total billed charges,27.68,90% of total billed charges,N/A,not seperately reimbursable,29.83,97% of total billed charges,28.6,93% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,3,100% of CMS fee schedule,29.83,97% of total billed charges,5.18,100% of CMS fee schedule,5.18,100% of CMS fee schedule,4.4,85% of CMS fee schedule,3,29.83,15.38
Outpatient Medical Services,LAB,87177,Ova + Parasites Stool,300,52.83,47.55,90% of total billed charges,8.9,100% of CMS fee schedule,42.26,80% of total billed charges,8.9,100% of CMS fee schedule,47.55,90% of total billed charges,8.25,100% of CMS fee schedule,51.25,97% of total billed charges,8.9,100% of CMS fee schedule,48.6,92% of total billed charges,8.9,100% of CMS fee schedule,36.1, 405.66% of CMS fee schedule,8.9,100% of CMS fee schedule,43.98,494.23% of CMS fee schedule,40.81, 458.54% of CMS fee schedule,47.55,90% of total billed charges,8.9,100% of CMS fee schedule,36.98,70% of total billed charges,47.55,90% of total billed charges,50.19,95% of total billed charges,50.19,95% of total billed charges,8.9,100% of CMS fee schedule,17.8,200% of CMS fee schedule,45.43,86% of total billed charges,42.26,80% of total billed charges,9.87,111% of CMS fee schedule,51.25,97% of total billed charges,47.55,90% of total billed charges,N/A,not seperately reimbursable,51.25,97% of total billed charges,49.13,93% of total billed charges,8.9,100% of CMS fee schedule,8.9,100% of CMS fee schedule,7.5,100% of CMS fee schedule,51.25,97% of total billed charges,8.9,100% of CMS fee schedule,8.9,100% of CMS fee schedule,7.56,85% of CMS fee schedule,7.5,51.25,26.42
Outpatient Medical Services,LAB,87177,Ova + Parasite Exam LC,300,52.83,47.55,90% of total billed charges,8.9,100% of CMS fee schedule,42.26,80% of total billed charges,8.9,100% of CMS fee schedule,47.55,90% of total billed charges,8.25,100% of CMS fee schedule,51.25,97% of total billed charges,8.9,100% of CMS fee schedule,48.6,92% of total billed charges,8.9,100% of CMS fee schedule,36.1, 405.66% of CMS fee schedule,8.9,100% of CMS fee schedule,43.98,494.23% of CMS fee schedule,40.81, 458.54% of CMS fee schedule,47.55,90% of total billed charges,8.9,100% of CMS fee schedule,36.98,70% of total billed charges,47.55,90% of total billed charges,50.19,95% of total billed charges,50.19,95% of total billed charges,8.9,100% of CMS fee schedule,17.8,200% of CMS fee schedule,45.43,86% of total billed charges,42.26,80% of total billed charges,9.87,111% of CMS fee schedule,51.25,97% of total billed charges,47.55,90% of total billed charges,N/A,not seperately reimbursable,51.25,97% of total billed charges,49.13,93% of total billed charges,8.9,100% of CMS fee schedule,8.9,100% of CMS fee schedule,7.5,100% of CMS fee schedule,51.25,97% of total billed charges,8.9,100% of CMS fee schedule,8.9,100% of CMS fee schedule,7.56,85% of CMS fee schedule,7.5,51.25,26.42
Outpatient Medical Services,LAB,87185,Beta Lactamase,300,28.2,25.38,90% of total billed charges,4.75,100% of CMS fee schedule,22.56,80% of total billed charges,4.75,100% of CMS fee schedule,25.38,90% of total billed charges,5.78,100% of CMS fee schedule,27.35,97% of total billed charges,4.75,100% of CMS fee schedule,25.94,92% of total billed charges,4.75,100% of CMS fee schedule,19.26, 405.66% of CMS fee schedule,4.75,100% of CMS fee schedule,23.47,494.23% of CMS fee schedule,21.78, 458.54% of CMS fee schedule,25.38,90% of total billed charges,4.75,100% of CMS fee schedule,19.74,70% of total billed charges,25.38,90% of total billed charges,26.79,95% of total billed charges,26.79,95% of total billed charges,4.75,100% of CMS fee schedule,9.5,200% of CMS fee schedule,24.25,86% of total billed charges,22.56,80% of total billed charges,5.27,111% of CMS fee schedule,27.35,97% of total billed charges,25.38,90% of total billed charges,N/A,not seperately reimbursable,27.35,97% of total billed charges,26.23,93% of total billed charges,4.75,100% of CMS fee schedule,4.75,100% of CMS fee schedule,5.25,100% of CMS fee schedule,27.35,97% of total billed charges,4.75,100% of CMS fee schedule,4.75,100% of CMS fee schedule,4.03,85% of CMS fee schedule,4.03,27.35,14.10
Outpatient Medical Services,LAB,87186,MICroSTREP,300,51.35,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,13.01,150% of AETNA fee schedule,8.65,100% of CMS fee schedule,46.22,90% of total billed charges,8.8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,47.24,92% of total billed charges,8.65,100% of CMS fee schedule,35.08, 405.66% of CMS fee schedule,8.65,100% of CMS fee schedule,42.75,494.23% of CMS fee schedule,39.66, 458.54% of CMS fee schedule,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,35.95,70% of total billed charges,46.22,90% of total billed charges,48.78,95% of total billed charges,48.78,95% of total billed charges,8.65,100% of CMS fee schedule,17.3,200% of CMS fee schedule,44.16,86% of total billed charges,41.08,80% of total billed charges,9.6,111% of CMS fee schedule,49.81,97% of total billed charges,46.22,90% of total billed charges,N/A,not seperately reimbursable,49.81,97% of total billed charges,47.76,93% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,7.35,85% of CMS fee schedule,7.35,49.81,25.68
Outpatient Medical Services,LAB,87186,Microscan Susceptibility Test,300,51.35,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,13.01,150% of AETNA fee schedule,8.65,100% of CMS fee schedule,46.22,90% of total billed charges,8.8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,47.24,92% of total billed charges,8.65,100% of CMS fee schedule,35.08, 405.66% of CMS fee schedule,8.65,100% of CMS fee schedule,42.75,494.23% of CMS fee schedule,39.66, 458.54% of CMS fee schedule,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,35.95,70% of total billed charges,46.22,90% of total billed charges,48.78,95% of total billed charges,48.78,95% of total billed charges,8.65,100% of CMS fee schedule,17.3,200% of CMS fee schedule,44.16,86% of total billed charges,41.08,80% of total billed charges,9.6,111% of CMS fee schedule,49.81,97% of total billed charges,46.22,90% of total billed charges,N/A,not seperately reimbursable,49.81,97% of total billed charges,47.76,93% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,7.35,85% of CMS fee schedule,7.35,49.81,25.68
Outpatient Medical Services,LAB,87186,Pos MIC 34,300,51.35,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,13.01,150% of AETNA fee schedule,8.65,100% of CMS fee schedule,46.22,90% of total billed charges,8.8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,47.24,92% of total billed charges,8.65,100% of CMS fee schedule,35.08, 405.66% of CMS fee schedule,8.65,100% of CMS fee schedule,42.75,494.23% of CMS fee schedule,39.66, 458.54% of CMS fee schedule,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,35.95,70% of total billed charges,46.22,90% of total billed charges,48.78,95% of total billed charges,48.78,95% of total billed charges,8.65,100% of CMS fee schedule,17.3,200% of CMS fee schedule,44.16,86% of total billed charges,41.08,80% of total billed charges,9.6,111% of CMS fee schedule,49.81,97% of total billed charges,46.22,90% of total billed charges,N/A,not seperately reimbursable,49.81,97% of total billed charges,47.76,93% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,7.35,85% of CMS fee schedule,7.35,49.81,25.68
Outpatient Medical Services,LAB,87186,Antifungal Suscep 4 Drugs LC,300,51.35,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,13.01,150% of AETNA fee schedule,8.65,100% of CMS fee schedule,46.22,90% of total billed charges,8.8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,47.24,92% of total billed charges,8.65,100% of CMS fee schedule,35.08, 405.66% of CMS fee schedule,8.65,100% of CMS fee schedule,42.75,494.23% of CMS fee schedule,39.66, 458.54% of CMS fee schedule,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,35.95,70% of total billed charges,46.22,90% of total billed charges,48.78,95% of total billed charges,48.78,95% of total billed charges,8.65,100% of CMS fee schedule,17.3,200% of CMS fee schedule,44.16,86% of total billed charges,41.08,80% of total billed charges,9.6,111% of CMS fee schedule,49.81,97% of total billed charges,46.22,90% of total billed charges,N/A,not seperately reimbursable,49.81,97% of total billed charges,47.76,93% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,7.35,85% of CMS fee schedule,7.35,49.81,25.68
Outpatient Medical Services,LAB,87186,Negative MIC 56,300,51.35,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,13.01,150% of AETNA fee schedule,8.65,100% of CMS fee schedule,46.22,90% of total billed charges,8.8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,47.24,92% of total billed charges,8.65,100% of CMS fee schedule,35.08, 405.66% of CMS fee schedule,8.65,100% of CMS fee schedule,42.75,494.23% of CMS fee schedule,39.66, 458.54% of CMS fee schedule,46.22,90% of total billed charges,8.65,100% of CMS fee schedule,35.95,70% of total billed charges,46.22,90% of total billed charges,48.78,95% of total billed charges,48.78,95% of total billed charges,8.65,100% of CMS fee schedule,17.3,200% of CMS fee schedule,44.16,86% of total billed charges,41.08,80% of total billed charges,9.6,111% of CMS fee schedule,49.81,97% of total billed charges,46.22,90% of total billed charges,N/A,not seperately reimbursable,49.81,97% of total billed charges,47.76,93% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,8,100% of CMS fee schedule,49.81,97% of total billed charges,8.65,100% of CMS fee schedule,8.65,100% of CMS fee schedule,7.35,85% of CMS fee schedule,7.35,49.81,25.68
Outpatient Medical Services,LAB,87205,Smear for fecal WBC,300,25.34,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,20.27,80% of total billed charges,4.26,100% of CMS fee schedule,22.81,90% of total billed charges,4.95,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,23.31,92% of total billed charges,4.26,100% of CMS fee schedule,17.32, 405.66% of CMS fee schedule,4.26,100% of CMS fee schedule,21.1,494.23% of CMS fee schedule,19.57, 458.54% of CMS fee schedule,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,17.74,70% of total billed charges,22.81,90% of total billed charges,24.07,95% of total billed charges,24.07,95% of total billed charges,4.26,100% of CMS fee schedule,8.54,200% of CMS fee schedule,21.79,86% of total billed charges,20.27,80% of total billed charges,4.73,111% of CMS fee schedule,24.58,97% of total billed charges,22.81,90% of total billed charges,N/A,not seperately reimbursable,24.58,97% of total billed charges,23.57,93% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.5,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,3.62,85% of CMS fee schedule,3.62,24.58,12.67
Outpatient Medical Services,LAB,87205,Gram Stain,300,25.34,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,20.27,80% of total billed charges,4.26,100% of CMS fee schedule,22.81,90% of total billed charges,4.95,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,23.31,92% of total billed charges,4.26,100% of CMS fee schedule,17.32, 405.66% of CMS fee schedule,4.26,100% of CMS fee schedule,21.1,494.23% of CMS fee schedule,19.57, 458.54% of CMS fee schedule,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,17.74,70% of total billed charges,22.81,90% of total billed charges,24.07,95% of total billed charges,24.07,95% of total billed charges,4.26,100% of CMS fee schedule,8.54,200% of CMS fee schedule,21.79,86% of total billed charges,20.27,80% of total billed charges,4.73,111% of CMS fee schedule,24.58,97% of total billed charges,22.81,90% of total billed charges,N/A,not seperately reimbursable,24.58,97% of total billed charges,23.57,93% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.5,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,3.62,85% of CMS fee schedule,3.62,24.58,12.67
Outpatient Medical Services,LAB,87205,RSV Antigen,300,25.34,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,20.27,80% of total billed charges,4.26,100% of CMS fee schedule,22.81,90% of total billed charges,4.95,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,23.31,92% of total billed charges,4.26,100% of CMS fee schedule,17.32, 405.66% of CMS fee schedule,4.26,100% of CMS fee schedule,21.1,494.23% of CMS fee schedule,19.57, 458.54% of CMS fee schedule,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,17.74,70% of total billed charges,22.81,90% of total billed charges,24.07,95% of total billed charges,24.07,95% of total billed charges,4.26,100% of CMS fee schedule,8.54,200% of CMS fee schedule,21.79,86% of total billed charges,20.27,80% of total billed charges,4.73,111% of CMS fee schedule,24.58,97% of total billed charges,22.81,90% of total billed charges,N/A,not seperately reimbursable,24.58,97% of total billed charges,23.57,93% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.5,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,3.62,85% of CMS fee schedule,3.62,24.58,12.67
Outpatient Medical Services,LAB,87205,"Eosinophil, Urine",300,25.34,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,20.27,80% of total billed charges,4.26,100% of CMS fee schedule,22.81,90% of total billed charges,4.95,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,23.31,92% of total billed charges,4.26,100% of CMS fee schedule,17.32, 405.66% of CMS fee schedule,4.26,100% of CMS fee schedule,21.1,494.23% of CMS fee schedule,19.57, 458.54% of CMS fee schedule,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,17.74,70% of total billed charges,22.81,90% of total billed charges,24.07,95% of total billed charges,24.07,95% of total billed charges,4.26,100% of CMS fee schedule,8.54,200% of CMS fee schedule,21.79,86% of total billed charges,20.27,80% of total billed charges,4.73,111% of CMS fee schedule,24.58,97% of total billed charges,22.81,90% of total billed charges,N/A,not seperately reimbursable,24.58,97% of total billed charges,23.57,93% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.5,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,3.62,85% of CMS fee schedule,3.62,24.58,12.67
Outpatient Medical Services,LAB,87205,Gram Stain Charge for Rejected Sputum Culture,300,25.34,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,20.27,80% of total billed charges,4.26,100% of CMS fee schedule,22.81,90% of total billed charges,4.95,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,23.31,92% of total billed charges,4.26,100% of CMS fee schedule,17.32, 405.66% of CMS fee schedule,4.26,100% of CMS fee schedule,21.1,494.23% of CMS fee schedule,19.57, 458.54% of CMS fee schedule,22.81,90% of total billed charges,4.26,100% of CMS fee schedule,17.74,70% of total billed charges,22.81,90% of total billed charges,24.07,95% of total billed charges,24.07,95% of total billed charges,4.26,100% of CMS fee schedule,8.54,200% of CMS fee schedule,21.79,86% of total billed charges,20.27,80% of total billed charges,4.73,111% of CMS fee schedule,24.58,97% of total billed charges,22.81,90% of total billed charges,N/A,not seperately reimbursable,24.58,97% of total billed charges,23.57,93% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,4.5,100% of CMS fee schedule,24.58,97% of total billed charges,4.26,100% of CMS fee schedule,4.26,100% of CMS fee schedule,3.62,85% of CMS fee schedule,3.62,24.58,12.67
Outpatient Medical Services,LAB,87207,Malarial Stain,300,35.55,32,90% of total billed charges,5.99,100% of CMS fee schedule,28.44,80% of total billed charges,5.99,100% of CMS fee schedule,32,90% of total billed charges,4.95,100% of CMS fee schedule,34.48,97% of total billed charges,5.99,100% of CMS fee schedule,32.71,92% of total billed charges,5.99,100% of CMS fee schedule,24.29, 405.66% of CMS fee schedule,5.99,100% of CMS fee schedule,29.6,494.23% of CMS fee schedule,27.46, 458.54% of CMS fee schedule,32,90% of total billed charges,5.99,100% of CMS fee schedule,24.89,70% of total billed charges,32,90% of total billed charges,33.77,95% of total billed charges,33.77,95% of total billed charges,5.99,100% of CMS fee schedule,11.98,200% of CMS fee schedule,30.57,86% of total billed charges,28.44,80% of total billed charges,6.64,111% of CMS fee schedule,34.48,97% of total billed charges,32,90% of total billed charges,N/A,not seperately reimbursable,34.48,97% of total billed charges,33.06,93% of total billed charges,5.99,100% of CMS fee schedule,5.99,100% of CMS fee schedule,4.5,100% of CMS fee schedule,34.48,97% of total billed charges,5.99,100% of CMS fee schedule,5.99,100% of CMS fee schedule,5.09,85% of CMS fee schedule,4.5,34.48,17.78
Outpatient Medical Services,LAB,87209,Trichrome Smear,306,106.73,96.06,90% of total billed charges,17.98,100% of CMS fee schedule,85.38,80% of total billed charges,17.98,100% of CMS fee schedule,96.06,90% of total billed charges,22.1,100% of CMS fee schedule,103.53,97% of total billed charges,17.98,100% of CMS fee schedule,98.19,92% of total billed charges,17.98,100% of CMS fee schedule,72.93, 405.66% of CMS fee schedule,17.98,100% of CMS fee schedule,88.86,494.23% of CMS fee schedule,82.44, 458.54% of CMS fee schedule,96.06,90% of total billed charges,17.98,100% of CMS fee schedule,74.71,70% of total billed charges,96.06,90% of total billed charges,101.39,95% of total billed charges,101.39,95% of total billed charges,17.98,100% of CMS fee schedule,35.96,200% of CMS fee schedule,91.79,86% of total billed charges,85.38,80% of total billed charges,19.95,111% of CMS fee schedule,103.53,97% of total billed charges,96.06,90% of total billed charges,N/A,not seperately reimbursable,103.53,97% of total billed charges,99.26,93% of total billed charges,17.98,100% of CMS fee schedule,17.98,100% of CMS fee schedule,20.09,100% of CMS fee schedule,103.53,97% of total billed charges,17.98,100% of CMS fee schedule,17.98,100% of CMS fee schedule,15.28,85% of CMS fee schedule,15.28,103.53,53.37
Outpatient Medical Services,LAB,87209,87209 add-on,300,106.73,96.06,90% of total billed charges,17.98,100% of CMS fee schedule,85.38,80% of total billed charges,17.98,100% of CMS fee schedule,96.06,90% of total billed charges,22.1,100% of CMS fee schedule,103.53,97% of total billed charges,17.98,100% of CMS fee schedule,98.19,92% of total billed charges,17.98,100% of CMS fee schedule,72.93, 405.66% of CMS fee schedule,17.98,100% of CMS fee schedule,88.86,494.23% of CMS fee schedule,82.44, 458.54% of CMS fee schedule,96.06,90% of total billed charges,17.98,100% of CMS fee schedule,74.71,70% of total billed charges,96.06,90% of total billed charges,101.39,95% of total billed charges,101.39,95% of total billed charges,17.98,100% of CMS fee schedule,35.96,200% of CMS fee schedule,91.79,86% of total billed charges,85.38,80% of total billed charges,19.95,111% of CMS fee schedule,103.53,97% of total billed charges,96.06,90% of total billed charges,N/A,not seperately reimbursable,103.53,97% of total billed charges,99.26,93% of total billed charges,17.98,100% of CMS fee schedule,17.98,100% of CMS fee schedule,20.09,100% of CMS fee schedule,103.53,97% of total billed charges,17.98,100% of CMS fee schedule,17.98,100% of CMS fee schedule,15.28,85% of CMS fee schedule,15.28,103.53,53.37
Outpatient Medical Services,LAB,87210,India Ink,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87210,Wet Prep,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87210,87210 Smear wet mount saline/ink,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87210,KOH/Wet Prep POC,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87210,Wet Mount POC,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87210,KOH POC,300,31.57,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,25.26,80% of total billed charges,5.82,100% of CMS fee schedule,28.41,90% of total billed charges,6.4,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,29.04,92% of total billed charges,5.82,100% of CMS fee schedule,23.6, 405.66% of CMS fee schedule,5.82,100% of CMS fee schedule,28.76,494.23% of CMS fee schedule,26.68, 458.54% of CMS fee schedule,28.41,90% of total billed charges,5.82,100% of CMS fee schedule,22.1,70% of total billed charges,28.41,90% of total billed charges,29.99,95% of total billed charges,29.99,95% of total billed charges,5.82,100% of CMS fee schedule,11.64,200% of CMS fee schedule,27.15,86% of total billed charges,25.26,80% of total billed charges,6.46,111% of CMS fee schedule,30.62,97% of total billed charges,28.41,90% of total billed charges,N/A,not seperately reimbursable,30.62,97% of total billed charges,29.36,93% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,30.62,97% of total billed charges,5.82,100% of CMS fee schedule,5.82,100% of CMS fee schedule,4.94,85% of CMS fee schedule,4.94,30.62,15.79
Outpatient Medical Services,LAB,87305,zzAspergillus Galactomannan Ag,300,67.09,60.38,90% of total billed charges,11.98,100% of CMS fee schedule,53.67,80% of total billed charges,11.98,100% of CMS fee schedule,60.38,90% of total billed charges,13.54,100% of CMS fee schedule,65.08,97% of total billed charges,11.98,100% of CMS fee schedule,61.72,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,60.38,90% of total billed charges,11.98,100% of CMS fee schedule,46.96,70% of total billed charges,60.38,90% of total billed charges,63.74,95% of total billed charges,63.74,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,57.7,86% of total billed charges,53.67,80% of total billed charges,13.29,111% of CMS fee schedule,65.08,97% of total billed charges,60.38,90% of total billed charges,N/A,not seperately reimbursable,65.08,97% of total billed charges,62.39,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,12.31,100% of CMS fee schedule,65.08,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,65.08,33.55
Outpatient Medical Services,LAB,87305,"Aspergillus Ag, BAL/Serum LC",300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,13.54,100% of CMS fee schedule,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,12.31,100% of CMS fee schedule,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87324,C difficile,300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87328,Cryptosporidium/Giardia Immunoassay,300,82.03,73.83,90% of total billed charges,13.82,100% of CMS fee schedule,65.62,80% of total billed charges,13.82,100% of CMS fee schedule,73.83,90% of total billed charges,N/A,not seperately reimbursable,79.57,97% of total billed charges,13.82,100% of CMS fee schedule,75.47,92% of total billed charges,13.82,100% of CMS fee schedule,56.06, 405.66% of CMS fee schedule,13.82,100% of CMS fee schedule,68.3,494.23% of CMS fee schedule,63.37, 458.54% of CMS fee schedule,73.83,90% of total billed charges,13.82,100% of CMS fee schedule,57.42,70% of total billed charges,73.83,90% of total billed charges,77.93,95% of total billed charges,77.93,95% of total billed charges,13.82,100% of CMS fee schedule,27.64,200% of CMS fee schedule,70.55,86% of total billed charges,65.62,80% of total billed charges,15.34,111% of CMS fee schedule,79.57,97% of total billed charges,73.83,90% of total billed charges,N/A,not seperately reimbursable,79.57,97% of total billed charges,76.29,93% of total billed charges,13.82,100% of CMS fee schedule,13.82,100% of CMS fee schedule,N/A,not seperately reimbursable,79.57,97% of total billed charges,13.82,100% of CMS fee schedule,13.82,100% of CMS fee schedule,11.74,85% of CMS fee schedule,11.74,79.57,41.02
Outpatient Medical Services,LAB,87329,Giardia Immunoassay,300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,13.54,100% of CMS fee schedule,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,12.31,100% of CMS fee schedule,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87340,Hep B Surface Antigen,300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,"EH Hepatitis Panel, HBsAG",300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,"Hep VIII, HBsAg",300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,Hepatitis B Surface - Antigen,300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,87340 add-on,300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,HBcAb 87340 Add-On,300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87340,Hepatitis B Surface Antigen,300,61.32,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,49.06,80% of total billed charges,10.33,100% of CMS fee schedule,55.19,90% of total billed charges,15.59,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,56.41,92% of total billed charges,10.33,100% of CMS fee schedule,41.9, 405.66% of CMS fee schedule,10.33,100% of CMS fee schedule,51.05,494.23% of CMS fee schedule,47.36, 458.54% of CMS fee schedule,55.19,90% of total billed charges,10.33,100% of CMS fee schedule,42.92,70% of total billed charges,55.19,90% of total billed charges,58.25,95% of total billed charges,58.25,95% of total billed charges,10.33,100% of CMS fee schedule,20.66,200% of CMS fee schedule,52.74,86% of total billed charges,49.06,80% of total billed charges,11.46,111% of CMS fee schedule,59.48,97% of total billed charges,55.19,90% of total billed charges,N/A,not seperately reimbursable,59.48,97% of total billed charges,57.03,93% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,14.17,100% of CMS fee schedule,59.48,97% of total billed charges,10.33,100% of CMS fee schedule,10.33,100% of CMS fee schedule,8.78,85% of CMS fee schedule,8.78,59.48,30.66
Outpatient Medical Services,LAB,87350,Hepatitis Be Antigen,300,68.44,61.6,90% of total billed charges,11.53,100% of CMS fee schedule,54.75,80% of total billed charges,11.53,100% of CMS fee schedule,61.6,90% of total billed charges,11,100% of CMS fee schedule,66.39,97% of total billed charges,11.53,100% of CMS fee schedule,62.96,92% of total billed charges,11.53,100% of CMS fee schedule,46.77, 405.66% of CMS fee schedule,11.53,100% of CMS fee schedule,56.98,494.23% of CMS fee schedule,52.86, 458.54% of CMS fee schedule,61.6,90% of total billed charges,11.53,100% of CMS fee schedule,47.91,70% of total billed charges,61.6,90% of total billed charges,65.02,95% of total billed charges,65.02,95% of total billed charges,11.53,100% of CMS fee schedule,23.06,200% of CMS fee schedule,58.86,86% of total billed charges,54.75,80% of total billed charges,12.79,111% of CMS fee schedule,66.39,97% of total billed charges,61.6,90% of total billed charges,N/A,not seperately reimbursable,66.39,97% of total billed charges,63.65,93% of total billed charges,11.53,100% of CMS fee schedule,11.53,100% of CMS fee schedule,10,100% of CMS fee schedule,66.39,97% of total billed charges,11.53,100% of CMS fee schedule,11.53,100% of CMS fee schedule,9.8,85% of CMS fee schedule,9.8,66.39,34.22
Outpatient Medical Services,LAB,87350,"Hep VIII, HBeAg",300,68.44,61.6,90% of total billed charges,11.53,100% of CMS fee schedule,54.75,80% of total billed charges,11.53,100% of CMS fee schedule,61.6,90% of total billed charges,11,100% of CMS fee schedule,66.39,97% of total billed charges,11.53,100% of CMS fee schedule,62.96,92% of total billed charges,11.53,100% of CMS fee schedule,46.77, 405.66% of CMS fee schedule,11.53,100% of CMS fee schedule,56.98,494.23% of CMS fee schedule,52.86, 458.54% of CMS fee schedule,61.6,90% of total billed charges,11.53,100% of CMS fee schedule,47.91,70% of total billed charges,61.6,90% of total billed charges,65.02,95% of total billed charges,65.02,95% of total billed charges,11.53,100% of CMS fee schedule,23.06,200% of CMS fee schedule,58.86,86% of total billed charges,54.75,80% of total billed charges,12.79,111% of CMS fee schedule,66.39,97% of total billed charges,61.6,90% of total billed charges,N/A,not seperately reimbursable,66.39,97% of total billed charges,63.65,93% of total billed charges,11.53,100% of CMS fee schedule,11.53,100% of CMS fee schedule,10,100% of CMS fee schedule,66.39,97% of total billed charges,11.53,100% of CMS fee schedule,11.53,100% of CMS fee schedule,9.8,85% of CMS fee schedule,9.8,66.39,34.22
Outpatient Medical Services,LAB,87389,"HIV 1/O/2, SO",300,142.94,128.65,90% of total billed charges,24.08,100% of CMS fee schedule,114.35,80% of total billed charges,24.08,100% of CMS fee schedule,128.65,90% of total billed charges,30.03,100% of CMS fee schedule,138.65,97% of total billed charges,24.08,100% of CMS fee schedule,131.5,92% of total billed charges,24.08,100% of CMS fee schedule,97.68, 405.66% of CMS fee schedule,24.08,100% of CMS fee schedule,119.01,494.23% of CMS fee schedule,110.41, 458.54% of CMS fee schedule,128.65,90% of total billed charges,24.08,100% of CMS fee schedule,100.06,70% of total billed charges,128.65,90% of total billed charges,135.79,95% of total billed charges,135.79,95% of total billed charges,24.08,100% of CMS fee schedule,48.16,200% of CMS fee schedule,122.93,86% of total billed charges,114.35,80% of total billed charges,26.72,111% of CMS fee schedule,138.65,97% of total billed charges,128.65,90% of total billed charges,N/A,not seperately reimbursable,138.65,97% of total billed charges,132.93,93% of total billed charges,24.08,100% of CMS fee schedule,24.08,100% of CMS fee schedule,27.3,100% of CMS fee schedule,138.65,97% of total billed charges,24.08,100% of CMS fee schedule,24.08,100% of CMS fee schedule,20.46,85% of CMS fee schedule,20.46,138.65,71.47
Outpatient Medical Services,LAB,87389,HIV 1/O/2,300,142.94,128.65,90% of total billed charges,24.08,100% of CMS fee schedule,114.35,80% of total billed charges,24.08,100% of CMS fee schedule,128.65,90% of total billed charges,30.03,100% of CMS fee schedule,138.65,97% of total billed charges,24.08,100% of CMS fee schedule,131.5,92% of total billed charges,24.08,100% of CMS fee schedule,97.68, 405.66% of CMS fee schedule,24.08,100% of CMS fee schedule,119.01,494.23% of CMS fee schedule,110.41, 458.54% of CMS fee schedule,128.65,90% of total billed charges,24.08,100% of CMS fee schedule,100.06,70% of total billed charges,128.65,90% of total billed charges,135.79,95% of total billed charges,135.79,95% of total billed charges,24.08,100% of CMS fee schedule,48.16,200% of CMS fee schedule,122.93,86% of total billed charges,114.35,80% of total billed charges,26.72,111% of CMS fee schedule,138.65,97% of total billed charges,128.65,90% of total billed charges,N/A,not seperately reimbursable,138.65,97% of total billed charges,132.93,93% of total billed charges,24.08,100% of CMS fee schedule,24.08,100% of CMS fee schedule,27.3,100% of CMS fee schedule,138.65,97% of total billed charges,24.08,100% of CMS fee schedule,24.08,100% of CMS fee schedule,20.46,85% of CMS fee schedule,20.46,138.65,71.47
Outpatient Medical Services,LAB,87426,COVID Antigen,300,209.72,188.75,90% of total billed charges,35.33,100% of CMS fee schedule,167.78,80% of total billed charges,35.33,100% of CMS fee schedule,188.75,90% of total billed charges,N/A,not seperately reimbursable,203.43,97% of total billed charges,35.33,100% of CMS fee schedule,192.94,92% of total billed charges,35.33,100% of CMS fee schedule,143.32, 405.66% of CMS fee schedule,35.33,100% of CMS fee schedule,174.61,494.23% of CMS fee schedule,162, 458.54% of CMS fee schedule,188.75,90% of total billed charges,35.33,100% of CMS fee schedule,146.8,70% of total billed charges,188.75,90% of total billed charges,199.23,95% of total billed charges,199.23,95% of total billed charges,35.33,100% of CMS fee schedule,70.66,200% of CMS fee schedule,180.36,86% of total billed charges,167.78,80% of total billed charges,N/A,not seperately reimbursable,203.43,97% of total billed charges,188.75,90% of total billed charges,N/A,not seperately reimbursable,203.43,97% of total billed charges,195.04,93% of total billed charges,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,N/A,not seperately reimbursable,203.43,97% of total billed charges,35.33,100% of CMS fee schedule,35.33,100% of CMS fee schedule,30.03,85% of CMS fee schedule,30.03,203.43,104.86
Outpatient Medical Services,LAB,87449,Culture Viral  Influenzae,300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87449,C Diff Antigen Quik Chek Complete,300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87449,Fungitell Beta-D-Glucan LC,300,71.12,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,56.9,80% of total billed charges,11.98,100% of CMS fee schedule,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,65.43,92% of total billed charges,11.98,100% of CMS fee schedule,48.59, 405.66% of CMS fee schedule,11.98,100% of CMS fee schedule,59.2,494.23% of CMS fee schedule,54.93, 458.54% of CMS fee schedule,64.01,90% of total billed charges,11.98,100% of CMS fee schedule,49.78,70% of total billed charges,64.01,90% of total billed charges,67.56,95% of total billed charges,67.56,95% of total billed charges,11.98,100% of CMS fee schedule,23.96,200% of CMS fee schedule,61.16,86% of total billed charges,56.9,80% of total billed charges,13.29,111% of CMS fee schedule,68.99,97% of total billed charges,64.01,90% of total billed charges,N/A,not seperately reimbursable,68.99,97% of total billed charges,66.14,93% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,N/A,not seperately reimbursable,68.99,97% of total billed charges,11.98,100% of CMS fee schedule,11.98,100% of CMS fee schedule,10.18,85% of CMS fee schedule,10.18,68.99,35.56
Outpatient Medical Services,LAB,87481,"Candida Albicans and Candida Glabrata, NAA",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.75,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.77,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87481,CV/TV,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.75,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.77,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87481,Candida glabrata,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.75,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.77,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87481,Candidiasis Vaginitis,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.75,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.77,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87491,Pathology Billing Chlamydia Probe,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,Chlamydia/Gonorrhea by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,Chlamydia by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,Chlamydia,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,Chlamydia trachomatis,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,"CT, Ng, Trich vag by NAA LC",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,"CT/GC NAA, Rectal LC",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87491,CT Ng TV HSV by NAA LC,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87493,C. difficle-Epi by PCR,300,221.23,199.11,90% of total billed charges,37.27,100% of CMS fee schedule,176.98,80% of total billed charges,37.27,100% of CMS fee schedule,199.11,90% of total billed charges,44.24,100% of CMS fee schedule,214.59,97% of total billed charges,37.27,100% of CMS fee schedule,203.53,92% of total billed charges,37.27,100% of CMS fee schedule,151.19, 405.66% of CMS fee schedule,37.27,100% of CMS fee schedule,184.19,494.23% of CMS fee schedule,170.89, 458.54% of CMS fee schedule,199.11,90% of total billed charges,37.27,100% of CMS fee schedule,154.86,70% of total billed charges,199.11,90% of total billed charges,210.17,95% of total billed charges,210.17,95% of total billed charges,37.27,100% of CMS fee schedule,74.54,200% of CMS fee schedule,190.26,86% of total billed charges,176.98,80% of total billed charges,41.36,111% of CMS fee schedule,214.59,97% of total billed charges,199.11,90% of total billed charges,N/A,not seperately reimbursable,214.59,97% of total billed charges,205.74,93% of total billed charges,37.27,100% of CMS fee schedule,37.27,100% of CMS fee schedule,40.22,100% of CMS fee schedule,214.59,97% of total billed charges,37.27,100% of CMS fee schedule,37.27,100% of CMS fee schedule,31.67,85% of CMS fee schedule,31.67,214.59,110.62
Outpatient Medical Services,LAB,87493,"PCR, C diff Toxin B/Epi",300,221.23,199.11,90% of total billed charges,37.27,100% of CMS fee schedule,176.98,80% of total billed charges,37.27,100% of CMS fee schedule,199.11,90% of total billed charges,44.24,100% of CMS fee schedule,214.59,97% of total billed charges,37.27,100% of CMS fee schedule,203.53,92% of total billed charges,37.27,100% of CMS fee schedule,151.19, 405.66% of CMS fee schedule,37.27,100% of CMS fee schedule,184.19,494.23% of CMS fee schedule,170.89, 458.54% of CMS fee schedule,199.11,90% of total billed charges,37.27,100% of CMS fee schedule,154.86,70% of total billed charges,199.11,90% of total billed charges,210.17,95% of total billed charges,210.17,95% of total billed charges,37.27,100% of CMS fee schedule,74.54,200% of CMS fee schedule,190.26,86% of total billed charges,176.98,80% of total billed charges,41.36,111% of CMS fee schedule,214.59,97% of total billed charges,199.11,90% of total billed charges,N/A,not seperately reimbursable,214.59,97% of total billed charges,205.74,93% of total billed charges,37.27,100% of CMS fee schedule,37.27,100% of CMS fee schedule,40.22,100% of CMS fee schedule,214.59,97% of total billed charges,37.27,100% of CMS fee schedule,37.27,100% of CMS fee schedule,31.67,85% of CMS fee schedule,31.67,214.59,110.62
Outpatient Medical Services,LAB,87507,Biofire Gastrointestinal (GI) Panel,300,2474.01,2226.61,90% of total billed charges,416.78,100% of CMS fee schedule,1979.21,80% of total billed charges,416.78,100% of CMS fee schedule,2226.61,90% of total billed charges,N/A,not seperately reimbursable,2399.79,97% of total billed charges,416.78,100% of CMS fee schedule,2276.09,92% of total billed charges,416.78,100% of CMS fee schedule,1690.72, 405.66% of CMS fee schedule,416.78,100% of CMS fee schedule,2059.85,494.23% of CMS fee schedule,1911.1, 458.54% of CMS fee schedule,2226.61,90% of total billed charges,416.78,100% of CMS fee schedule,1731.81,70% of total billed charges,2226.61,90% of total billed charges,2350.31,95% of total billed charges,2350.31,95% of total billed charges,416.78,100% of CMS fee schedule,833.56,200% of CMS fee schedule,2127.65,86% of total billed charges,1979.21,80% of total billed charges,462.62,111% of CMS fee schedule,2399.79,97% of total billed charges,2226.61,90% of total billed charges,N/A,not seperately reimbursable,2399.79,97% of total billed charges,2300.83,93% of total billed charges,416.78,100% of CMS fee schedule,416.78,100% of CMS fee schedule,N/A,not seperately reimbursable,2399.79,97% of total billed charges,416.78,100% of CMS fee schedule,416.78,100% of CMS fee schedule,354.26,85% of CMS fee schedule,354.26,2399.79,1237.01
Outpatient Medical Services,LAB,87521,"Anti Mullerian Hormone, SO",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.03,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.21,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87521,HCV NAA Qualitative (rfx Geno) LC,300,205.09,184.58,90% of total billed charges,35.09,100% of CMS fee schedule,164.07,80% of total billed charges,35.09,100% of CMS fee schedule,184.58,90% of total billed charges,42.03,100% of CMS fee schedule,198.94,97% of total billed charges,35.09,100% of CMS fee schedule,188.68,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,184.58,90% of total billed charges,35.09,100% of CMS fee schedule,143.56,70% of total billed charges,184.58,90% of total billed charges,194.84,95% of total billed charges,194.84,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,176.38,86% of total billed charges,164.07,80% of total billed charges,38.94,111% of CMS fee schedule,198.94,97% of total billed charges,184.58,90% of total billed charges,N/A,not seperately reimbursable,198.94,97% of total billed charges,190.73,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.21,100% of CMS fee schedule,198.94,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,198.94,102.55
Outpatient Medical Services,LAB,87529,Herpes Simplex Virus I/II DNA PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87529,"HSV II, DNA, PCR",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87529,"HSV 1/2 PCR, CSF LC",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87529,87529 - CT Ng TV HSV by NAA LC ADD-ON,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87529,"87529 - HSV 1/2 PCR, CSF Lc ADD-ON",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,N/A,not seperately reimbursable,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87591,GC by Nucleic Acid Amplification,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,Pathology Billing GC probe,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,Neisseria gonorrhoeae by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,Gonorrhea by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,Gonorrhea,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,Neisseria gonorrhoeae,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,"Ct, Ng, Trich 87591 Add-On",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,87591 - CT Ng TV HSV by NAA LC ADD-ON,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87591,"87591 - CT/GC NAA, Rectal LC ADD-ON",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,52.79,150% of AETNA fee schedule,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,25.51,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,23.19,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,23.19,202.04,104.15
Outpatient Medical Services,LAB,87631,Flu/RSV by PCR,300,846.65,761.99,90% of total billed charges,142.63,100% of CMS fee schedule,677.32,80% of total billed charges,142.63,100% of CMS fee schedule,761.99,90% of total billed charges,155.18,100% of CMS fee schedule,821.25,97% of total billed charges,142.63,100% of CMS fee schedule,778.92,92% of total billed charges,142.63,100% of CMS fee schedule,578.59, 405.66% of CMS fee schedule,142.63,100% of CMS fee schedule,704.92,494.23% of CMS fee schedule,654.01, 458.54% of CMS fee schedule,761.99,90% of total billed charges,142.63,100% of CMS fee schedule,592.66,70% of total billed charges,761.99,90% of total billed charges,804.32,95% of total billed charges,804.32,95% of total billed charges,142.63,100% of CMS fee schedule,285.26,200% of CMS fee schedule,728.12,86% of total billed charges,677.32,80% of total billed charges,158.31,111% of CMS fee schedule,821.25,97% of total billed charges,761.99,90% of total billed charges,N/A,not seperately reimbursable,821.25,97% of total billed charges,787.38,93% of total billed charges,142.63,100% of CMS fee schedule,142.63,100% of CMS fee schedule,141.07,100% of CMS fee schedule,821.25,97% of total billed charges,142.63,100% of CMS fee schedule,142.63,100% of CMS fee schedule,121.23,85% of CMS fee schedule,121.23,821.25,423.33
Outpatient Medical Services,LAB,87641,MRSA by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.15,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.23,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87641,MRSA/SA SSTI by PCR,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,43.15,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,39.23,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87661,Trichomonas vaginalis,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.13,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.3,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87661,Trichomonas vaginalis,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.13,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.3,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87661,Trichomonas Only,306,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.13,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.3,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87661,"Ct, Ng, Trich 87661 Add-On",300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.13,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.3,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87661,87661 - CT Ng TV HSV by NAA LC ADD-ON,300,208.29,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,166.63,80% of total billed charges,35.09,100% of CMS fee schedule,187.46,90% of total billed charges,42.13,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,191.63,92% of total billed charges,35.09,100% of CMS fee schedule,142.34, 405.66% of CMS fee schedule,35.09,100% of CMS fee schedule,173.42,494.23% of CMS fee schedule,160.9, 458.54% of CMS fee schedule,187.46,90% of total billed charges,35.09,100% of CMS fee schedule,145.8,70% of total billed charges,187.46,90% of total billed charges,197.88,95% of total billed charges,197.88,95% of total billed charges,35.09,100% of CMS fee schedule,70.18,200% of CMS fee schedule,179.13,86% of total billed charges,166.63,80% of total billed charges,38.94,111% of CMS fee schedule,202.04,97% of total billed charges,187.46,90% of total billed charges,N/A,not seperately reimbursable,202.04,97% of total billed charges,193.71,93% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,38.3,100% of CMS fee schedule,202.04,97% of total billed charges,35.09,100% of CMS fee schedule,35.09,100% of CMS fee schedule,29.82,85% of CMS fee schedule,29.82,202.04,104.15
Outpatient Medical Services,LAB,87804,Influenza POC,300,98.24,88.42,90% of total billed charges,16.55,100% of CMS fee schedule,78.59,80% of total billed charges,16.55,100% of CMS fee schedule,88.42,90% of total billed charges,12.49,100% of CMS fee schedule,95.29,97% of total billed charges,16.55,100% of CMS fee schedule,90.38,92% of total billed charges,16.55,100% of CMS fee schedule,67.13, 405.66% of CMS fee schedule,16.55,100% of CMS fee schedule,81.79,494.23% of CMS fee schedule,75.88, 458.54% of CMS fee schedule,88.42,90% of total billed charges,16.55,100% of CMS fee schedule,68.77,70% of total billed charges,88.42,90% of total billed charges,93.33,95% of total billed charges,93.33,95% of total billed charges,16.55,100% of CMS fee schedule,33.1,200% of CMS fee schedule,84.49,86% of total billed charges,78.59,80% of total billed charges,18.37,111% of CMS fee schedule,95.29,97% of total billed charges,88.42,90% of total billed charges,N/A,not seperately reimbursable,95.29,97% of total billed charges,91.36,93% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,11.35,100% of CMS fee schedule,95.29,97% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,14.06,85% of CMS fee schedule,11.35,95.29,49.12
Outpatient Medical Services,LAB,87804,Infliximab Drug + Antibody LC,300,542.86,488.57,90% of total billed charges,16.55,100% of CMS fee schedule,434.29,80% of total billed charges,16.55,100% of CMS fee schedule,488.57,90% of total billed charges,12.49,100% of CMS fee schedule,526.57,97% of total billed charges,16.55,100% of CMS fee schedule,499.43,92% of total billed charges,16.55,100% of CMS fee schedule,67.13, 405.66% of CMS fee schedule,16.55,100% of CMS fee schedule,81.79,494.23% of CMS fee schedule,75.88, 458.54% of CMS fee schedule,488.57,90% of total billed charges,16.55,100% of CMS fee schedule,380,70% of total billed charges,488.57,90% of total billed charges,515.72,95% of total billed charges,515.72,95% of total billed charges,16.55,100% of CMS fee schedule,33.1,200% of CMS fee schedule,466.86,86% of total billed charges,434.29,80% of total billed charges,18.37,111% of CMS fee schedule,526.57,97% of total billed charges,488.57,90% of total billed charges,N/A,not seperately reimbursable,526.57,97% of total billed charges,504.86,93% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,11.35,100% of CMS fee schedule,526.57,97% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,14.06,85% of CMS fee schedule,11.35,526.57,271.43
Outpatient Medical Services,LAB,87804,87804 - Infliximab Drug + Antibody LC ADD-ON,300,542.86,488.57,90% of total billed charges,16.55,100% of CMS fee schedule,434.29,80% of total billed charges,16.55,100% of CMS fee schedule,488.57,90% of total billed charges,12.49,100% of CMS fee schedule,526.57,97% of total billed charges,16.55,100% of CMS fee schedule,499.43,92% of total billed charges,16.55,100% of CMS fee schedule,67.13, 405.66% of CMS fee schedule,16.55,100% of CMS fee schedule,81.79,494.23% of CMS fee schedule,75.88, 458.54% of CMS fee schedule,488.57,90% of total billed charges,16.55,100% of CMS fee schedule,380,70% of total billed charges,488.57,90% of total billed charges,515.72,95% of total billed charges,515.72,95% of total billed charges,16.55,100% of CMS fee schedule,33.1,200% of CMS fee schedule,466.86,86% of total billed charges,434.29,80% of total billed charges,18.37,111% of CMS fee schedule,526.57,97% of total billed charges,488.57,90% of total billed charges,N/A,not seperately reimbursable,526.57,97% of total billed charges,504.86,93% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,11.35,100% of CMS fee schedule,526.57,97% of total billed charges,16.55,100% of CMS fee schedule,16.55,100% of CMS fee schedule,14.06,85% of CMS fee schedule,11.35,526.57,271.43
Outpatient Medical Services,LAB,87807,zzzRespiratory Syncytial Virus Antigen,300,77.76,69.98,90% of total billed charges,13.1,100% of CMS fee schedule,62.21,80% of total billed charges,13.1,100% of CMS fee schedule,69.98,90% of total billed charges,13.54,100% of CMS fee schedule,75.43,97% of total billed charges,13.1,100% of CMS fee schedule,71.54,92% of total billed charges,13.1,100% of CMS fee schedule,53.14, 405.66% of CMS fee schedule,13.1,100% of CMS fee schedule,64.74,494.23% of CMS fee schedule,60.06, 458.54% of CMS fee schedule,69.98,90% of total billed charges,13.1,100% of CMS fee schedule,54.43,70% of total billed charges,69.98,90% of total billed charges,73.87,95% of total billed charges,73.87,95% of total billed charges,13.1,100% of CMS fee schedule,26.2,200% of CMS fee schedule,66.87,86% of total billed charges,62.21,80% of total billed charges,14.54,111% of CMS fee schedule,75.43,97% of total billed charges,69.98,90% of total billed charges,N/A,not seperately reimbursable,75.43,97% of total billed charges,72.32,93% of total billed charges,13.1,100% of CMS fee schedule,13.1,100% of CMS fee schedule,12.31,100% of CMS fee schedule,75.43,97% of total billed charges,13.1,100% of CMS fee schedule,13.1,100% of CMS fee schedule,11.13,85% of CMS fee schedule,11.13,75.43,38.88
Outpatient Medical Services,LAB,87807,RSV POC,300,77.76,69.98,90% of total billed charges,13.1,100% of CMS fee schedule,62.21,80% of total billed charges,13.1,100% of CMS fee schedule,69.98,90% of total billed charges,13.54,100% of CMS fee schedule,75.43,97% of total billed charges,13.1,100% of CMS fee schedule,71.54,92% of total billed charges,13.1,100% of CMS fee schedule,53.14, 405.66% of CMS fee schedule,13.1,100% of CMS fee schedule,64.74,494.23% of CMS fee schedule,60.06, 458.54% of CMS fee schedule,69.98,90% of total billed charges,13.1,100% of CMS fee schedule,54.43,70% of total billed charges,69.98,90% of total billed charges,73.87,95% of total billed charges,73.87,95% of total billed charges,13.1,100% of CMS fee schedule,26.2,200% of CMS fee schedule,66.87,86% of total billed charges,62.21,80% of total billed charges,14.54,111% of CMS fee schedule,75.43,97% of total billed charges,69.98,90% of total billed charges,N/A,not seperately reimbursable,75.43,97% of total billed charges,72.32,93% of total billed charges,13.1,100% of CMS fee schedule,13.1,100% of CMS fee schedule,12.31,100% of CMS fee schedule,75.43,97% of total billed charges,13.1,100% of CMS fee schedule,13.1,100% of CMS fee schedule,11.13,85% of CMS fee schedule,11.13,75.43,38.88
Outpatient Medical Services,LAB,87880,Rapid Strep Test,300,98.12,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,78.5,80% of total billed charges,16.53,100% of CMS fee schedule,88.31,90% of total billed charges,6.93,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,90.27,92% of total billed charges,16.53,100% of CMS fee schedule,67.05, 405.66% of CMS fee schedule,16.53,100% of CMS fee schedule,81.69,494.23% of CMS fee schedule,75.79, 458.54% of CMS fee schedule,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,68.68,70% of total billed charges,88.31,90% of total billed charges,93.21,95% of total billed charges,93.21,95% of total billed charges,16.53,100% of CMS fee schedule,33.06,200% of CMS fee schedule,84.38,86% of total billed charges,78.5,80% of total billed charges,18.34,111% of CMS fee schedule,95.18,97% of total billed charges,88.31,90% of total billed charges,N/A,not seperately reimbursable,95.18,97% of total billed charges,91.25,93% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,6.3,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,14.05,85% of CMS fee schedule,6.3,95.18,49.06
Outpatient Medical Services,LAB,87880,Rapid Strep A Screen,510,98.12,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,78.5,80% of total billed charges,16.53,100% of CMS fee schedule,88.31,90% of total billed charges,6.93,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,90.27,92% of total billed charges,16.53,100% of CMS fee schedule,67.05, 405.66% of CMS fee schedule,16.53,100% of CMS fee schedule,81.69,494.23% of CMS fee schedule,75.79, 458.54% of CMS fee schedule,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,68.68,70% of total billed charges,88.31,90% of total billed charges,93.21,95% of total billed charges,93.21,95% of total billed charges,16.53,100% of CMS fee schedule,33.06,200% of CMS fee schedule,84.38,86% of total billed charges,78.5,80% of total billed charges,18.34,111% of CMS fee schedule,95.18,97% of total billed charges,88.31,90% of total billed charges,N/A,not seperately reimbursable,95.18,97% of total billed charges,91.25,93% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,6.3,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,14.05,85% of CMS fee schedule,6.3,95.18,49.06
Outpatient Medical Services,LAB,87880,Rapid Strep POC,300,98.12,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,78.5,80% of total billed charges,16.53,100% of CMS fee schedule,88.31,90% of total billed charges,6.93,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,90.27,92% of total billed charges,16.53,100% of CMS fee schedule,67.05, 405.66% of CMS fee schedule,16.53,100% of CMS fee schedule,81.69,494.23% of CMS fee schedule,75.79, 458.54% of CMS fee schedule,88.31,90% of total billed charges,16.53,100% of CMS fee schedule,68.68,70% of total billed charges,88.31,90% of total billed charges,93.21,95% of total billed charges,93.21,95% of total billed charges,16.53,100% of CMS fee schedule,33.06,200% of CMS fee schedule,84.38,86% of total billed charges,78.5,80% of total billed charges,18.34,111% of CMS fee schedule,95.18,97% of total billed charges,88.31,90% of total billed charges,N/A,not seperately reimbursable,95.18,97% of total billed charges,91.25,93% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,6.3,100% of CMS fee schedule,95.18,97% of total billed charges,16.53,100% of CMS fee schedule,16.53,100% of CMS fee schedule,14.05,85% of CMS fee schedule,6.3,95.18,49.06
Outpatient Medical Services,LAB,87899,Cryptococcal Antigen CSF,300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,87899,Strep Pneumo Antigen,300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,87899,Legionella Antigen,300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,87899,"Cryptococcus Antigen, CSF LC",300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,87899,.Cryptococcus Ag Titer CSF 183018 LC,300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,87899,"Cryptococcus Antigen, Serum LC",300,95.39,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,76.31,80% of total billed charges,16.07,100% of CMS fee schedule,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,87.76,92% of total billed charges,16.07,100% of CMS fee schedule,65.19, 405.66% of CMS fee schedule,16.07,100% of CMS fee schedule,79.42,494.23% of CMS fee schedule,73.68, 458.54% of CMS fee schedule,85.85,90% of total billed charges,16.07,100% of CMS fee schedule,66.77,70% of total billed charges,85.85,90% of total billed charges,90.62,95% of total billed charges,90.62,95% of total billed charges,16.07,100% of CMS fee schedule,32.14,200% of CMS fee schedule,82.04,86% of total billed charges,76.31,80% of total billed charges,17.83,111% of CMS fee schedule,92.53,97% of total billed charges,85.85,90% of total billed charges,N/A,not seperately reimbursable,92.53,97% of total billed charges,88.71,93% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,N/A,not seperately reimbursable,92.53,97% of total billed charges,16.07,100% of CMS fee schedule,16.07,100% of CMS fee schedule,13.65,85% of CMS fee schedule,13.65,92.53,47.70
Outpatient Medical Services,LAB,89051,Cell Count w/ Differential Body Fluid,300,33.24,29.92,90% of total billed charges,5.6,100% of CMS fee schedule,26.59,80% of total billed charges,5.6,100% of CMS fee schedule,29.92,90% of total billed charges,7.7,100% of CMS fee schedule,32.24,97% of total billed charges,5.6,100% of CMS fee schedule,30.58,92% of total billed charges,5.6,100% of CMS fee schedule,22.71, 405.66% of CMS fee schedule,5.6,100% of CMS fee schedule,27.67,494.23% of CMS fee schedule,25.67, 458.54% of CMS fee schedule,29.92,90% of total billed charges,5.6,100% of CMS fee schedule,23.27,70% of total billed charges,29.92,90% of total billed charges,31.58,95% of total billed charges,31.58,95% of total billed charges,5.6,100% of CMS fee schedule,11.2,200% of CMS fee schedule,28.59,86% of total billed charges,26.59,80% of total billed charges,6.21,111% of CMS fee schedule,32.24,97% of total billed charges,29.92,90% of total billed charges,N/A,not seperately reimbursable,32.24,97% of total billed charges,30.91,93% of total billed charges,5.6,100% of CMS fee schedule,5.6,100% of CMS fee schedule,7,100% of CMS fee schedule,32.24,97% of total billed charges,5.6,100% of CMS fee schedule,5.6,100% of CMS fee schedule,4.75,85% of CMS fee schedule,4.75,32.24,16.62
Outpatient Medical Services,LAB,89051,Cell Count w/ Differential CSF,300,33.24,29.92,90% of total billed charges,5.6,100% of CMS fee schedule,26.59,80% of total billed charges,5.6,100% of CMS fee schedule,29.92,90% of total billed charges,7.7,100% of CMS fee schedule,32.24,97% of total billed charges,5.6,100% of CMS fee schedule,30.58,92% of total billed charges,5.6,100% of CMS fee schedule,22.71, 405.66% of CMS fee schedule,5.6,100% of CMS fee schedule,27.67,494.23% of CMS fee schedule,25.67, 458.54% of CMS fee schedule,29.92,90% of total billed charges,5.6,100% of CMS fee schedule,23.27,70% of total billed charges,29.92,90% of total billed charges,31.58,95% of total billed charges,31.58,95% of total billed charges,5.6,100% of CMS fee schedule,11.2,200% of CMS fee schedule,28.59,86% of total billed charges,26.59,80% of total billed charges,6.21,111% of CMS fee schedule,32.24,97% of total billed charges,29.92,90% of total billed charges,N/A,not seperately reimbursable,32.24,97% of total billed charges,30.91,93% of total billed charges,5.6,100% of CMS fee schedule,5.6,100% of CMS fee schedule,7,100% of CMS fee schedule,32.24,97% of total billed charges,5.6,100% of CMS fee schedule,5.6,100% of CMS fee schedule,4.75,85% of CMS fee schedule,4.75,32.24,16.62
Outpatient Medical Services,LAB,89060,Crystals Body Fluid,300,43.51,39.16,90% of total billed charges,7.33,100% of CMS fee schedule,34.81,80% of total billed charges,7.33,100% of CMS fee schedule,39.16,90% of total billed charges,8.25,100% of CMS fee schedule,42.2,97% of total billed charges,7.33,100% of CMS fee schedule,40.03,92% of total billed charges,7.33,100% of CMS fee schedule,29.73, 405.66% of CMS fee schedule,7.33,100% of CMS fee schedule,36.22,494.23% of CMS fee schedule,33.61, 458.54% of CMS fee schedule,39.16,90% of total billed charges,7.33,100% of CMS fee schedule,30.46,70% of total billed charges,39.16,90% of total billed charges,41.33,95% of total billed charges,41.33,95% of total billed charges,7.33,100% of CMS fee schedule,14.66,200% of CMS fee schedule,37.42,86% of total billed charges,34.81,80% of total billed charges,8.13,111% of CMS fee schedule,42.2,97% of total billed charges,39.16,90% of total billed charges,N/A,not seperately reimbursable,42.2,97% of total billed charges,40.46,93% of total billed charges,7.33,100% of CMS fee schedule,7.33,100% of CMS fee schedule,7.5,100% of CMS fee schedule,42.2,97% of total billed charges,7.33,100% of CMS fee schedule,7.33,100% of CMS fee schedule,6.23,85% of CMS fee schedule,6.23,42.2,21.76
Outpatient Medical Services,EMERGENCY ROOM,90471,FBC Vaccination,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,RI INF Vaccine,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,90471 -Immunization admin,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,AMB Admin Immunization Charge -> First Vaccine 90471,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,AMB Admin Injection Charge -> ID Admin Charge 90471,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,ED Vaccine Administration,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,90471,IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,771,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,N/A,not seperately reimbursable,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,57.53,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,92950,Cardiopulmonary Resuscitation,450,1868.4,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1494.72,80% of total billed charges,296.16,100% of CMS IPPS rate,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,1718.93,92% of total billed charges,296.16,100% of CMS IPPS rate,722,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,1151.02,100% of CMS IPPS rate,1457.94,100% of CMS IPPS rate,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1307.88,70% of total billed charges,1681.56,90% of total billed charges,1774.98,95% of total billed charges,1774.98,95% of total billed charges,296.16,100% of CMS IPPS rate,543.24,100% of CMS IPPS rate,1606.82,86% of total billed charges,1494.72,80% of total billed charges,261.67,100% of CMS IPPS rate,1812.35,97% of total billed charges,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,1737.61,93% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,251.73,100% of CMS IPPS rate,251.73,1812.35,934.20
Outpatient Medical Services,EMERGENCY ROOM,92950,92950- Cardiopulmonary resuscitation,450,1868.4,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1494.72,80% of total billed charges,296.16,100% of CMS IPPS rate,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,1718.93,92% of total billed charges,296.16,100% of CMS IPPS rate,722,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,1151.02,100% of CMS IPPS rate,1457.94,100% of CMS IPPS rate,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1307.88,70% of total billed charges,1681.56,90% of total billed charges,1774.98,95% of total billed charges,1774.98,95% of total billed charges,296.16,100% of CMS IPPS rate,543.24,100% of CMS IPPS rate,1606.82,86% of total billed charges,1494.72,80% of total billed charges,261.67,100% of CMS IPPS rate,1812.35,97% of total billed charges,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,1737.61,93% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,251.73,100% of CMS IPPS rate,251.73,1812.35,934.20
Outpatient Medical Services,EMERGENCY ROOM,92950,Respiratory Therapy Time/Equipment,410,1868.4,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1494.72,80% of total billed charges,296.16,100% of CMS IPPS rate,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,1718.93,92% of total billed charges,296.16,100% of CMS IPPS rate,722,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,1151.02,100% of CMS IPPS rate,1457.94,100% of CMS IPPS rate,1681.56,90% of total billed charges,296.16,100% of CMS IPPS rate,1307.88,70% of total billed charges,1681.56,90% of total billed charges,1774.98,95% of total billed charges,1774.98,95% of total billed charges,296.16,100% of CMS IPPS rate,543.24,100% of CMS IPPS rate,1606.82,86% of total billed charges,1494.72,80% of total billed charges,261.67,100% of CMS IPPS rate,1812.35,97% of total billed charges,1681.56,90% of total billed charges,N/A,not seperately reimbursable,1812.35,97% of total billed charges,1737.61,93% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,N/A,not seperately reimbursable,1812.35,97% of total billed charges,296.16,100% of CMS IPPS rate,296.16,100% of CMS IPPS rate,251.73,100% of CMS IPPS rate,251.73,1812.35,934.20
Outpatient Medical Services,ECCG,93000,"93000- Electrocardiogram (ECG), Routine 12-Lead, Tracing and I&R (Global)",730,338.05,304.25,90% of total billed charges,N/A,not seperately reimbursable,270.44,80% of total billed charges,N/A,not seperately reimbursable,304.25,90% of total billed charges,21.14,100% of CMS fee schedule,327.91,97% of total billed charges,N/A,not seperately reimbursable,311.01,92% of total billed charges,N/A,not seperately reimbursable,215.89,63.86% of total billed charges,N/A,not seperately reimbursable,265.88, 78.65% of total billed charges,301.99,89.33% of total billed charges,304.25,90% of total billed charges,N/A,not seperately reimbursable,236.64,70% of total billed charges,304.25,90% of total billed charges,321.15,95% of total billed charges,321.15,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,290.72,86% of total billed charges,270.44,80% of total billed charges,N/A,not seperately reimbursable,327.91,97% of total billed charges,304.25,90% of total billed charges,N/A,not seperately reimbursable,327.91,97% of total billed charges,314.39,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,19.22,100% of CMS fee schedule,327.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,19.22,327.91,169.03
Outpatient Medical Services,ECCG,93000,Clinic EKG,730,338.05,304.25,90% of total billed charges,N/A,not seperately reimbursable,270.44,80% of total billed charges,N/A,not seperately reimbursable,304.25,90% of total billed charges,21.14,100% of CMS fee schedule,327.91,97% of total billed charges,N/A,not seperately reimbursable,311.01,92% of total billed charges,N/A,not seperately reimbursable,215.89,63.86% of total billed charges,N/A,not seperately reimbursable,265.88, 78.65% of total billed charges,301.99,89.33% of total billed charges,304.25,90% of total billed charges,N/A,not seperately reimbursable,236.64,70% of total billed charges,304.25,90% of total billed charges,321.15,95% of total billed charges,321.15,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,290.72,86% of total billed charges,270.44,80% of total billed charges,N/A,not seperately reimbursable,327.91,97% of total billed charges,304.25,90% of total billed charges,N/A,not seperately reimbursable,327.91,97% of total billed charges,314.39,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,19.22,100% of CMS fee schedule,327.91,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,19.22,327.91,169.03
Outpatient Medical Services,CARDIAC,93005,Electrocardiogram-Inpatient,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,Electrocardiogram-Outpatient,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,EKG-Inpatient,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,EKG Pre/Post Unit,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,PAT EKG,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,93005- Electrocardiogram tracing,730,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,93005-EKG PRE/POST  UNIT,481,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93005,93005-ECG ROUTINE ECG W/LEAST 12 LDS TRACING ONLY,450,356.4,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,285.12,80% of total billed charges,56.49,100% of CMS IPPS rate,320.76,90% of total billed charges,11.51,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,327.89,92% of total billed charges,56.49,100% of CMS IPPS rate,140.7,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,224.31,100% of CMS IPPS rate,284.12,100% of CMS IPPS rate,320.76,90% of total billed charges,56.49,100% of CMS IPPS rate,249.48,70% of total billed charges,320.76,90% of total billed charges,338.58,95% of total billed charges,338.58,95% of total billed charges,56.49,100% of CMS IPPS rate,105.86,100% of CMS IPPS rate,306.5,86% of total billed charges,285.12,80% of total billed charges,56.87,100% of CMS IPPS rate,345.71,97% of total billed charges,320.76,90% of total billed charges,N/A,not seperately reimbursable,345.71,97% of total billed charges,331.45,93% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,10.46,100% of CMS fee schedule,345.71,97% of total billed charges,56.49,100% of CMS IPPS rate,56.49,100% of CMS IPPS rate,48.02,100% of CMS IPPS rate,10.46,345.71,178.20
Outpatient Medical Services,CARDIAC,93270,Event Monitoring,731,223.74,201.37,90% of total billed charges,35.46,100% of CMS IPPS rate,178.99,80% of total billed charges,35.46,100% of CMS IPPS rate,201.37,90% of total billed charges,16.17,100% of CMS fee schedule,217.03,97% of total billed charges,35.46,100% of CMS IPPS rate,205.84,92% of total billed charges,35.46,100% of CMS IPPS rate,86.74,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,138.28,100% of CMS IPPS rate,175.16,100% of CMS IPPS rate,201.37,90% of total billed charges,35.46,100% of CMS IPPS rate,156.62,70% of total billed charges,201.37,90% of total billed charges,212.55,95% of total billed charges,212.55,95% of total billed charges,35.46,100% of CMS IPPS rate,65.26,100% of CMS IPPS rate,192.42,86% of total billed charges,178.99,80% of total billed charges,37.47,100% of CMS IPPS rate,217.03,97% of total billed charges,201.37,90% of total billed charges,N/A,not seperately reimbursable,217.03,97% of total billed charges,208.08,93% of total billed charges,35.46,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,14.7,100% of CMS fee schedule,217.03,97% of total billed charges,35.46,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,30.14,100% of CMS IPPS rate,14.7,217.03,111.87
Outpatient Medical Services,CARDIAC,93270,93270- Ext pt/auto ECG/30 day/MD interp,731,223.74,201.37,90% of total billed charges,35.46,100% of CMS IPPS rate,178.99,80% of total billed charges,35.46,100% of CMS IPPS rate,201.37,90% of total billed charges,16.17,100% of CMS fee schedule,217.03,97% of total billed charges,35.46,100% of CMS IPPS rate,205.84,92% of total billed charges,35.46,100% of CMS IPPS rate,86.74,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,138.28,100% of CMS IPPS rate,175.16,100% of CMS IPPS rate,201.37,90% of total billed charges,35.46,100% of CMS IPPS rate,156.62,70% of total billed charges,201.37,90% of total billed charges,212.55,95% of total billed charges,212.55,95% of total billed charges,35.46,100% of CMS IPPS rate,65.26,100% of CMS IPPS rate,192.42,86% of total billed charges,178.99,80% of total billed charges,37.47,100% of CMS IPPS rate,217.03,97% of total billed charges,201.37,90% of total billed charges,N/A,not seperately reimbursable,217.03,97% of total billed charges,208.08,93% of total billed charges,35.46,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,14.7,100% of CMS fee schedule,217.03,97% of total billed charges,35.46,100% of CMS IPPS rate,35.46,100% of CMS IPPS rate,30.14,100% of CMS IPPS rate,14.7,217.03,111.87
Outpatient Medical Services,CARDIAC,93306,Echocardiogram,483,3289.8,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2631.84,80% of total billed charges,521.47,100% of CMS IPPS rate,2960.82,90% of total billed charges,107.95,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,3026.62,92% of total billed charges,521.47,100% of CMS IPPS rate,1269,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,2023.05,100% of CMS IPPS rate,2562.51,100% of CMS IPPS rate,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2302.86,70% of total billed charges,2960.82,90% of total billed charges,3125.31,95% of total billed charges,3125.31,95% of total billed charges,521.47,100% of CMS IPPS rate,954.81,100% of CMS IPPS rate,2829.23,86% of total billed charges,2631.84,80% of total billed charges,497.89,100% of CMS IPPS rate,3191.11,97% of total billed charges,2960.82,90% of total billed charges,N/A,not seperately reimbursable,3191.11,97% of total billed charges,3059.51,93% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,98.14,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,443.26,100% of CMS IPPS rate,98.14,3191.11,1644.90
Outpatient Medical Services,CARDIAC,93306,CL Adult Echocardiogram,483,3289.8,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2631.84,80% of total billed charges,521.47,100% of CMS IPPS rate,2960.82,90% of total billed charges,107.95,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,3026.62,92% of total billed charges,521.47,100% of CMS IPPS rate,1269,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,2023.05,100% of CMS IPPS rate,2562.51,100% of CMS IPPS rate,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2302.86,70% of total billed charges,2960.82,90% of total billed charges,3125.31,95% of total billed charges,3125.31,95% of total billed charges,521.47,100% of CMS IPPS rate,954.81,100% of CMS IPPS rate,2829.23,86% of total billed charges,2631.84,80% of total billed charges,497.89,100% of CMS IPPS rate,3191.11,97% of total billed charges,2960.82,90% of total billed charges,N/A,not seperately reimbursable,3191.11,97% of total billed charges,3059.51,93% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,98.14,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,443.26,100% of CMS IPPS rate,98.14,3191.11,1644.90
Outpatient Medical Services,CARDIAC,93306,93306- TTE/2D/M-mode/spec dop/color flow,483,3289.8,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2631.84,80% of total billed charges,521.47,100% of CMS IPPS rate,2960.82,90% of total billed charges,107.95,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,3026.62,92% of total billed charges,521.47,100% of CMS IPPS rate,1269,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,2023.05,100% of CMS IPPS rate,2562.51,100% of CMS IPPS rate,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2302.86,70% of total billed charges,2960.82,90% of total billed charges,3125.31,95% of total billed charges,3125.31,95% of total billed charges,521.47,100% of CMS IPPS rate,954.81,100% of CMS IPPS rate,2829.23,86% of total billed charges,2631.84,80% of total billed charges,497.89,100% of CMS IPPS rate,3191.11,97% of total billed charges,2960.82,90% of total billed charges,N/A,not seperately reimbursable,3191.11,97% of total billed charges,3059.51,93% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,98.14,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,443.26,100% of CMS IPPS rate,98.14,3191.11,1644.90
Outpatient Medical Services,CARDIAC,93306,MCNH Echo Transthoracic Complete,483,3289.8,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2631.84,80% of total billed charges,521.47,100% of CMS IPPS rate,2960.82,90% of total billed charges,107.95,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,3026.62,92% of total billed charges,521.47,100% of CMS IPPS rate,1269,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,2023.05,100% of CMS IPPS rate,2562.51,100% of CMS IPPS rate,2960.82,90% of total billed charges,521.47,100% of CMS IPPS rate,2302.86,70% of total billed charges,2960.82,90% of total billed charges,3125.31,95% of total billed charges,3125.31,95% of total billed charges,521.47,100% of CMS IPPS rate,954.81,100% of CMS IPPS rate,2829.23,86% of total billed charges,2631.84,80% of total billed charges,497.89,100% of CMS IPPS rate,3191.11,97% of total billed charges,2960.82,90% of total billed charges,N/A,not seperately reimbursable,3191.11,97% of total billed charges,3059.51,93% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,98.14,100% of CMS fee schedule,3191.11,97% of total billed charges,521.47,100% of CMS IPPS rate,521.47,100% of CMS IPPS rate,443.26,100% of CMS IPPS rate,98.14,3191.11,1644.90
Outpatient Medical Services,CARDIAC,93452,"93452-LHC, LV only",481,19298.46,17368.61,90% of total billed charges,N/A,not seperately reimbursable,15438.77,80% of total billed charges,N/A,not seperately reimbursable,17368.61,90% of total billed charges,N/A,not seperately reimbursable,18719.51,97% of total billed charges,N/A,not seperately reimbursable,17754.58,92% of total billed charges,N/A,not seperately reimbursable,7495.63,100% of CMS IPPS rate,N/A,not seperately reimbursable,11949.58,100% of CMS IPPS rate,15135.95,100% of CMS IPPS rate,17368.61,90% of total billed charges,N/A,not seperately reimbursable,13508.92,70% of total billed charges,17368.61,90% of total billed charges,18333.54,95% of total billed charges,18333.54,95% of total billed charges,N/A,not seperately reimbursable,5639.8,100% of CMS IPPS rate,16596.68,86% of total billed charges,15438.77,80% of total billed charges,2946.49,100% of CMS IPPS rate,18719.51,97% of total billed charges,17368.61,90% of total billed charges,N/A,not seperately reimbursable,18719.51,97% of total billed charges,17947.57,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18719.51,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2946.49,18719.51,9649.23
Outpatient Medical Services,CARDIAC,93458,"93458-LEFT HEART CATH, LV, COR",481,19298.46,17368.61,90% of total billed charges,N/A,not seperately reimbursable,15438.77,80% of total billed charges,N/A,not seperately reimbursable,17368.61,90% of total billed charges,N/A,not seperately reimbursable,18719.51,97% of total billed charges,N/A,not seperately reimbursable,17754.58,92% of total billed charges,N/A,not seperately reimbursable,7495.63,100% of CMS IPPS rate,N/A,not seperately reimbursable,11949.58,100% of CMS IPPS rate,15135.95,100% of CMS IPPS rate,17368.61,90% of total billed charges,N/A,not seperately reimbursable,13508.92,70% of total billed charges,17368.61,90% of total billed charges,18333.54,95% of total billed charges,18333.54,95% of total billed charges,N/A,not seperately reimbursable,5639.8,100% of CMS IPPS rate,16596.68,86% of total billed charges,15438.77,80% of total billed charges,2946.49,100% of CMS IPPS rate,18719.51,97% of total billed charges,17368.61,90% of total billed charges,N/A,not seperately reimbursable,18719.51,97% of total billed charges,17947.57,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18719.51,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2946.49,18719.51,9649.23
Outpatient Medical Services,RADIOLOGY,93880,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,SCMP US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,SCSN US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,CL Carotid Duplex Complete LT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,CL Carotid Duplex Complete RT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,CL Carotid Duplex Complete BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,93880-(TC)-Dup scan/extracran art/bilat/comp,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,SCMP US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,SCSN US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,93880 - (TC) Duplex scan of extracranial arteries; complete bilateral study,510,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93880,93880 - Duplex scan of extracranial arteries; complete bilateral study,510,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,131.27,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,119.34,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,119.34,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93926,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,US Duplex Limited Lower,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCMP US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,CL Femoral Groin Artery LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,CL Femoral Groin Artery RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,CL Femoral Groin Artery BILAT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,93926- Dup scan/LE art/graft/unilat/ltd,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCSN US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCSN US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCMP US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCSN US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,SCSN US Exam,920,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93926,93926 - Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCMP US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL US Vein Map Mark Lower Extrem BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL US Vein Map Mark Upper Extrem BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL US Venous Insuff Lower Extrem BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL US Venous Insuff Upper Extrem BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL Periph Venous US Lower BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL Periph Venous US Upper BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,CL Upper Periph Arterial Duplex BILAT,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL Periph Venous US Lower BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL Periph Venous US Upper BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL Upper Periph Arterial Duplex BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL US Vein Map Mark Lower Extrem BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL US Vein Map Mark Upper Extrem BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL US Venous Insuff Lower Extrem BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970-CL US Venous Insuff Upper Extrem BILAT,481,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970- Dup scan/extremity vein/bilat/comp,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,920,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCMP US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCMP US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,510,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,510,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,Read,510,1266.57,1139.91,90% of total billed charges,229.9,100% of CMS IPPS rate,1013.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1139.91,90% of total billed charges,125.62,100% of CMS fee schedule,1228.57,97% of total billed charges,229.9,100% of CMS IPPS rate,1165.24,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1139.91,90% of total billed charges,229.9,100% of CMS IPPS rate,886.6,70% of total billed charges,1139.91,90% of total billed charges,1203.24,95% of total billed charges,1203.24,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1089.25,86% of total billed charges,1013.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1228.57,97% of total billed charges,1139.91,90% of total billed charges,N/A,not seperately reimbursable,1228.57,97% of total billed charges,1177.91,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1228.57,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1228.57,633.29
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,921,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,93970 (TC) Duplex scan of extremity veins including responses to compression and other maneuvers; co,510,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93970,SCSN US Exam,402,1450.32,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1160.26,80% of total billed charges,229.9,100% of CMS IPPS rate,1305.29,90% of total billed charges,125.62,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,1334.29,92% of total billed charges,229.9,100% of CMS IPPS rate,563.65,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,898.58,100% of CMS IPPS rate,1138.19,100% of CMS IPPS rate,1305.29,90% of total billed charges,229.9,100% of CMS IPPS rate,1015.22,70% of total billed charges,1305.29,90% of total billed charges,1377.8,95% of total billed charges,1377.8,95% of total billed charges,229.9,100% of CMS IPPS rate,424.1,100% of CMS IPPS rate,1247.28,86% of total billed charges,1160.26,80% of total billed charges,240.93,100% of CMS IPPS rate,1406.81,97% of total billed charges,1305.29,90% of total billed charges,N/A,not seperately reimbursable,1406.81,97% of total billed charges,1348.8,93% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,114.2,100% of CMS fee schedule,1406.81,97% of total billed charges,229.9,100% of CMS IPPS rate,229.9,100% of CMS IPPS rate,195.41,100% of CMS IPPS rate,114.2,1406.81,725.16
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Extremity Vein Unilat Lt Lower for DVT,921,568.27,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,454.62,80% of total billed charges,101.14,100% of CMS IPPS rate,511.44,90% of total billed charges,86.46,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,522.81,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,397.79,70% of total billed charges,511.44,90% of total billed charges,539.86,95% of total billed charges,539.86,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,488.71,86% of total billed charges,454.62,80% of total billed charges,115.86,100% of CMS IPPS rate,551.22,97% of total billed charges,511.44,90% of total billed charges,N/A,not seperately reimbursable,551.22,97% of total billed charges,528.49,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,551.22,284.14
Outpatient Medical Services,RADIOLOGY,93971,US Extremity Vein Unilat Lt Upper for DVT,921,568.27,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,454.62,80% of total billed charges,101.14,100% of CMS IPPS rate,511.44,90% of total billed charges,86.46,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,522.81,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,397.79,70% of total billed charges,511.44,90% of total billed charges,539.86,95% of total billed charges,539.86,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,488.71,86% of total billed charges,454.62,80% of total billed charges,115.86,100% of CMS IPPS rate,551.22,97% of total billed charges,511.44,90% of total billed charges,N/A,not seperately reimbursable,551.22,97% of total billed charges,528.49,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,551.22,284.14
Outpatient Medical Services,RADIOLOGY,93971,US Extremity Vein Unilat Rt Lower for DVT,921,568.27,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,454.62,80% of total billed charges,101.14,100% of CMS IPPS rate,511.44,90% of total billed charges,86.46,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,522.81,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,397.79,70% of total billed charges,511.44,90% of total billed charges,539.86,95% of total billed charges,539.86,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,488.71,86% of total billed charges,454.62,80% of total billed charges,115.86,100% of CMS IPPS rate,551.22,97% of total billed charges,511.44,90% of total billed charges,N/A,not seperately reimbursable,551.22,97% of total billed charges,528.49,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,551.22,284.14
Outpatient Medical Services,RADIOLOGY,93971,US Extremity Vein Unilat Rt Upper for DVT,921,568.27,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,454.62,80% of total billed charges,101.14,100% of CMS IPPS rate,511.44,90% of total billed charges,86.46,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,522.81,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,511.44,90% of total billed charges,101.14,100% of CMS IPPS rate,397.79,70% of total billed charges,511.44,90% of total billed charges,539.86,95% of total billed charges,539.86,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,488.71,86% of total billed charges,454.62,80% of total billed charges,115.86,100% of CMS IPPS rate,551.22,97% of total billed charges,511.44,90% of total billed charges,N/A,not seperately reimbursable,551.22,97% of total billed charges,528.49,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,551.22,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,551.22,284.14
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Vein Map Mark Lower Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Vein Map Mark Lower Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Vein Map Mark Upper Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Vein Map Mark Upper Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Venous Insuff Lower Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Venous Insuff Lower Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Venous Insuff Upper Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL US Venous Insuff Upper Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Periph Venous US Lower LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Periph Venous US Lower RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Periph Venous US Upper LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Periph Venous US Upper RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Upper Periph Arterial Duplex RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,CL Upper Periph Arterial Duplex LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Periph Venous US Lower LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Periph Venous US Lower RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Periph Venous US Upper LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Periph Venous US Upper RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Upper Periph Arterial Duplex LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL Upper Periph Arterial Duplex RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Vein Map Mark Lower Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Vein Map Mark Lower Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Vein Map Mark Upper Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Vein Map Mark Upper Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Venous Insuff Lower Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Venous Insuff Lower Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Venous Insuff Upper Extrem LT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971-CL US Venous Insuff Upper Extrem RT,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971- Dup scan/extremity vein/unilat/ltd,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,402,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,SCSN US Exam,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971 (TC) Duplex scan of extremity veins including responses to compression and other maneuvers; un,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971 -Duplex scan of extremity veins including responses to compression and other maneuvers; unilat,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,93971 - PB Tech Duplex scan of extremity veins including responses to compression and other maneuver,510,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93971,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,450,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93976,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93976,US Duplex Abd Pelvic Retro Limited,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93976,US Exam,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,RADIOLOGY,93976,93976- Dup scan/abd/pelvic/scrotal/ltd,921,638.04,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,510.43,80% of total billed charges,101.14,100% of CMS IPPS rate,574.24,90% of total billed charges,86.46,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,587,92% of total billed charges,101.14,100% of CMS IPPS rate,252.88,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,403.15,100% of CMS IPPS rate,510.66,100% of CMS IPPS rate,574.24,90% of total billed charges,101.14,100% of CMS IPPS rate,446.63,70% of total billed charges,574.24,90% of total billed charges,606.14,95% of total billed charges,606.14,95% of total billed charges,101.14,100% of CMS IPPS rate,190.28,100% of CMS IPPS rate,548.71,86% of total billed charges,510.43,80% of total billed charges,115.86,100% of CMS IPPS rate,618.9,97% of total billed charges,574.24,90% of total billed charges,N/A,not seperately reimbursable,618.9,97% of total billed charges,593.38,93% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,78.6,100% of CMS fee schedule,618.9,97% of total billed charges,101.14,100% of CMS IPPS rate,101.14,100% of CMS IPPS rate,85.96,100% of CMS IPPS rate,78.6,618.9,319.02
Outpatient Medical Services,AMBULATORY SURGERY,94640,IPPB w/ Nebulized Medication,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,Nebulizer,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,Inhaler Treatment,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,94640- Inhalation tx/AAO/therapeutic/diag,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,RT CHARGE Aerosol Therapy -> Subsequent,940,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,RT CHARGE Aerosol Therapy -> Initial,940,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94640,AMB Admin INH Charge -> INH Treatment 94640,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,CARDIAC,94660,BIPAP,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,CARDIAC,94660,"94660- CPAP vent, initiat/manage",410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,CARDIAC,94660,CPAP VENTILATION CPAP INITIATION&MGMT,450,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,N/A,not seperately reimbursable,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,164.42,1183.73,610.17
Outpatient Medical Services,CARDIAC,94664,Flutter Valve,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,13,100% of CMS fee schedule,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,11.82,100% of CMS fee schedule,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,11.82,1183.73,610.17
Outpatient Medical Services,CARDIAC,94664,Inhalation Initial Demo/Evaluation,410,1220.34,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,976.27,80% of total billed charges,193.44,100% of CMS IPPS rate,1098.31,90% of total billed charges,13,100% of CMS fee schedule,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,1122.71,92% of total billed charges,193.44,100% of CMS IPPS rate,490.62,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,782.15,100% of CMS IPPS rate,990.72,100% of CMS IPPS rate,1098.31,90% of total billed charges,193.44,100% of CMS IPPS rate,854.24,70% of total billed charges,1098.31,90% of total billed charges,1159.32,95% of total billed charges,1159.32,95% of total billed charges,193.44,100% of CMS IPPS rate,369.15,100% of CMS IPPS rate,1049.49,86% of total billed charges,976.27,80% of total billed charges,190.19,100% of CMS IPPS rate,1183.73,97% of total billed charges,1098.31,90% of total billed charges,N/A,not seperately reimbursable,1183.73,97% of total billed charges,1134.92,93% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,11.82,100% of CMS fee schedule,1183.73,97% of total billed charges,193.44,100% of CMS IPPS rate,193.44,100% of CMS IPPS rate,164.42,100% of CMS IPPS rate,11.82,1183.73,610.17
Outpatient Medical Services,AMBULATORY SURGERY,94760,Ear Oximeter,460,243.72,219.35,90% of total billed charges,N/A,not seperately reimbursable,194.98,80% of total billed charges,N/A,not seperately reimbursable,219.35,90% of total billed charges,2.18,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,224.22,92% of total billed charges,N/A,not seperately reimbursable,155.64,63.86% of total billed charges,N/A,not seperately reimbursable,191.69, 78.65% of total billed charges,217.72,89.33% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,170.6,70% of total billed charges,219.35,90% of total billed charges,231.53,95% of total billed charges,231.53,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,209.6,86% of total billed charges,194.98,80% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,226.66,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,236.41,121.86
Outpatient Medical Services,AMBULATORY SURGERY,94760,Pulse Oximetry Determination,460,243.72,219.35,90% of total billed charges,N/A,not seperately reimbursable,194.98,80% of total billed charges,N/A,not seperately reimbursable,219.35,90% of total billed charges,2.18,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,224.22,92% of total billed charges,N/A,not seperately reimbursable,155.64,63.86% of total billed charges,N/A,not seperately reimbursable,191.69, 78.65% of total billed charges,217.72,89.33% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,170.6,70% of total billed charges,219.35,90% of total billed charges,231.53,95% of total billed charges,231.53,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,209.6,86% of total billed charges,194.98,80% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,226.66,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,236.41,121.86
Outpatient Medical Services,AMBULATORY SURGERY,94760,94760- Noninv ear/pulse ox/single determ,460,243.72,219.35,90% of total billed charges,N/A,not seperately reimbursable,194.98,80% of total billed charges,N/A,not seperately reimbursable,219.35,90% of total billed charges,2.18,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,224.22,92% of total billed charges,N/A,not seperately reimbursable,155.64,63.86% of total billed charges,N/A,not seperately reimbursable,191.69, 78.65% of total billed charges,217.72,89.33% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,170.6,70% of total billed charges,219.35,90% of total billed charges,231.53,95% of total billed charges,231.53,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,209.6,86% of total billed charges,194.98,80% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,219.35,90% of total billed charges,N/A,not seperately reimbursable,236.41,97% of total billed charges,226.66,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,100% of CMS fee schedule,236.41,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.98,236.41,121.86
Outpatient Medical Services,SLEEP STUDIES,95810,Sleep Study - In Lab PSG 95810,740,6104.34,5493.91,90% of total billed charges,967.63,100% of CMS IPPS rate,4883.47,80% of total billed charges,967.63,100% of CMS IPPS rate,5493.91,90% of total billed charges,297.35,100% of CMS fee schedule,5921.21,97% of total billed charges,967.63,100% of CMS IPPS rate,5615.99,92% of total billed charges,967.63,100% of CMS IPPS rate,2405.03,100% of CMS IPPS rate,967.63,100% of CMS IPPS rate,3834.13,100% of CMS IPPS rate,4856.5,100% of CMS IPPS rate,5493.91,90% of total billed charges,967.63,100% of CMS IPPS rate,4273.04,70% of total billed charges,5493.91,90% of total billed charges,5799.12,95% of total billed charges,5799.12,95% of total billed charges,967.63,100% of CMS IPPS rate,1809.58,100% of CMS IPPS rate,5249.73,86% of total billed charges,4883.47,80% of total billed charges,939.73,100% of CMS IPPS rate,5921.21,97% of total billed charges,5493.91,90% of total billed charges,N/A,not seperately reimbursable,5921.21,97% of total billed charges,5677.04,93% of total billed charges,967.63,100% of CMS IPPS rate,967.63,100% of CMS IPPS rate,270.32,100% of CMS fee schedule,5921.21,97% of total billed charges,967.63,100% of CMS IPPS rate,967.63,100% of CMS IPPS rate,822.49,100% of CMS IPPS rate,270.32,5921.21,3052.17
Outpatient Medical Services,EMERGENCY ROOM,96360,ED Hydration Initial,450,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96360,FBC Hydration Initial,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96360,CT RAD Hydration Initial,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96360,Infusion for Hydration Initial 31 to 60 Minutes 96360,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96360,96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96360,CT RAD Hydration Initial Hour,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.79,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.63,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.63,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96361,ED Hydration Add'l Hours,450,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,9.9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,9,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96361,FBC Hydration Add'l Hours,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,9.9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,9,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96361,CT RAD Hydration Add?l Hours,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,9.9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,9,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96361,Infusion for Hydration Each Additional Hour 96361,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,9.9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,9,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96361,96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,9.9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,9,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,9,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96365,ED Drug Infusion Initial,450,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,43.23,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,39.3,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,39.3,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96365,FBC Drug Infusion Initial,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,43.23,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,39.3,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,39.3,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96365,"Inf for Therapy, Prophylaxis, Dx Initial up to 1 Hour 96365",940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,43.23,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,39.3,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,39.3,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96365,"96365- IV tx, first hour",483,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,43.23,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,39.3,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,39.3,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96365,96365 - IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST >1 HOUR,940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,43.23,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,39.3,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,39.3,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96366,ED Drug Infusion Add'l Hours,450,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,13.52,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,12.29,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,12.29,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96366,FBC Drug Infusion Add'l Hours,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,13.52,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,12.29,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,12.29,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96366,"Inf for Therapy, Prophylaxis or Dx Each Addl Hour 96366",940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,13.52,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,12.29,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,12.29,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96366,96366 - IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,13.52,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,12.29,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,12.29,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96367,ED Sequential Drug Infusion,450,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,21.16,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.32,100% of CMS IPPS rate,327.2,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,19.24,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,19.24,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96367,FBC Sequential Drug Infusion,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,21.16,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.32,100% of CMS IPPS rate,327.2,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,19.24,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,19.24,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96367,Inf for Tx Prophylaxis Dx Addl Seq Infusion New Drug 96367,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,21.16,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.32,100% of CMS IPPS rate,327.2,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,19.24,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,19.24,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96367,96367 - IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,21.16,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.32,100% of CMS IPPS rate,327.2,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,19.24,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,19.24,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96368,ED Concurrent Non-Chemo Infusion,450,623.18,560.86,90% of total billed charges,N/A,not seperately reimbursable,498.54,80% of total billed charges,N/A,not seperately reimbursable,560.86,90% of total billed charges,12.57,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,573.33,92% of total billed charges,N/A,not seperately reimbursable,397.98,63.86% of total billed charges,N/A,not seperately reimbursable,490.14, 78.65% of total billed charges,556.7,89.33% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,436.23,70% of total billed charges,560.86,90% of total billed charges,592.02,95% of total billed charges,592.02,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,535.93,86% of total billed charges,498.54,80% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,579.56,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,604.48,311.59
Outpatient Medical Services,EMERGENCY ROOM,96368,"Inf for Therapy, Prophylaxis, Dx Initial up to 1 Hour 96368",940,623.18,560.86,90% of total billed charges,N/A,not seperately reimbursable,498.54,80% of total billed charges,N/A,not seperately reimbursable,560.86,90% of total billed charges,12.57,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,573.33,92% of total billed charges,N/A,not seperately reimbursable,397.98,63.86% of total billed charges,N/A,not seperately reimbursable,490.14, 78.65% of total billed charges,556.7,89.33% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,436.23,70% of total billed charges,560.86,90% of total billed charges,592.02,95% of total billed charges,592.02,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,535.93,86% of total billed charges,498.54,80% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,579.56,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,604.48,311.59
Outpatient Medical Services,EMERGENCY ROOM,96368,96368 - IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,940,623.18,560.86,90% of total billed charges,N/A,not seperately reimbursable,498.54,80% of total billed charges,N/A,not seperately reimbursable,560.86,90% of total billed charges,12.57,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,573.33,92% of total billed charges,N/A,not seperately reimbursable,397.98,63.86% of total billed charges,N/A,not seperately reimbursable,490.14, 78.65% of total billed charges,556.7,89.33% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,436.23,70% of total billed charges,560.86,90% of total billed charges,592.02,95% of total billed charges,592.02,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,535.93,86% of total billed charges,498.54,80% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,560.86,90% of total billed charges,N/A,not seperately reimbursable,604.48,97% of total billed charges,579.56,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,100% of CMS fee schedule,604.48,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.43,604.48,311.59
Outpatient Medical Services,EMERGENCY ROOM,96372,ED IM/SQ,450,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,FBC IM/SQ,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,INF/NC SQ/IM Injection,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,INF/C Subcut or IM Non-Hormonal,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,"Therapy, Prophylactic, Diagnostic Injection SQ or IM 96372",940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,96372- Subq/IM Injection,761,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,940,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,AMB Admin Injection Charge -> IM/SQ Admin Charge 96372,260,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,96372 - IM/SQ injectin,510,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96372,ED IM SQ,450,427.02,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,341.62,80% of total billed charges,67.68,100% of CMS IPPS rate,384.32,90% of total billed charges,13.97,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,392.86,92% of total billed charges,67.68,100% of CMS IPPS rate,162.04,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,258.33,100% of CMS IPPS rate,327.21,100% of CMS IPPS rate,384.32,90% of total billed charges,67.68,100% of CMS IPPS rate,298.91,70% of total billed charges,384.32,90% of total billed charges,405.67,95% of total billed charges,405.67,95% of total billed charges,67.68,100% of CMS IPPS rate,121.92,100% of CMS IPPS rate,367.24,86% of total billed charges,341.62,80% of total billed charges,62.51,100% of CMS IPPS rate,414.21,97% of total billed charges,384.32,90% of total billed charges,N/A,not seperately reimbursable,414.21,97% of total billed charges,397.13,93% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,12.7,100% of CMS fee schedule,414.21,97% of total billed charges,67.68,100% of CMS IPPS rate,67.68,100% of CMS IPPS rate,57.53,100% of CMS IPPS rate,12.7,414.21,213.51
Outpatient Medical Services,EMERGENCY ROOM,96374,INFS IVP Initial,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,ED IVP Initial,450,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,FBC IVP Initial,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,Tx Prophylactic or Diag IVP Single or Initial Drug 96374,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,"96374- IV Injection, single/initial",940,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,96374 - Ther/proph/diag inj iv push,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,96374 - THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,AMB Admin Injection Charge -> IV Push Admin Charge 96374,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,450,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96374,Ther Proph/Dx Inj IVPush Sngl/1st Sbst/Drug,260,1264.14,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,1011.31,80% of total billed charges,200.38,100% of CMS IPPS rate,1137.73,90% of total billed charges,34.12,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,1163.01,92% of total billed charges,200.38,100% of CMS IPPS rate,493.04,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,786,100% of CMS IPPS rate,995.59,100% of CMS IPPS rate,1137.73,90% of total billed charges,200.38,100% of CMS IPPS rate,884.9,70% of total billed charges,1137.73,90% of total billed charges,1200.93,95% of total billed charges,1200.93,95% of total billed charges,200.38,100% of CMS IPPS rate,370.97,100% of CMS IPPS rate,1087.16,86% of total billed charges,1011.31,80% of total billed charges,189.96,100% of CMS IPPS rate,1226.22,97% of total billed charges,1137.73,90% of total billed charges,N/A,not seperately reimbursable,1226.22,97% of total billed charges,1175.65,93% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,31.02,100% of CMS fee schedule,1226.22,97% of total billed charges,200.38,100% of CMS IPPS rate,200.38,100% of CMS IPPS rate,170.32,100% of CMS IPPS rate,31.02,1226.22,632.07
Outpatient Medical Services,EMERGENCY ROOM,96375,INFS IVP New,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,14.31,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,13.01,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,13.01,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96375,ED IVP New,450,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,14.31,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,13.01,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,13.01,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96375,FBC IVP New,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,14.31,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,13.01,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,13.01,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96375,"Therapy, Prophylactic, Diag Each Addl Seq IVP New Drug 96375",940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,14.31,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,13.01,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,13.01,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96375,96375 - THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG,940,276.84,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,221.47,80% of total billed charges,43.88,100% of CMS IPPS rate,249.16,90% of total billed charges,14.31,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,254.69,92% of total billed charges,43.88,100% of CMS IPPS rate,109.26,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,174.19,100% of CMS IPPS rate,220.64,100% of CMS IPPS rate,249.16,90% of total billed charges,43.88,100% of CMS IPPS rate,193.79,70% of total billed charges,249.16,90% of total billed charges,263,95% of total billed charges,263,95% of total billed charges,43.88,100% of CMS IPPS rate,82.21,100% of CMS IPPS rate,238.08,86% of total billed charges,221.47,80% of total billed charges,39.39,100% of CMS IPPS rate,268.53,97% of total billed charges,249.16,90% of total billed charges,N/A,not seperately reimbursable,268.53,97% of total billed charges,257.46,93% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,13.01,100% of CMS fee schedule,268.53,97% of total billed charges,43.88,100% of CMS IPPS rate,43.88,100% of CMS IPPS rate,37.29,100% of CMS IPPS rate,13.01,268.53,138.42
Outpatient Medical Services,EMERGENCY ROOM,96376,ED IVP Same,450,194.35,174.92,90% of total billed charges,N/A,not seperately reimbursable,155.48,80% of total billed charges,N/A,not seperately reimbursable,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,178.8,92% of total billed charges,N/A,not seperately reimbursable,124.12,63.86% of total billed charges,N/A,not seperately reimbursable,152.86, 78.65% of total billed charges,173.62,89.33% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,136.05,70% of total billed charges,174.92,90% of total billed charges,184.63,95% of total billed charges,184.63,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,167.14,86% of total billed charges,155.48,80% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,180.75,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,124.12,188.52,97.18
Outpatient Medical Services,EMERGENCY ROOM,96376,FBC IVP Same,940,168.13,151.32,90% of total billed charges,N/A,not seperately reimbursable,134.5,80% of total billed charges,N/A,not seperately reimbursable,151.32,90% of total billed charges,N/A,not seperately reimbursable,163.09,97% of total billed charges,N/A,not seperately reimbursable,154.68,92% of total billed charges,N/A,not seperately reimbursable,107.37,63.86% of total billed charges,N/A,not seperately reimbursable,132.24, 78.65% of total billed charges,150.19,89.33% of total billed charges,151.32,90% of total billed charges,N/A,not seperately reimbursable,117.69,70% of total billed charges,151.32,90% of total billed charges,159.72,95% of total billed charges,159.72,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,144.59,86% of total billed charges,134.5,80% of total billed charges,N/A,not seperately reimbursable,163.09,97% of total billed charges,151.32,90% of total billed charges,N/A,not seperately reimbursable,163.09,97% of total billed charges,156.36,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,163.09,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,107.37,163.09,84.07
Outpatient Medical Services,EMERGENCY ROOM,96376,Tx Prophylactic Diagnostic Each Addl Seq IVP Same Drug 96376,940,194.35,174.92,90% of total billed charges,N/A,not seperately reimbursable,155.48,80% of total billed charges,N/A,not seperately reimbursable,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,178.8,92% of total billed charges,N/A,not seperately reimbursable,124.12,63.86% of total billed charges,N/A,not seperately reimbursable,152.86, 78.65% of total billed charges,173.62,89.33% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,136.05,70% of total billed charges,174.92,90% of total billed charges,184.63,95% of total billed charges,184.63,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,167.14,86% of total billed charges,155.48,80% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,180.75,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,124.12,188.52,97.18
Outpatient Medical Services,EMERGENCY ROOM,96376,96376 - EACH ADDITIONAL SEQUENTIAL IV PUSH,940,194.35,174.92,90% of total billed charges,N/A,not seperately reimbursable,155.48,80% of total billed charges,N/A,not seperately reimbursable,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,178.8,92% of total billed charges,N/A,not seperately reimbursable,124.12,63.86% of total billed charges,N/A,not seperately reimbursable,152.86, 78.65% of total billed charges,173.62,89.33% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,136.05,70% of total billed charges,174.92,90% of total billed charges,184.63,95% of total billed charges,184.63,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,167.14,86% of total billed charges,155.48,80% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,174.92,90% of total billed charges,N/A,not seperately reimbursable,188.52,97% of total billed charges,180.75,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,188.52,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,124.12,188.52,97.18
Outpatient Medical Services,THERAPY,97110,PT Kinetic Leg Exerciser/CPM Application,420,317.86,286.07,90% of total billed charges,N/A,not seperately reimbursable,254.29,80% of total billed charges,N/A,not seperately reimbursable,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,292.43,92% of total billed charges,N/A,not seperately reimbursable,111.23, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,135.52,494.23% of CMS fee schedule,125.73, 458.54% of CMS fee schedule,286.07,90% of total billed charges,N/A,not seperately reimbursable,222.5,70% of total billed charges,286.07,90% of total billed charges,301.97,95% of total billed charges,301.97,95% of total billed charges,N/A,not seperately reimbursable,54.84,200% of CMS fee schedule,273.36,86% of total billed charges,254.29,80% of total billed charges,32.76,111% of CMS fee schedule,308.32,97% of total billed charges,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,295.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.76,308.32,158.93
Outpatient Medical Services,THERAPY,97110,Therapeutic Procedure,420,317.86,286.07,90% of total billed charges,N/A,not seperately reimbursable,254.29,80% of total billed charges,N/A,not seperately reimbursable,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,292.43,92% of total billed charges,N/A,not seperately reimbursable,111.23, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,135.52,494.23% of CMS fee schedule,125.73, 458.54% of CMS fee schedule,286.07,90% of total billed charges,N/A,not seperately reimbursable,222.5,70% of total billed charges,286.07,90% of total billed charges,301.97,95% of total billed charges,301.97,95% of total billed charges,N/A,not seperately reimbursable,54.84,200% of CMS fee schedule,273.36,86% of total billed charges,254.29,80% of total billed charges,32.76,111% of CMS fee schedule,308.32,97% of total billed charges,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,295.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.76,308.32,158.93
Outpatient Medical Services,THERAPY,97110,Chest PDP,460,317.86,286.07,90% of total billed charges,N/A,not seperately reimbursable,254.29,80% of total billed charges,N/A,not seperately reimbursable,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,292.43,92% of total billed charges,N/A,not seperately reimbursable,111.23, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,135.52,494.23% of CMS fee schedule,125.73, 458.54% of CMS fee schedule,286.07,90% of total billed charges,N/A,not seperately reimbursable,222.5,70% of total billed charges,286.07,90% of total billed charges,301.97,95% of total billed charges,301.97,95% of total billed charges,N/A,not seperately reimbursable,54.84,200% of CMS fee schedule,273.36,86% of total billed charges,254.29,80% of total billed charges,32.76,111% of CMS fee schedule,308.32,97% of total billed charges,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,295.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.76,308.32,158.93
Outpatient Medical Services,THERAPY,97110,OT Therapeutic Procedure 15 min,430,317.86,286.07,90% of total billed charges,N/A,not seperately reimbursable,254.29,80% of total billed charges,N/A,not seperately reimbursable,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,292.43,92% of total billed charges,N/A,not seperately reimbursable,111.23, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,135.52,494.23% of CMS fee schedule,125.73, 458.54% of CMS fee schedule,286.07,90% of total billed charges,N/A,not seperately reimbursable,222.5,70% of total billed charges,286.07,90% of total billed charges,301.97,95% of total billed charges,301.97,95% of total billed charges,N/A,not seperately reimbursable,54.84,200% of CMS fee schedule,273.36,86% of total billed charges,254.29,80% of total billed charges,32.76,111% of CMS fee schedule,308.32,97% of total billed charges,286.07,90% of total billed charges,N/A,not seperately reimbursable,308.32,97% of total billed charges,295.61,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,308.32,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.76,308.32,158.93
Outpatient Medical Services,THERAPY,97116,PT Gait Training,420,95.64,86.08,90% of total billed charges,N/A,not seperately reimbursable,76.51,80% of total billed charges,N/A,not seperately reimbursable,86.08,90% of total billed charges,N/A,not seperately reimbursable,92.77,97% of total billed charges,N/A,not seperately reimbursable,87.99,92% of total billed charges,N/A,not seperately reimbursable,111.23, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,135.52,494.23% of CMS fee schedule,125.73, 458.54% of CMS fee schedule,86.08,90% of total billed charges,N/A,not seperately reimbursable,66.95,70% of total billed charges,86.08,90% of total billed charges,90.86,95% of total billed charges,90.86,95% of total billed charges,N/A,not seperately reimbursable,54.84,200% of CMS fee schedule,82.25,86% of total billed charges,76.51,80% of total billed charges,32.41,111% of CMS fee schedule,92.77,97% of total billed charges,86.08,90% of total billed charges,N/A,not seperately reimbursable,92.77,97% of total billed charges,88.95,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,92.77,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.41,135.52,47.82
Outpatient Medical Services,THERAPY,97161,PT Evaluation Initial Low Complexity,424,323.97,291.57,90% of total billed charges,N/A,not seperately reimbursable,259.18,80% of total billed charges,N/A,not seperately reimbursable,291.57,90% of total billed charges,N/A,not seperately reimbursable,314.25,97% of total billed charges,N/A,not seperately reimbursable,298.05,92% of total billed charges,N/A,not seperately reimbursable,380.84, 405.66% of CMS fee schedule,N/A,not seperately reimbursable,463.98,494.23% of CMS fee schedule,430.48, 458.54% of CMS fee schedule,291.57,90% of total billed charges,N/A,not seperately reimbursable,226.78,70% of total billed charges,291.57,90% of total billed charges,307.77,95% of total billed charges,307.77,95% of total billed charges,N/A,not seperately reimbursable,187.76,200% of CMS fee schedule,278.61,86% of total billed charges,259.18,80% of total billed charges,91.08,111% of CMS fee schedule,314.25,97% of total billed charges,291.57,90% of total billed charges,N/A,not seperately reimbursable,314.25,97% of total billed charges,301.29,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,314.25,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,91.08,463.98,161.99
Outpatient Medical Services,AMBULATORY SURGERY,99152,"Moderate Sedation, Initial 15 Minute",450,1167.68,1050.91,90% of total billed charges,N/A,not seperately reimbursable,934.14,80% of total billed charges,N/A,not seperately reimbursable,1050.91,90% of total billed charges,10.89,100% of CMS fee schedule,1132.65,97% of total billed charges,N/A,not seperately reimbursable,1074.27,92% of total billed charges,N/A,not seperately reimbursable,745.71,63.86% of total billed charges,N/A,not seperately reimbursable,918.41, 78.65% of total billed charges,1043.11,89.33% of total billed charges,1050.91,90% of total billed charges,N/A,not seperately reimbursable,817.38,70% of total billed charges,1050.91,90% of total billed charges,1109.3,95% of total billed charges,1109.3,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1004.2,86% of total billed charges,934.14,80% of total billed charges,N/A,not seperately reimbursable,1132.65,97% of total billed charges,1050.91,90% of total billed charges,N/A,not seperately reimbursable,1132.65,97% of total billed charges,1085.94,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,100% of CMS fee schedule,1132.65,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,1132.65,583.84
Outpatient Medical Services,AMBULATORY SURGERY,99152,99152-Moderate Sedation Initial,370,1167.68,1050.91,90% of total billed charges,N/A,not seperately reimbursable,934.14,80% of total billed charges,N/A,not seperately reimbursable,1050.91,90% of total billed charges,10.89,100% of CMS fee schedule,1132.65,97% of total billed charges,N/A,not seperately reimbursable,1074.27,92% of total billed charges,N/A,not seperately reimbursable,745.71,63.86% of total billed charges,N/A,not seperately reimbursable,918.41, 78.65% of total billed charges,1043.11,89.33% of total billed charges,1050.91,90% of total billed charges,N/A,not seperately reimbursable,817.38,70% of total billed charges,1050.91,90% of total billed charges,1109.3,95% of total billed charges,1109.3,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1004.2,86% of total billed charges,934.14,80% of total billed charges,N/A,not seperately reimbursable,1132.65,97% of total billed charges,1050.91,90% of total billed charges,N/A,not seperately reimbursable,1132.65,97% of total billed charges,1085.94,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,100% of CMS fee schedule,1132.65,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,1132.65,583.84
Outpatient Medical Services,AMBULATORY SURGERY,99152,99152 - MOD SED SAME PHYS/QHP 5/>YRS,370,182.69,164.42,90% of total billed charges,N/A,not seperately reimbursable,146.15,80% of total billed charges,N/A,not seperately reimbursable,164.42,90% of total billed charges,10.89,100% of CMS fee schedule,177.21,97% of total billed charges,N/A,not seperately reimbursable,168.07,92% of total billed charges,N/A,not seperately reimbursable,116.67,63.86% of total billed charges,N/A,not seperately reimbursable,143.69, 78.65% of total billed charges,163.2,89.33% of total billed charges,164.42,90% of total billed charges,N/A,not seperately reimbursable,127.88,70% of total billed charges,164.42,90% of total billed charges,173.56,95% of total billed charges,173.56,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,157.11,86% of total billed charges,146.15,80% of total billed charges,N/A,not seperately reimbursable,177.21,97% of total billed charges,164.42,90% of total billed charges,N/A,not seperately reimbursable,177.21,97% of total billed charges,169.9,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,100% of CMS fee schedule,177.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,177.21,91.35
Outpatient Medical Services,AMBULATORY SURGERY,99153,"Moderate Sedation, Each Add 15 Min",450,584.63,526.17,90% of total billed charges,N/A,not seperately reimbursable,467.7,80% of total billed charges,N/A,not seperately reimbursable,526.17,90% of total billed charges,9.16,100% of CMS fee schedule,567.09,97% of total billed charges,N/A,not seperately reimbursable,537.86,92% of total billed charges,N/A,not seperately reimbursable,373.36,63.86% of total billed charges,N/A,not seperately reimbursable,459.82, 78.65% of total billed charges,522.26,89.33% of total billed charges,526.17,90% of total billed charges,N/A,not seperately reimbursable,409.24,70% of total billed charges,526.17,90% of total billed charges,555.4,95% of total billed charges,555.4,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.78,86% of total billed charges,467.7,80% of total billed charges,N/A,not seperately reimbursable,567.09,97% of total billed charges,526.17,90% of total billed charges,N/A,not seperately reimbursable,567.09,97% of total billed charges,543.71,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,100% of CMS fee schedule,567.09,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,567.09,292.32
Outpatient Medical Services,AMBULATORY SURGERY,99153,99153-Moderate Sedation additional 15 min,370,584.63,526.17,90% of total billed charges,N/A,not seperately reimbursable,467.7,80% of total billed charges,N/A,not seperately reimbursable,526.17,90% of total billed charges,9.16,100% of CMS fee schedule,567.09,97% of total billed charges,N/A,not seperately reimbursable,537.86,92% of total billed charges,N/A,not seperately reimbursable,373.36,63.86% of total billed charges,N/A,not seperately reimbursable,459.82, 78.65% of total billed charges,522.26,89.33% of total billed charges,526.17,90% of total billed charges,N/A,not seperately reimbursable,409.24,70% of total billed charges,526.17,90% of total billed charges,555.4,95% of total billed charges,555.4,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.78,86% of total billed charges,467.7,80% of total billed charges,N/A,not seperately reimbursable,567.09,97% of total billed charges,526.17,90% of total billed charges,N/A,not seperately reimbursable,567.09,97% of total billed charges,543.71,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,100% of CMS fee schedule,567.09,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,567.09,292.32
Outpatient Medical Services,AMBULATORY SURGERY,99153,99153 - MOD SED SAME PHYS/QHP EA,370,60.1,54.09,90% of total billed charges,N/A,not seperately reimbursable,48.08,80% of total billed charges,N/A,not seperately reimbursable,54.09,90% of total billed charges,9.16,100% of CMS fee schedule,58.3,97% of total billed charges,N/A,not seperately reimbursable,55.29,92% of total billed charges,N/A,not seperately reimbursable,38.38,63.86% of total billed charges,N/A,not seperately reimbursable,47.27, 78.65% of total billed charges,53.69,89.33% of total billed charges,54.09,90% of total billed charges,N/A,not seperately reimbursable,42.07,70% of total billed charges,54.09,90% of total billed charges,57.1,95% of total billed charges,57.1,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.69,86% of total billed charges,48.08,80% of total billed charges,N/A,not seperately reimbursable,58.3,97% of total billed charges,54.09,90% of total billed charges,N/A,not seperately reimbursable,58.3,97% of total billed charges,55.89,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,100% of CMS fee schedule,58.3,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,58.3,30.05
Outpatient Medical Services,VISIT,99203,99203- Office/OP New SF 30 Minutes,510,276.41,248.77,90% of total billed charges,N/A,not seperately reimbursable,221.13,80% of total billed charges,N/A,not seperately reimbursable,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,254.3,92% of total billed charges,N/A,not seperately reimbursable,176.52,63.86% of total billed charges,N/A,not seperately reimbursable,217.4, 78.65% of total billed charges,246.92,89.33% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,193.49,70% of total billed charges,248.77,90% of total billed charges,262.59,95% of total billed charges,262.59,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,237.71,86% of total billed charges,221.13,80% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,257.06,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,176.52,268.12,138.21
Outpatient Medical Services,VISIT,99204,99204- Office/OP New SF 45 Minutes,510,276.41,248.77,90% of total billed charges,N/A,not seperately reimbursable,221.13,80% of total billed charges,N/A,not seperately reimbursable,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,254.3,92% of total billed charges,N/A,not seperately reimbursable,176.52,63.86% of total billed charges,N/A,not seperately reimbursable,217.4, 78.65% of total billed charges,246.92,89.33% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,193.49,70% of total billed charges,248.77,90% of total billed charges,262.59,95% of total billed charges,262.59,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,237.71,86% of total billed charges,221.13,80% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,257.06,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,176.52,268.12,138.21
Outpatient Medical Services,VISIT,99205,99205-Office/OP New SF 60 Minutes,510,276.41,248.77,90% of total billed charges,N/A,not seperately reimbursable,221.13,80% of total billed charges,N/A,not seperately reimbursable,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,254.3,92% of total billed charges,N/A,not seperately reimbursable,176.52,63.86% of total billed charges,N/A,not seperately reimbursable,217.4, 78.65% of total billed charges,246.92,89.33% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,193.49,70% of total billed charges,248.77,90% of total billed charges,262.59,95% of total billed charges,262.59,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,237.71,86% of total billed charges,221.13,80% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,248.77,90% of total billed charges,N/A,not seperately reimbursable,268.12,97% of total billed charges,257.06,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.12,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,176.52,268.12,138.21
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency Room Brief,450,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,422.64,80% of total billed charges,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,17.81,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,204.22,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,325.56,100% of CMS IPPS rate,412.38,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,153.66,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,71.97,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.19,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.19,512.45,264.15
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency Room Brief W/Mod,450,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,422.64,80% of total billed charges,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,17.81,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,204.22,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,325.56,100% of CMS IPPS rate,412.38,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,153.66,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,71.97,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.19,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.19,512.45,264.15
Outpatient Medical Services,EMERGENCY ROOM,99281,OB Triage Level Assignment -> Level 1 (OB Triage),510,528.3,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,422.64,80% of total billed charges,83.74,100% of CMS IPPS rate,475.47,90% of total billed charges,17.81,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,486.04,92% of total billed charges,83.74,100% of CMS IPPS rate,204.22,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,325.56,100% of CMS IPPS rate,412.38,100% of CMS IPPS rate,475.47,90% of total billed charges,83.74,100% of CMS IPPS rate,369.81,70% of total billed charges,475.47,90% of total billed charges,501.89,95% of total billed charges,501.89,95% of total billed charges,83.74,100% of CMS IPPS rate,153.66,100% of CMS IPPS rate,454.34,86% of total billed charges,422.64,80% of total billed charges,71.97,100% of CMS IPPS rate,512.45,97% of total billed charges,475.47,90% of total billed charges,N/A,not seperately reimbursable,512.45,97% of total billed charges,491.32,93% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,16.19,100% of CMS fee schedule,512.45,97% of total billed charges,83.74,100% of CMS IPPS rate,83.74,100% of CMS IPPS rate,71.18,100% of CMS IPPS rate,16.19,512.45,264.15
Outpatient Medical Services,EMERGENCY ROOM,99282,Emer Room Routine,450,950.16,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,760.13,80% of total billed charges,150.61,100% of CMS IPPS rate,855.14,90% of total billed charges,29.54,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,874.15,92% of total billed charges,150.61,100% of CMS IPPS rate,376.21,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,599.76,100% of CMS IPPS rate,759.68,100% of CMS IPPS rate,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,665.11,70% of total billed charges,855.14,90% of total billed charges,902.65,95% of total billed charges,902.65,95% of total billed charges,150.61,100% of CMS IPPS rate,283.06,100% of CMS IPPS rate,817.14,86% of total billed charges,760.13,80% of total billed charges,132.29,100% of CMS IPPS rate,921.66,97% of total billed charges,855.14,90% of total billed charges,N/A,not seperately reimbursable,921.66,97% of total billed charges,883.65,93% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,26.85,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,128.01,100% of CMS IPPS rate,26.85,921.66,475.08
Outpatient Medical Services,EMERGENCY ROOM,99282,Emer Room Routine W/Mod,450,950.16,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,760.13,80% of total billed charges,150.61,100% of CMS IPPS rate,855.14,90% of total billed charges,29.54,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,874.15,92% of total billed charges,150.61,100% of CMS IPPS rate,376.21,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,599.76,100% of CMS IPPS rate,759.68,100% of CMS IPPS rate,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,665.11,70% of total billed charges,855.14,90% of total billed charges,902.65,95% of total billed charges,902.65,95% of total billed charges,150.61,100% of CMS IPPS rate,283.06,100% of CMS IPPS rate,817.14,86% of total billed charges,760.13,80% of total billed charges,132.29,100% of CMS IPPS rate,921.66,97% of total billed charges,855.14,90% of total billed charges,N/A,not seperately reimbursable,921.66,97% of total billed charges,883.65,93% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,26.85,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,128.01,100% of CMS IPPS rate,26.85,921.66,475.08
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,450,950.16,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,760.13,80% of total billed charges,150.61,100% of CMS IPPS rate,855.14,90% of total billed charges,29.54,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,874.15,92% of total billed charges,150.61,100% of CMS IPPS rate,376.21,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,599.76,100% of CMS IPPS rate,759.68,100% of CMS IPPS rate,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,665.11,70% of total billed charges,855.14,90% of total billed charges,902.65,95% of total billed charges,902.65,95% of total billed charges,150.61,100% of CMS IPPS rate,283.06,100% of CMS IPPS rate,817.14,86% of total billed charges,760.13,80% of total billed charges,132.29,100% of CMS IPPS rate,921.66,97% of total billed charges,855.14,90% of total billed charges,N/A,not seperately reimbursable,921.66,97% of total billed charges,883.65,93% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,26.85,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,128.01,100% of CMS IPPS rate,26.85,921.66,475.08
Outpatient Medical Services,EMERGENCY ROOM,99282,OB Triage Level Assignment -> Level 2 (OB Triage),510,950.16,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,760.13,80% of total billed charges,150.61,100% of CMS IPPS rate,855.14,90% of total billed charges,29.54,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,874.15,92% of total billed charges,150.61,100% of CMS IPPS rate,376.21,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,599.76,100% of CMS IPPS rate,759.68,100% of CMS IPPS rate,855.14,90% of total billed charges,150.61,100% of CMS IPPS rate,665.11,70% of total billed charges,855.14,90% of total billed charges,902.65,95% of total billed charges,902.65,95% of total billed charges,150.61,100% of CMS IPPS rate,283.06,100% of CMS IPPS rate,817.14,86% of total billed charges,760.13,80% of total billed charges,132.29,100% of CMS IPPS rate,921.66,97% of total billed charges,855.14,90% of total billed charges,N/A,not seperately reimbursable,921.66,97% of total billed charges,883.65,93% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,26.85,100% of CMS fee schedule,921.66,97% of total billed charges,150.61,100% of CMS IPPS rate,150.61,100% of CMS IPPS rate,128.01,100% of CMS IPPS rate,26.85,921.66,475.08
Outpatient Medical Services,EMERGENCY ROOM,99283,Emer Room Moderate,450,1661.34,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1329.07,80% of total billed charges,263.35,100% of CMS IPPS rate,1495.21,90% of total billed charges,38.5,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,1528.43,92% of total billed charges,263.35,100% of CMS IPPS rate,656.3,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,1046.29,100% of CMS IPPS rate,1325.29,100% of CMS IPPS rate,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1162.94,70% of total billed charges,1495.21,90% of total billed charges,1578.27,95% of total billed charges,1578.27,95% of total billed charges,263.35,100% of CMS IPPS rate,493.82,100% of CMS IPPS rate,1428.75,86% of total billed charges,1329.07,80% of total billed charges,230.89,100% of CMS IPPS rate,1611.5,97% of total billed charges,1495.21,90% of total billed charges,N/A,not seperately reimbursable,1611.5,97% of total billed charges,1545.05,93% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,35,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,223.84,100% of CMS IPPS rate,35,1611.5,830.67
Outpatient Medical Services,EMERGENCY ROOM,99283,Emer Room Moderate W/Mod,450,1661.34,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1329.07,80% of total billed charges,263.35,100% of CMS IPPS rate,1495.21,90% of total billed charges,38.5,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,1528.43,92% of total billed charges,263.35,100% of CMS IPPS rate,656.3,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,1046.29,100% of CMS IPPS rate,1325.29,100% of CMS IPPS rate,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1162.94,70% of total billed charges,1495.21,90% of total billed charges,1578.27,95% of total billed charges,1578.27,95% of total billed charges,263.35,100% of CMS IPPS rate,493.82,100% of CMS IPPS rate,1428.75,86% of total billed charges,1329.07,80% of total billed charges,230.89,100% of CMS IPPS rate,1611.5,97% of total billed charges,1495.21,90% of total billed charges,N/A,not seperately reimbursable,1611.5,97% of total billed charges,1545.05,93% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,35,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,223.84,100% of CMS IPPS rate,35,1611.5,830.67
Outpatient Medical Services,EMERGENCY ROOM,99283,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,450,1661.34,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1329.07,80% of total billed charges,263.35,100% of CMS IPPS rate,1495.21,90% of total billed charges,38.5,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,1528.43,92% of total billed charges,263.35,100% of CMS IPPS rate,656.3,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,1046.29,100% of CMS IPPS rate,1325.29,100% of CMS IPPS rate,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1162.94,70% of total billed charges,1495.21,90% of total billed charges,1578.27,95% of total billed charges,1578.27,95% of total billed charges,263.35,100% of CMS IPPS rate,493.82,100% of CMS IPPS rate,1428.75,86% of total billed charges,1329.07,80% of total billed charges,230.89,100% of CMS IPPS rate,1611.5,97% of total billed charges,1495.21,90% of total billed charges,N/A,not seperately reimbursable,1611.5,97% of total billed charges,1545.05,93% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,35,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,223.84,100% of CMS IPPS rate,35,1611.5,830.67
Outpatient Medical Services,EMERGENCY ROOM,99283,OB Triage Level Assignment -> Level 3 (OB Triage),510,1661.34,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1329.07,80% of total billed charges,263.35,100% of CMS IPPS rate,1495.21,90% of total billed charges,38.5,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,1528.43,92% of total billed charges,263.35,100% of CMS IPPS rate,656.3,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,1046.29,100% of CMS IPPS rate,1325.29,100% of CMS IPPS rate,1495.21,90% of total billed charges,263.35,100% of CMS IPPS rate,1162.94,70% of total billed charges,1495.21,90% of total billed charges,1578.27,95% of total billed charges,1578.27,95% of total billed charges,263.35,100% of CMS IPPS rate,493.82,100% of CMS IPPS rate,1428.75,86% of total billed charges,1329.07,80% of total billed charges,230.89,100% of CMS IPPS rate,1611.5,97% of total billed charges,1495.21,90% of total billed charges,N/A,not seperately reimbursable,1611.5,97% of total billed charges,1545.05,93% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,35,100% of CMS fee schedule,1611.5,97% of total billed charges,263.35,100% of CMS IPPS rate,263.35,100% of CMS IPPS rate,223.84,100% of CMS IPPS rate,35,1611.5,830.67
Outpatient Medical Services,EMERGENCY ROOM,99284,Emer Room Intermediate,450,2554.92,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,2043.94,80% of total billed charges,404.99,100% of CMS IPPS rate,2299.43,90% of total billed charges,55,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,2350.53,92% of total billed charges,404.99,100% of CMS IPPS rate,1018.81,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,1624.2,100% of CMS IPPS rate,2057.29,100% of CMS IPPS rate,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,1788.44,70% of total billed charges,2299.43,90% of total billed charges,2427.17,95% of total billed charges,2427.17,95% of total billed charges,404.99,100% of CMS IPPS rate,766.57,100% of CMS IPPS rate,2197.23,86% of total billed charges,2043.94,80% of total billed charges,363.7,100% of CMS IPPS rate,2478.27,97% of total billed charges,2299.43,90% of total billed charges,N/A,not seperately reimbursable,2478.27,97% of total billed charges,2376.08,93% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,50,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,344.24,100% of CMS IPPS rate,50,2478.27,1277.46
Outpatient Medical Services,EMERGENCY ROOM,99284,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY-MOD 25,450,2554.92,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,2043.94,80% of total billed charges,404.99,100% of CMS IPPS rate,2299.43,90% of total billed charges,55,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,2350.53,92% of total billed charges,404.99,100% of CMS IPPS rate,1018.81,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,1624.2,100% of CMS IPPS rate,2057.29,100% of CMS IPPS rate,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,1788.44,70% of total billed charges,2299.43,90% of total billed charges,2427.17,95% of total billed charges,2427.17,95% of total billed charges,404.99,100% of CMS IPPS rate,766.57,100% of CMS IPPS rate,2197.23,86% of total billed charges,2043.94,80% of total billed charges,363.7,100% of CMS IPPS rate,2478.27,97% of total billed charges,2299.43,90% of total billed charges,N/A,not seperately reimbursable,2478.27,97% of total billed charges,2376.08,93% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,50,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,344.24,100% of CMS IPPS rate,50,2478.27,1277.46
Outpatient Medical Services,EMERGENCY ROOM,99284,OB Triage Level Assignment -> Level 4 (OB Triage),510,2554.92,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,2043.94,80% of total billed charges,404.99,100% of CMS IPPS rate,2299.43,90% of total billed charges,55,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,2350.53,92% of total billed charges,404.99,100% of CMS IPPS rate,1018.81,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,1624.2,100% of CMS IPPS rate,2057.29,100% of CMS IPPS rate,2299.43,90% of total billed charges,404.99,100% of CMS IPPS rate,1788.44,70% of total billed charges,2299.43,90% of total billed charges,2427.17,95% of total billed charges,2427.17,95% of total billed charges,404.99,100% of CMS IPPS rate,766.57,100% of CMS IPPS rate,2197.23,86% of total billed charges,2043.94,80% of total billed charges,363.7,100% of CMS IPPS rate,2478.27,97% of total billed charges,2299.43,90% of total billed charges,N/A,not seperately reimbursable,2478.27,97% of total billed charges,2376.08,93% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,50,100% of CMS fee schedule,2478.27,97% of total billed charges,404.99,100% of CMS IPPS rate,404.99,100% of CMS IPPS rate,344.24,100% of CMS IPPS rate,50,2478.27,1277.46
Outpatient Medical Services,EMERGENCY ROOM,99285,Emer Room Extended/Complex,450,3678.6,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2942.88,80% of total billed charges,583.11,100% of CMS IPPS rate,3310.74,90% of total billed charges,55,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,3384.31,92% of total billed charges,583.11,100% of CMS IPPS rate,1477.5,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,2355.44,100% of CMS IPPS rate,2983.52,100% of CMS IPPS rate,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2575.02,70% of total billed charges,3310.74,90% of total billed charges,3494.67,95% of total billed charges,3494.67,95% of total billed charges,583.11,100% of CMS IPPS rate,1111.69,100% of CMS IPPS rate,3163.6,86% of total billed charges,2942.88,80% of total billed charges,521.59,100% of CMS IPPS rate,3568.24,97% of total billed charges,3310.74,90% of total billed charges,N/A,not seperately reimbursable,3568.24,97% of total billed charges,3421.1,93% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,50,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,495.64,100% of CMS IPPS rate,50,3568.24,1839.30
Outpatient Medical Services,EMERGENCY ROOM,99285,Emer Room Extended/Comple W/Mod,450,3678.6,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2942.88,80% of total billed charges,583.11,100% of CMS IPPS rate,3310.74,90% of total billed charges,55,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,3384.31,92% of total billed charges,583.11,100% of CMS IPPS rate,1477.5,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,2355.44,100% of CMS IPPS rate,2983.52,100% of CMS IPPS rate,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2575.02,70% of total billed charges,3310.74,90% of total billed charges,3494.67,95% of total billed charges,3494.67,95% of total billed charges,583.11,100% of CMS IPPS rate,1111.69,100% of CMS IPPS rate,3163.6,86% of total billed charges,2942.88,80% of total billed charges,521.59,100% of CMS IPPS rate,3568.24,97% of total billed charges,3310.74,90% of total billed charges,N/A,not seperately reimbursable,3568.24,97% of total billed charges,3421.1,93% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,50,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,495.64,100% of CMS IPPS rate,50,3568.24,1839.30
Outpatient Medical Services,EMERGENCY ROOM,99285,OB Triage Level Assignment -> Level 5 (OB Triage),510,3678.6,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2942.88,80% of total billed charges,583.11,100% of CMS IPPS rate,3310.74,90% of total billed charges,55,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,3384.31,92% of total billed charges,583.11,100% of CMS IPPS rate,1477.5,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,2355.44,100% of CMS IPPS rate,2983.52,100% of CMS IPPS rate,3310.74,90% of total billed charges,583.11,100% of CMS IPPS rate,2575.02,70% of total billed charges,3310.74,90% of total billed charges,3494.67,95% of total billed charges,3494.67,95% of total billed charges,583.11,100% of CMS IPPS rate,1111.69,100% of CMS IPPS rate,3163.6,86% of total billed charges,2942.88,80% of total billed charges,521.59,100% of CMS IPPS rate,3568.24,97% of total billed charges,3310.74,90% of total billed charges,N/A,not seperately reimbursable,3568.24,97% of total billed charges,3421.1,93% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,50,100% of CMS fee schedule,3568.24,97% of total billed charges,583.11,100% of CMS IPPS rate,583.11,100% of CMS IPPS rate,495.64,100% of CMS IPPS rate,50,3568.24,1839.30
Outpatient Medical Services,EMERGENCY ROOM,99291,Emer Room Critical Care,450,5055.66,4550.09,90% of total billed charges,801.4,100% of CMS IPPS rate,4044.53,80% of total billed charges,801.4,100% of CMS IPPS rate,4550.09,90% of total billed charges,166.79,100% of CMS fee schedule,4903.99,97% of total billed charges,801.4,100% of CMS IPPS rate,4651.21,92% of total billed charges,801.4,100% of CMS IPPS rate,2041.2,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,3254.1,100% of CMS IPPS rate,4121.82,100% of CMS IPPS rate,4550.09,90% of total billed charges,801.4,100% of CMS IPPS rate,3538.96,70% of total billed charges,4550.09,90% of total billed charges,4802.88,95% of total billed charges,4802.88,95% of total billed charges,801.4,100% of CMS IPPS rate,1535.83,100% of CMS IPPS rate,4347.87,86% of total billed charges,4044.53,80% of total billed charges,689.24,100% of CMS IPPS rate,4903.99,97% of total billed charges,4550.09,90% of total billed charges,N/A,not seperately reimbursable,4903.99,97% of total billed charges,4701.76,93% of total billed charges,801.4,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,151.63,100% of CMS fee schedule,4903.99,97% of total billed charges,801.4,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,681.18,100% of CMS IPPS rate,151.63,4903.99,2527.83
Outpatient Medical Services,EMERGENCY ROOM,99291,Emer Room Critical,450,5055.66,4550.09,90% of total billed charges,801.4,100% of CMS IPPS rate,4044.53,80% of total billed charges,801.4,100% of CMS IPPS rate,4550.09,90% of total billed charges,166.79,100% of CMS fee schedule,4903.99,97% of total billed charges,801.4,100% of CMS IPPS rate,4651.21,92% of total billed charges,801.4,100% of CMS IPPS rate,2041.2,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,3254.1,100% of CMS IPPS rate,4121.82,100% of CMS IPPS rate,4550.09,90% of total billed charges,801.4,100% of CMS IPPS rate,3538.96,70% of total billed charges,4550.09,90% of total billed charges,4802.88,95% of total billed charges,4802.88,95% of total billed charges,801.4,100% of CMS IPPS rate,1535.83,100% of CMS IPPS rate,4347.87,86% of total billed charges,4044.53,80% of total billed charges,689.24,100% of CMS IPPS rate,4903.99,97% of total billed charges,4550.09,90% of total billed charges,N/A,not seperately reimbursable,4903.99,97% of total billed charges,4701.76,93% of total billed charges,801.4,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,151.63,100% of CMS fee schedule,4903.99,97% of total billed charges,801.4,100% of CMS IPPS rate,801.4,100% of CMS IPPS rate,681.18,100% of CMS IPPS rate,151.63,4903.99,2527.83
Outpatient Medical Services,EMERGENCY ROOM,99292,Emer Room Critical Care Add 30Min,450,529.09,476.18,90% of total billed charges,N/A,not seperately reimbursable,423.27,80% of total billed charges,N/A,not seperately reimbursable,476.18,90% of total billed charges,81.84,100% of CMS fee schedule,513.22,97% of total billed charges,N/A,not seperately reimbursable,486.76,92% of total billed charges,N/A,not seperately reimbursable,337.89,63.86% of total billed charges,N/A,not seperately reimbursable,416.14, 78.65% of total billed charges,472.64,89.33% of total billed charges,476.18,90% of total billed charges,N/A,not seperately reimbursable,370.36,70% of total billed charges,476.18,90% of total billed charges,502.64,95% of total billed charges,502.64,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,455.02,86% of total billed charges,423.27,80% of total billed charges,N/A,not seperately reimbursable,513.22,97% of total billed charges,476.18,90% of total billed charges,N/A,not seperately reimbursable,513.22,97% of total billed charges,492.05,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,100% of CMS fee schedule,513.22,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,513.22,264.55
Outpatient Medical Services,LAB,G0103,PSA Screening,300,114.63,103.17,90% of total billed charges,19.3,100% of CMS fee schedule,91.7,80% of total billed charges,19.3,100% of CMS fee schedule,103.17,90% of total billed charges,N/A,not seperately reimbursable,111.19,97% of total billed charges,19.3,100% of CMS fee schedule,105.46,92% of total billed charges,19.3,100% of CMS fee schedule,78.33, 405.66% of CMS fee schedule,19.3,100% of CMS fee schedule,95.43,494.23% of CMS fee schedule,88.54, 458.54% of CMS fee schedule,103.17,90% of total billed charges,19.3,100% of CMS fee schedule,80.24,70% of total billed charges,103.17,90% of total billed charges,108.9,95% of total billed charges,108.9,95% of total billed charges,19.3,100% of CMS fee schedule,38.62,200% of CMS fee schedule,98.58,86% of total billed charges,91.7,80% of total billed charges,21.43,111% of CMS fee schedule,111.19,97% of total billed charges,103.17,90% of total billed charges,N/A,not seperately reimbursable,111.19,97% of total billed charges,106.61,93% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,N/A,not seperately reimbursable,111.19,97% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,16.41,85% of CMS fee schedule,16.41,111.19,57.32
Outpatient Medical Services,LAB,G0103,Direct Access Lab PSA,300,26.6,23.94,90% of total billed charges,19.3,100% of CMS fee schedule,21.28,80% of total billed charges,19.3,100% of CMS fee schedule,23.94,90% of total billed charges,N/A,not seperately reimbursable,25.8,97% of total billed charges,19.3,100% of CMS fee schedule,24.47,92% of total billed charges,19.3,100% of CMS fee schedule,78.33, 405.66% of CMS fee schedule,19.3,100% of CMS fee schedule,95.43,494.23% of CMS fee schedule,88.54, 458.54% of CMS fee schedule,23.94,90% of total billed charges,19.3,100% of CMS fee schedule,18.62,70% of total billed charges,23.94,90% of total billed charges,25.27,95% of total billed charges,25.27,95% of total billed charges,19.3,100% of CMS fee schedule,38.62,200% of CMS fee schedule,22.88,86% of total billed charges,21.28,80% of total billed charges,21.43,111% of CMS fee schedule,25.8,97% of total billed charges,23.94,90% of total billed charges,N/A,not seperately reimbursable,25.8,97% of total billed charges,24.74,93% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,N/A,not seperately reimbursable,25.8,97% of total billed charges,19.3,100% of CMS fee schedule,19.3,100% of CMS fee schedule,16.41,85% of CMS fee schedule,16.41,95.43,13.30
Outpatient Medical Services,AMBULATORY SURGERY,G0378,ROOM/BED: Observation,762,116.87,105.18,90% of total billed charges,N/A,not seperately reimbursable,93.5,80% of total billed charges,N/A,not seperately reimbursable,105.18,90% of total billed charges,1074.19,100% of CMS fee schedule,113.36,97% of total billed charges,N/A,not seperately reimbursable,107.52,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,105.18,90% of total billed charges,N/A,not seperately reimbursable,81.81,70% of total billed charges,105.18,90% of total billed charges,111.03,95% of total billed charges,111.03,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,100.51,86% of total billed charges,93.5,80% of total billed charges,N/A,not seperately reimbursable,113.36,97% of total billed charges,105.18,90% of total billed charges,N/A,not seperately reimbursable,113.36,97% of total billed charges,108.69,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,976.54,100% of CMS fee schedule,113.36,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.81,1074.19,58.44
Outpatient Medical Services,LAB,P9016,RBC AS1,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC AS3,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC AS5,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC CPDA1,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,APC AS1,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,APC CPDA1,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,DPC AS1,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,DPC CPDA1,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,ALQ1,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC CPD,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,AS-1 RBC IRR,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC AS3 (04741),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC AS3 (04761),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC CPD IRR,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,APC AS5,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,DPC AS5,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPD AS1 LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPD AS1 LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CP2D AS3 LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CP2D AS3 LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC CP2D AS3 LR,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC CP2D AS3 LR 1st Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPD AS5 LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPD AS5 LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC CP2D AS3 LR 2nd Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC ACD-A AS3 LR,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC ACD-A AS3 LR 1st Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC ACD-A AS3 2nd Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Deglycerolized RBC LR Open,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC CPD LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPD LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPDA-1 LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPDA-1 LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CP2D LR 450 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CP2D LR 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC CPDA1 500 ml,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC AS1 (03820),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,RBC AS1 (03311),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,AS-3 RBC IRR (05761),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,AS-3 RBC IRR (05741),390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,Apheresis RBC ACD-A AS1 LR 2nd Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,Apheresis RBC ACD-A AS1 LR 1st Cont,390,1021.76,919.58,90% of total billed charges,182,100% of CMS IPPS rate,817.41,80% of total billed charges,182,100% of CMS IPPS rate,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,940.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,919.58,90% of total billed charges,182,100% of CMS IPPS rate,715.23,70% of total billed charges,919.58,90% of total billed charges,970.67,95% of total billed charges,970.67,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,878.71,86% of total billed charges,817.41,80% of total billed charges,209.06,100% of CMS IPPS rate,991.11,97% of total billed charges,919.58,90% of total billed charges,N/A,not seperately reimbursable,991.11,97% of total billed charges,950.24,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,991.11,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,991.11,510.88
Outpatient Medical Services,LAB,P9016,RBC AS3 NLR,390,929.37,836.43,90% of total billed charges,182,100% of CMS IPPS rate,743.5,80% of total billed charges,182,100% of CMS IPPS rate,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,855.02,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,836.43,90% of total billed charges,182,100% of CMS IPPS rate,650.56,70% of total billed charges,836.43,90% of total billed charges,882.9,95% of total billed charges,882.9,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,799.26,86% of total billed charges,743.5,80% of total billed charges,209.06,100% of CMS IPPS rate,901.49,97% of total billed charges,836.43,90% of total billed charges,N/A,not seperately reimbursable,901.49,97% of total billed charges,864.31,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,901.49,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,970.55,464.69
Outpatient Medical Services,LAB,P9016,Autologous RBC CPD AS1 LR 500 ml,390,1231.42,1108.28,90% of total billed charges,182,100% of CMS IPPS rate,985.14,80% of total billed charges,182,100% of CMS IPPS rate,1108.28,90% of total billed charges,N/A,not seperately reimbursable,1194.48,97% of total billed charges,182,100% of CMS IPPS rate,1132.91,92% of total billed charges,182,100% of CMS IPPS rate,480.64,100% of CMS IPPS rate,182,100% of CMS IPPS rate,766.24,100% of CMS IPPS rate,970.55,100% of CMS IPPS rate,1108.28,90% of total billed charges,182,100% of CMS IPPS rate,861.99,70% of total billed charges,1108.28,90% of total billed charges,1169.85,95% of total billed charges,1169.85,95% of total billed charges,182,100% of CMS IPPS rate,361.64,100% of CMS IPPS rate,1059.02,86% of total billed charges,985.14,80% of total billed charges,209.06,100% of CMS IPPS rate,1194.48,97% of total billed charges,1108.28,90% of total billed charges,N/A,not seperately reimbursable,1194.48,97% of total billed charges,1145.22,93% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,N/A,not seperately reimbursable,1194.48,97% of total billed charges,182,100% of CMS IPPS rate,182,100% of CMS IPPS rate,154.69,100% of CMS IPPS rate,154.69,1194.48,615.71
Outpatient Medical Services,RADIOLOGY,Q9963,IR MD76-1mL contrast,250,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9963,Gastroview -1ml,636,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9963,Q9963-CONTRAST MD76 1ML,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9963,"CONTRAST, GASTROGRAFIN 66%-10% Soln",255,5.8,5.22,90% of total billed charges,N/A,not seperately reimbursable,4.64,80% of total billed charges,N/A,not seperately reimbursable,5.22,90% of total billed charges,N/A,not seperately reimbursable,5.63,97% of total billed charges,N/A,not seperately reimbursable,5.34,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.22,90% of total billed charges,N/A,not seperately reimbursable,4.06,70% of total billed charges,5.22,90% of total billed charges,5.51,95% of total billed charges,5.51,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.99,86% of total billed charges,4.64,80% of total billed charges,N/A,not seperately reimbursable,5.63,97% of total billed charges,5.22,90% of total billed charges,N/A,not seperately reimbursable,5.63,97% of total billed charges,5.39,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.63,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.06,5.63,2.90
Outpatient Medical Services,RADIOLOGY,Q9967,DR Optiray 320-1ml,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9967,DR Isovue 300-1ml,255,5.32,4.79,90% of total billed charges,N/A,not seperately reimbursable,4.26,80% of total billed charges,N/A,not seperately reimbursable,4.79,90% of total billed charges,N/A,not seperately reimbursable,5.16,97% of total billed charges,N/A,not seperately reimbursable,4.89,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.79,90% of total billed charges,N/A,not seperately reimbursable,3.72,70% of total billed charges,4.79,90% of total billed charges,5.05,95% of total billed charges,5.05,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.58,86% of total billed charges,4.26,80% of total billed charges,N/A,not seperately reimbursable,5.16,97% of total billed charges,4.79,90% of total billed charges,N/A,not seperately reimbursable,5.16,97% of total billed charges,4.95,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.16,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.72,5.16,2.66
Outpatient Medical Services,RADIOLOGY,Q9967,CT Optiray 320-1ml,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9967,DR Visipaque 320-1ml,255,3.36,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,3.09,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.35,70% of total billed charges,3.02,90% of total billed charges,3.19,95% of total billed charges,3.19,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.89,86% of total billed charges,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.12,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.35,3.26,1.68
Outpatient Medical Services,RADIOLOGY,Q9967,CT Optiray 300-1ml,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9967,CT Visipaque 320-1ml,255,3.36,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,3.09,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.35,70% of total billed charges,3.02,90% of total billed charges,3.19,95% of total billed charges,3.19,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.89,86% of total billed charges,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.12,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.35,3.26,1.68
Outpatient Medical Services,RADIOLOGY,Q9967,IR Optiray 350-1ml,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9967,IR Visipaque 320-1ml,255,3.36,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,3.09,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.35,70% of total billed charges,3.02,90% of total billed charges,3.19,95% of total billed charges,3.19,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.89,86% of total billed charges,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.12,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.35,3.26,1.68
Outpatient Medical Services,RADIOLOGY,Q9967,CT Optiray 300-1ml Waste,255,0.01,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,0.01,N/A
Outpatient Medical Services,RADIOLOGY,Q9967,CT Optiray 320-1ml Waste,255,0.01,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,0.01,N/A
Outpatient Medical Services,RADIOLOGY,Q9967,DR Isovue 300-1ml Waste,255,0.01,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,0.01,N/A
Outpatient Medical Services,RADIOLOGY,Q9967,DR Optiray 320-1ml Waste,255,0.01,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,0.01,0.01,N/A
Outpatient Medical Services,RADIOLOGY,Q9967,Q9967-OPTIRAY CONTRAST LOCM300-399,255,2.24,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,2.06,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.02,90% of total billed charges,N/A,not seperately reimbursable,1.57,70% of total billed charges,2.02,90% of total billed charges,2.13,95% of total billed charges,2.13,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.93,86% of total billed charges,1.79,80% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.02,90% of total billed charges,N/A,not seperately reimbursable,2.17,97% of total billed charges,2.08,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.17,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1.57,2.17,1.12
Outpatient Medical Services,RADIOLOGY,Q9967,Q9967-VISIPAQUE CONTRAST LOCM300-399,255,3.36,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,3.09,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.02,90% of total billed charges,N/A,not seperately reimbursable,2.35,70% of total billed charges,3.02,90% of total billed charges,3.19,95% of total billed charges,3.19,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.89,86% of total billed charges,2.69,80% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.02,90% of total billed charges,N/A,not seperately reimbursable,3.26,97% of total billed charges,3.12,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.26,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.35,3.26,1.68
Outpatient Medical Services,RADIOLOGY,Q9967,OMNIPAQUE 300 INJ 10 mL,255,337.33,303.6,90% of total billed charges,N/A,not seperately reimbursable,269.86,80% of total billed charges,N/A,not seperately reimbursable,303.6,90% of total billed charges,N/A,not seperately reimbursable,327.21,97% of total billed charges,N/A,not seperately reimbursable,310.34,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,303.6,90% of total billed charges,N/A,not seperately reimbursable,236.13,70% of total billed charges,303.6,90% of total billed charges,320.46,95% of total billed charges,320.46,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,290.1,86% of total billed charges,269.86,80% of total billed charges,N/A,not seperately reimbursable,327.21,97% of total billed charges,303.6,90% of total billed charges,N/A,not seperately reimbursable,327.21,97% of total billed charges,313.72,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,327.21,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,236.13,327.21,168.67
Outpatient Medical Services,RADIOLOGY,Q9967,CT Isovue 370 1-mL,255,3.96,3.56,90% of total billed charges,N/A,not seperately reimbursable,3.17,80% of total billed charges,N/A,not seperately reimbursable,3.56,90% of total billed charges,N/A,not seperately reimbursable,3.84,97% of total billed charges,N/A,not seperately reimbursable,3.64,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.56,90% of total billed charges,N/A,not seperately reimbursable,2.77,70% of total billed charges,3.56,90% of total billed charges,3.76,95% of total billed charges,3.76,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.41,86% of total billed charges,3.17,80% of total billed charges,N/A,not seperately reimbursable,3.84,97% of total billed charges,3.56,90% of total billed charges,N/A,not seperately reimbursable,3.84,97% of total billed charges,3.68,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.84,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.77,3.84,1.98
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE 300 61% 50ML",255,6.49,5.84,90% of total billed charges,N/A,not seperately reimbursable,5.19,80% of total billed charges,N/A,not seperately reimbursable,5.84,90% of total billed charges,N/A,not seperately reimbursable,6.3,97% of total billed charges,N/A,not seperately reimbursable,5.97,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.84,90% of total billed charges,N/A,not seperately reimbursable,4.54,70% of total billed charges,5.84,90% of total billed charges,6.17,95% of total billed charges,6.17,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.58,86% of total billed charges,5.19,80% of total billed charges,N/A,not seperately reimbursable,6.3,97% of total billed charges,5.84,90% of total billed charges,N/A,not seperately reimbursable,6.3,97% of total billed charges,6.04,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6.3,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.54,6.3,3.25
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE 300 61% 100ML",255,6.34,5.71,90% of total billed charges,N/A,not seperately reimbursable,5.07,80% of total billed charges,N/A,not seperately reimbursable,5.71,90% of total billed charges,N/A,not seperately reimbursable,6.15,97% of total billed charges,N/A,not seperately reimbursable,5.83,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.71,90% of total billed charges,N/A,not seperately reimbursable,4.44,70% of total billed charges,5.71,90% of total billed charges,6.02,95% of total billed charges,6.02,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.45,86% of total billed charges,5.07,80% of total billed charges,N/A,not seperately reimbursable,6.15,97% of total billed charges,5.71,90% of total billed charges,N/A,not seperately reimbursable,6.15,97% of total billed charges,5.9,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,6.15,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.44,6.15,3.17
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE 300 61% 200ML",255,3.42,3.08,90% of total billed charges,N/A,not seperately reimbursable,2.74,80% of total billed charges,N/A,not seperately reimbursable,3.08,90% of total billed charges,N/A,not seperately reimbursable,3.32,97% of total billed charges,N/A,not seperately reimbursable,3.15,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.08,90% of total billed charges,N/A,not seperately reimbursable,2.39,70% of total billed charges,3.08,90% of total billed charges,3.25,95% of total billed charges,3.25,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.94,86% of total billed charges,2.74,80% of total billed charges,N/A,not seperately reimbursable,3.32,97% of total billed charges,3.08,90% of total billed charges,N/A,not seperately reimbursable,3.32,97% of total billed charges,3.18,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.32,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.39,3.32,1.71
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE-M-300 61% 15 mL",255,41.22,37.1,90% of total billed charges,N/A,not seperately reimbursable,32.98,80% of total billed charges,N/A,not seperately reimbursable,37.1,90% of total billed charges,N/A,not seperately reimbursable,39.98,97% of total billed charges,N/A,not seperately reimbursable,37.92,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,37.1,90% of total billed charges,N/A,not seperately reimbursable,28.85,70% of total billed charges,37.1,90% of total billed charges,39.16,95% of total billed charges,39.16,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,35.45,86% of total billed charges,32.98,80% of total billed charges,N/A,not seperately reimbursable,39.98,97% of total billed charges,37.1,90% of total billed charges,N/A,not seperately reimbursable,39.98,97% of total billed charges,38.33,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,39.98,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.85,39.98,20.61
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE 300 61% 30 ML",255,5.29,4.76,90% of total billed charges,N/A,not seperately reimbursable,4.23,80% of total billed charges,N/A,not seperately reimbursable,4.76,90% of total billed charges,N/A,not seperately reimbursable,5.13,97% of total billed charges,N/A,not seperately reimbursable,4.87,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.76,90% of total billed charges,N/A,not seperately reimbursable,3.7,70% of total billed charges,4.76,90% of total billed charges,5.03,95% of total billed charges,5.03,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4.55,86% of total billed charges,4.23,80% of total billed charges,N/A,not seperately reimbursable,5.13,97% of total billed charges,4.76,90% of total billed charges,N/A,not seperately reimbursable,5.13,97% of total billed charges,4.92,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,5.13,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.7,5.13,2.65
Outpatient Medical Services,RADIOLOGY,Q9967,"CONTRAST, ISOVUE 370 76% 100ML",255,3.66,3.29,90% of total billed charges,N/A,not seperately reimbursable,2.93,80% of total billed charges,N/A,not seperately reimbursable,3.29,90% of total billed charges,N/A,not seperately reimbursable,3.55,97% of total billed charges,N/A,not seperately reimbursable,3.37,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.29,90% of total billed charges,N/A,not seperately reimbursable,2.56,70% of total billed charges,3.29,90% of total billed charges,3.48,95% of total billed charges,3.48,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.15,86% of total billed charges,2.93,80% of total billed charges,N/A,not seperately reimbursable,3.55,97% of total billed charges,3.29,90% of total billed charges,N/A,not seperately reimbursable,3.55,97% of total billed charges,3.4,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.55,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.56,3.55,1.83
Outpatient Medical Services,RADIOLOGY,Q9967,MEDIA CONTRAST ISOVUE 370 100ML CHARGE ONLY 1ML,636,12,10.8,90% of total billed charges,N/A,not seperately reimbursable,9.6,80% of total billed charges,N/A,not seperately reimbursable,10.8,90% of total billed charges,N/A,not seperately reimbursable,11.64,97% of total billed charges,N/A,not seperately reimbursable,11.04,92% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,10.8,90% of total billed charges,N/A,not seperately reimbursable,8.4,70% of total billed charges,10.8,90% of total billed charges,11.4,95% of total billed charges,11.4,95% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,10.32,86% of total billed charges,9.6,80% of total billed charges,N/A,not seperately reimbursable,11.64,97% of total billed charges,10.8,90% of total billed charges,N/A,not seperately reimbursable,11.64,97% of total billed charges,11.16,93% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.64,97% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.4,11.64,6.00
Outpatient Medical Services,AMBULATORY SURGERY,19120,19120- Removal of breast lesion,960,897.32,807.59,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1132.19,140% of CIGNA fee schedule,173,100% of CMS fee schedule,358.93,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,409.87,100% of CMS fee schedule,555.91,100% of CMS fee schedule,N/A,not seperately reimbursable,625.25,100% of CMS fee schedule,625.25,100% of CMS fee schedule,631.89,150% of CMS fee schedule,631.89,150% of CMS fee schedule,332.48,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,745.63,100% of CMS fee schedule,523.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173,100% of CMS fee schedule,442.09,100% of CMS fee schedule,N/A,not seperately reimbursable,973.08,100% of CMS fee schedule,973.08,100% of CMS fee schedule,173,1132.19,448.66
Outpatient Medical Services,OUTPATIENT SERVICES,29826,29826- Arthroscop/shoulder/decomp/subacro,960,367.19,330.47,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,543.5,100% of CMS fee schedule,146.88,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,167.81,100% of CMS fee schedule,261.38,100% of CMS fee schedule,N/A,not seperately reimbursable,293.98,100% of CMS fee schedule,293.98,100% of CMS fee schedule,269.55,150% of CMS fee schedule,269.55,150% of CMS fee schedule,195.75,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,318.06,100% of CMS fee schedule,221.23,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,543.5,100% of CMS fee schedule,900.26,100% of CMS fee schedule,N/A,not seperately reimbursable,1348.44,100% of CMS fee schedule,1348.44,100% of CMS fee schedule,146.88,1348.44,183.60
Outpatient Medical Services,OUTPATIENT SERVICES,29881,29881- Arthroscopy/knee/menisc/med or lat,960,1145.09,1030.58,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1242.57,140% of CIGNA fee schedule,543.5,100% of CMS fee schedule,458.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,524.03,100% of CMS fee schedule,807.41,100% of CMS fee schedule,N/A,not seperately reimbursable,908.12,100% of CMS fee schedule,908.12,100% of CMS fee schedule,806.87,150% of CMS fee schedule,806.87,150% of CMS fee schedule,600.6,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,952.1,100% of CMS fee schedule,636.99,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,543.5,100% of CMS fee schedule,762.48,100% of CMS fee schedule,N/A,not seperately reimbursable,1311.04,100% of CMS fee schedule,1311.04,100% of CMS fee schedule,458.04,1311.04,572.55
Outpatient Medical Services,LAB,36415,36415 Venipuncture,978,47.9,43.11,90% of total billed charges,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.27,135% of GEHA fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,8.83,100% of CMS fee schedule,3.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.39,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.09,100% of CMS fee schedule,18.18,200% of CMS fee schedule,N/A,not seperately reimbursable,3.75,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.27,100% of UHC fee schedule,9.09,100% of CMS fee schedule,12.27,135% of CMS fee schedule,12.27,135% of CMS fee schedule,9.09,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,3.3,100% of CMS fee schedule,9.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.39,43.11,23.95
Outpatient Medical Services,LAB,36415,36415-PF COLLECTION VENOUS BLOOD VENIPUNCTURE,981,N/A,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,36416,36416 - Collection of Capillary Blood Specimen,983,45.42,40.88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18.17,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3.09,100% of CMS fee schedule,N/A,not seperately reimbursable,3.48,100% of CMS fee schedule,3.48,100% of CMS fee schedule,3.71,150% of CMS fee schedule,3.71,150% of CMS fee schedule,13.63,70% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.6,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2.6,40.88,22.71
Outpatient Medical Services,LAB,36430,36430-PF  TRANSFUSION BLOOD/BLOOD COMPONENTS,981,80.09,72.08,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,27.84,100% of CMS fee schedule,32.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,36.76,100% of CMS fee schedule,42.74,100% of CMS fee schedule,N/A,not seperately reimbursable,48.07,100% of CMS fee schedule,48.07,100% of CMS fee schedule,46.35,150% of CMS fee schedule,46.35,150% of CMS fee schedule,30.57,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,54.69,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,27.84,100% of CMS fee schedule,40.43,100% of CMS fee schedule,N/A,not seperately reimbursable,61.88,100% of CMS fee schedule,61.88,100% of CMS fee schedule,27.84,72.08,40.05
Outpatient Medical Services,LAB,36600,36600- Arterial puncture/blood draw,960,31.27,28.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,12.51,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.35,100% of CMS fee schedule,17.38,100% of CMS fee schedule,N/A,not seperately reimbursable,19.55,100% of CMS fee schedule,19.55,100% of CMS fee schedule,23.99,150% of CMS fee schedule,23.99,150% of CMS fee schedule,12.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.3,100% of CMS fee schedule,18.05,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,30.16,100% of CMS fee schedule,N/A,not seperately reimbursable,59.84,100% of CMS fee schedule,59.84,100% of CMS fee schedule,12.01,59.84,15.64
Outpatient Medical Services,LAB,36600,36600 - PF Arterial Puncture Withdrawal Blood Dx,960,31.27,28.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,12.51,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.35,100% of CMS fee schedule,17.38,100% of CMS fee schedule,N/A,not seperately reimbursable,19.55,100% of CMS fee schedule,19.55,100% of CMS fee schedule,23.99,150% of CMS fee schedule,23.99,150% of CMS fee schedule,12.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.3,100% of CMS fee schedule,18.05,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,30.16,100% of CMS fee schedule,N/A,not seperately reimbursable,59.84,100% of CMS fee schedule,59.84,100% of CMS fee schedule,12.01,59.84,15.64
Outpatient Medical Services,LAB,36600,36600-PF ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,981,31.27,28.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,12.51,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,14.35,100% of CMS fee schedule,17.38,100% of CMS fee schedule,N/A,not seperately reimbursable,19.55,100% of CMS fee schedule,19.55,100% of CMS fee schedule,23.99,150% of CMS fee schedule,23.99,150% of CMS fee schedule,12.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.3,100% of CMS fee schedule,18.05,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13,100% of CMS fee schedule,30.16,100% of CMS fee schedule,N/A,not seperately reimbursable,59.84,100% of CMS fee schedule,59.84,100% of CMS fee schedule,12.01,59.84,15.64
Outpatient Medical Services,OUTPATIENT SERVICES,42820,42820- T & A < 12 yrs,983,613.87,552.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,639.02,140% of CIGNA fee schedule,184,100% of CMS fee schedule,245.55,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,281.26,100% of CMS fee schedule,382.66,100% of CMS fee schedule,N/A,not seperately reimbursable,430.39,100% of CMS fee schedule,430.39,100% of CMS fee schedule,427.91,150% of CMS fee schedule,427.91,150% of CMS fee schedule,231.34,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,504.93,100% of CMS fee schedule,325.89,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,184,100% of CMS fee schedule,390.2,100% of CMS fee schedule,N/A,not seperately reimbursable,610.64,100% of CMS fee schedule,610.64,100% of CMS fee schedule,184,639.02,306.94
Outpatient Medical Services,OUTPATIENT SERVICES,43235,43235- EGD/flex/transoral/diag,983,255.71,230.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,102.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,117.17,100% of CMS fee schedule,148.34,100% of CMS fee schedule,N/A,not seperately reimbursable,166.84,100% of CMS fee schedule,166.84,100% of CMS fee schedule,185.9,150% of CMS fee schedule,185.9,150% of CMS fee schedule,103.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.36,100% of CMS fee schedule,142.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,333.6,100% of CMS fee schedule,N/A,not seperately reimbursable,575.96,100% of CMS fee schedule,575.96,100% of CMS fee schedule,102.28,575.96,127.86
Outpatient Medical Services,OUTPATIENT SERVICES,43235,43235 - PF EGD Diagnostic Brush Wash,960,255.71,230.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,102.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,117.17,100% of CMS fee schedule,148.34,100% of CMS fee schedule,N/A,not seperately reimbursable,166.84,100% of CMS fee schedule,166.84,100% of CMS fee schedule,185.9,150% of CMS fee schedule,185.9,150% of CMS fee schedule,103.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.36,100% of CMS fee schedule,142.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,333.6,100% of CMS fee schedule,N/A,not seperately reimbursable,575.96,100% of CMS fee schedule,575.96,100% of CMS fee schedule,102.28,575.96,127.86
Outpatient Medical Services,OUTPATIENT SERVICES,43235,43235-PF ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,981,255.71,230.14,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,102.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,117.17,100% of CMS fee schedule,148.34,100% of CMS fee schedule,N/A,not seperately reimbursable,166.84,100% of CMS fee schedule,166.84,100% of CMS fee schedule,185.9,150% of CMS fee schedule,185.9,150% of CMS fee schedule,103.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.36,100% of CMS fee schedule,142.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,125.22,100% of CMS fee schedule,333.6,100% of CMS fee schedule,N/A,not seperately reimbursable,575.96,100% of CMS fee schedule,575.96,100% of CMS fee schedule,102.28,575.96,127.86
Outpatient Medical Services,OUTPATIENT SERVICES,43239,43239- EGD w/biopsy/single/multiple,983,289.33,260.4,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,148.58,100% of CMS fee schedule,115.73,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,132.56,100% of CMS fee schedule,167.2,100% of CMS fee schedule,N/A,not seperately reimbursable,188.05,100% of CMS fee schedule,188.05,100% of CMS fee schedule,209.52,150% of CMS fee schedule,209.52,150% of CMS fee schedule,123.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,247.23,100% of CMS fee schedule,159.52,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,148.58,100% of CMS fee schedule,374.05,100% of CMS fee schedule,N/A,not seperately reimbursable,670.48,100% of CMS fee schedule,670.48,100% of CMS fee schedule,115.73,670.48,144.67
Outpatient Medical Services,OUTPATIENT SERVICES,43239,43239 - PF EGD Transoral Bx Sngl/ Mult,960,289.33,260.4,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,148.58,100% of CMS fee schedule,115.73,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,132.56,100% of CMS fee schedule,167.2,100% of CMS fee schedule,N/A,not seperately reimbursable,188.05,100% of CMS fee schedule,188.05,100% of CMS fee schedule,209.52,150% of CMS fee schedule,209.52,150% of CMS fee schedule,123.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,247.23,100% of CMS fee schedule,159.52,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,148.58,100% of CMS fee schedule,374.05,100% of CMS fee schedule,N/A,not seperately reimbursable,670.48,100% of CMS fee schedule,670.48,100% of CMS fee schedule,115.73,670.48,144.67
Outpatient Medical Services,OUTPATIENT SERVICES,45378,45378 - PF DIAGNOSTIC COLONSCOPY,960,386.13,347.52,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,712.03,140% of CIGNA fee schedule,180.5,100% of CMS fee schedule,154.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,176.88,100% of CMS fee schedule,224.19,100% of CMS fee schedule,N/A,not seperately reimbursable,252.15,100% of CMS fee schedule,252.15,100% of CMS fee schedule,282.09,150% of CMS fee schedule,282.09,150% of CMS fee schedule,155.38,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,332.87,100% of CMS fee schedule,216.9,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,180.5,100% of CMS fee schedule,448.6,100% of CMS fee schedule,N/A,not seperately reimbursable,775.2,100% of CMS fee schedule,775.2,100% of CMS fee schedule,154.45,775.2,193.07
Outpatient Medical Services,OUTPATIENT SERVICES,45378,45378 - PF Colonoscopy Flx Dx w/ Coll Spec When Pfrmd,960,386.13,347.52,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,712.03,140% of CIGNA fee schedule,180.5,100% of CMS fee schedule,154.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,176.88,100% of CMS fee schedule,224.19,100% of CMS fee schedule,N/A,not seperately reimbursable,252.15,100% of CMS fee schedule,252.15,100% of CMS fee schedule,282.09,150% of CMS fee schedule,282.09,150% of CMS fee schedule,155.38,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,332.87,100% of CMS fee schedule,216.9,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,180.5,100% of CMS fee schedule,448.6,100% of CMS fee schedule,N/A,not seperately reimbursable,775.2,100% of CMS fee schedule,775.2,100% of CMS fee schedule,154.45,775.2,193.07
Outpatient Medical Services,AMBULATORY SURGERY,45380,45380 - PF Colonoscopy w/ Bx Sngl/Mult,960,419.07,377.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,225.42,100% of CMS fee schedule,167.63,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,192.01,100% of CMS fee schedule,242.63,100% of CMS fee schedule,N/A,not seperately reimbursable,272.89,100% of CMS fee schedule,272.89,100% of CMS fee schedule,304.83,150% of CMS fee schedule,304.83,150% of CMS fee schedule,186.45,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,359.7,100% of CMS fee schedule,232.06,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,225.42,100% of CMS fee schedule,505.34,100% of CMS fee schedule,N/A,not seperately reimbursable,923.44,100% of CMS fee schedule,923.44,100% of CMS fee schedule,167.63,923.44,209.54
Outpatient Medical Services,OUTPATIENT SERVICES,45385,45385- Colonoscopy/snare rmv/tumor/polyp,983,530.98,477.88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.08,100% of CMS fee schedule,212.39,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,243.28,100% of CMS fee schedule,307.99,100% of CMS fee schedule,N/A,not seperately reimbursable,346.41,100% of CMS fee schedule,346.41,100% of CMS fee schedule,387.35,150% of CMS fee schedule,387.35,150% of CMS fee schedule,221.04,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,457.06,100% of CMS fee schedule,294.86,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.08,100% of CMS fee schedule,559.54,100% of CMS fee schedule,N/A,not seperately reimbursable,1042.44,100% of CMS fee schedule,1042.44,100% of CMS fee schedule,212.39,1042.44,265.49
Outpatient Medical Services,OUTPATIENT SERVICES,45385,45385 - PF Colsc Flx w/ Rmvl Of Tumor Polup Lesion Snare Tq,960,530.98,477.88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.08,100% of CMS fee schedule,212.39,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,243.28,100% of CMS fee schedule,307.99,100% of CMS fee schedule,N/A,not seperately reimbursable,346.41,100% of CMS fee schedule,346.41,100% of CMS fee schedule,387.35,150% of CMS fee schedule,387.35,150% of CMS fee schedule,221.04,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,457.06,100% of CMS fee schedule,294.86,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,268.08,100% of CMS fee schedule,559.54,100% of CMS fee schedule,N/A,not seperately reimbursable,1042.44,100% of CMS fee schedule,1042.44,100% of CMS fee schedule,212.39,1042.44,265.49
Outpatient Medical Services,OUTPATIENT SERVICES,45391,45391 COLONOSCOPY W/ENDOSCOPE US,960,537.23,483.51,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.29,100% of CMS fee schedule,214.89,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,246.2,100% of CMS fee schedule,311.35,100% of CMS fee schedule,N/A,not seperately reimbursable,350.18,100% of CMS fee schedule,350.18,100% of CMS fee schedule,390.96,150% of CMS fee schedule,390.96,150% of CMS fee schedule,214.84,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,461.33,100% of CMS fee schedule,294.86,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,219.29,100% of CMS fee schedule,354.05,100% of CMS fee schedule,N/A,not seperately reimbursable,605.88,100% of CMS fee schedule,605.88,100% of CMS fee schedule,214.84,605.88,268.62
Outpatient Medical Services,OUTPATIENT SERVICES,47562,47562- Cholecystectomy/laparoscopy,983,1434.52,1291.07,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,589.35,100% of CMS fee schedule,573.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,654.72,100% of CMS fee schedule,1011.61,100% of CMS fee schedule,N/A,not seperately reimbursable,1137.79,100% of CMS fee schedule,1137.79,100% of CMS fee schedule,1024.11,150% of CMS fee schedule,1024.11,150% of CMS fee schedule,531.59,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1208.45,100% of CMS fee schedule,866.52,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,589.35,100% of CMS fee schedule,844.5,100% of CMS fee schedule,N/A,not seperately reimbursable,1515.72,100% of CMS fee schedule,1515.72,100% of CMS fee schedule,531.59,1515.72,717.26
Outpatient Medical Services,OUTPATIENT SERVICES,47562,47562 - PF Laparoscopy Surg Cholecystectomy,960,1434.52,1291.07,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,589.35,100% of CMS fee schedule,573.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,654.72,100% of CMS fee schedule,1011.61,100% of CMS fee schedule,N/A,not seperately reimbursable,1137.79,100% of CMS fee schedule,1137.79,100% of CMS fee schedule,1024.11,150% of CMS fee schedule,1024.11,150% of CMS fee schedule,531.59,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1208.45,100% of CMS fee schedule,866.52,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,589.35,100% of CMS fee schedule,844.5,100% of CMS fee schedule,N/A,not seperately reimbursable,1515.72,100% of CMS fee schedule,1515.72,100% of CMS fee schedule,531.59,1515.72,717.26
Outpatient Medical Services,OUTPATIENT SERVICES,49505,"49505- Repair initial inguinal hernia, age 5 years or older; reducible",960,1132.78,1019.5,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1217.62,140% of CIGNA fee schedule,317.5,100% of CMS fee schedule,453.11,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,517.14,100% of CMS fee schedule,799.69,100% of CMS fee schedule,N/A,not seperately reimbursable,899.44,100% of CMS fee schedule,899.44,100% of CMS fee schedule,805.31,150% of CMS fee schedule,805.31,150% of CMS fee schedule,420.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,950.26,100% of CMS fee schedule,675.6,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,317.5,100% of CMS fee schedule,539.45,100% of CMS fee schedule,N/A,not seperately reimbursable,1048.56,100% of CMS fee schedule,1048.56,100% of CMS fee schedule,317.5,1217.62,566.39
Outpatient Medical Services,OUTPATIENT SERVICES,49505,49505 - PF Rpr 1st Inguin Hrna Age 5 yrs/> Reducible,960,1132.78,1019.5,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1217.62,140% of CIGNA fee schedule,317.5,100% of CMS fee schedule,453.11,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,517.14,100% of CMS fee schedule,799.69,100% of CMS fee schedule,N/A,not seperately reimbursable,899.44,100% of CMS fee schedule,899.44,100% of CMS fee schedule,805.31,150% of CMS fee schedule,805.31,150% of CMS fee schedule,420.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,950.26,100% of CMS fee schedule,675.6,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,317.5,100% of CMS fee schedule,539.45,100% of CMS fee schedule,N/A,not seperately reimbursable,1048.56,100% of CMS fee schedule,1048.56,100% of CMS fee schedule,317.5,1217.62,566.39
Outpatient Medical Services,AMBULATORY SURGERY,55700,Read,972,275.81,248.23,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,595.04,140% of CIGNA fee schedule,89.5,100% of CMS fee schedule,110.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,126.34,100% of CMS fee schedule,186.69,100% of CMS fee schedule,N/A,not seperately reimbursable,209.98,100% of CMS fee schedule,209.98,100% of CMS fee schedule,200.16,150% of CMS fee schedule,200.16,150% of CMS fee schedule,104.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,236.19,100% of CMS fee schedule,153.02,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,100% of CMS fee schedule,300.69,100% of CMS fee schedule,N/A,not seperately reimbursable,420.92,100% of CMS fee schedule,420.92,100% of CMS fee schedule,89.5,595.04,137.91
Outpatient Medical Services,AMBULATORY SURGERY,55700,55700PF Bx Prostate Needle/Punch Single/Multiple Any Approach,960,275.81,248.23,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,595.04,140% of CIGNA fee schedule,89.5,100% of CMS fee schedule,110.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,126.34,100% of CMS fee schedule,186.69,100% of CMS fee schedule,N/A,not seperately reimbursable,209.98,100% of CMS fee schedule,209.98,100% of CMS fee schedule,200.16,150% of CMS fee schedule,200.16,150% of CMS fee schedule,104.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,236.19,100% of CMS fee schedule,153.02,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.5,100% of CMS fee schedule,300.69,100% of CMS fee schedule,N/A,not seperately reimbursable,420.92,100% of CMS fee schedule,420.92,100% of CMS fee schedule,89.5,595.04,137.91
Outpatient Medical Services,OUTPATIENT SERVICES,55866,55866- Laparoscopy/surg/prostatect/robot,960,3557.08,3201.37,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1000,100% of CMS fee schedule,1422.83,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1158.82,100% of CMS fee schedule,2197.71,100% of CMS fee schedule,N/A,not seperately reimbursable,2471.84,100% of CMS fee schedule,2471.84,100% of CMS fee schedule,2206.83,150% of CMS fee schedule,2206.83,150% of CMS fee schedule,1273.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2604.06,100% of CMS fee schedule,1688.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1000,100% of CMS fee schedule,3010.1,100% of CMS fee schedule,N/A,not seperately reimbursable,3477.52,100% of CMS fee schedule,3477.52,100% of CMS fee schedule,1000,3477.52,1778.54
Outpatient Medical Services,OUTPATIENT SERVICES,55866,55866PF Laparoscopy Surgical Prostatectomy Retropubic Radical w/Nerve Sparing w/Robotic Assist,960,2529.4,2276.46,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1000,100% of CMS fee schedule,1011.76,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1158.82,100% of CMS fee schedule,2197.71,100% of CMS fee schedule,N/A,not seperately reimbursable,2471.84,100% of CMS fee schedule,2471.84,100% of CMS fee schedule,2206.83,150% of CMS fee schedule,2206.83,150% of CMS fee schedule,1273.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2529.4,100% of CMS fee schedule,1688.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,1000,100% of CMS fee schedule,3010.1,100% of CMS fee schedule,N/A,not seperately reimbursable,3477.52,100% of CMS fee schedule,3477.52,100% of CMS fee schedule,1000,3477.52,1264.70
Outpatient Medical Services,OUTPATIENT SERVICES,59400,59400- Obstetric care/routine,960,5261.25,4735.13,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4025,140% of CIGNA fee schedule,N/A,not seperately reimbursable,2104.5,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2400.06,100% of CMS fee schedule,2653.85,100% of CMS fee schedule,N/A,not seperately reimbursable,2984.87,100% of CMS fee schedule,2984.87,100% of CMS fee schedule,3275.18,150% of CMS fee schedule,3275.18,150% of CMS fee schedule,1578.38,70% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3624.52,100% of CMS fee schedule,2782.18,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2707.34,100% of CMS fee schedule,N/A,not seperately reimbursable,3893.68,100% of CMS fee schedule,3893.68,100% of CMS fee schedule,1578.38,4735.13,2630.63
Outpatient Medical Services,OUTPATIENT SERVICES,59510,59510- Total OB care/cesarean delivery,960,5888.23,5299.41,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4025,140% of CIGNA fee schedule,N/A,not seperately reimbursable,2355.29,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2683.77,100% of CMS fee schedule,2653.85,100% of CMS fee schedule,N/A,not seperately reimbursable,2984.87,100% of CMS fee schedule,2984.87,100% of CMS fee schedule,3647.4,150% of CMS fee schedule,3647.4,150% of CMS fee schedule,1766.47,70% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,4036.45,100% of CMS fee schedule,3151.02,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2720.86,100% of CMS fee schedule,N/A,not seperately reimbursable,4313.92,100% of CMS fee schedule,4313.92,100% of CMS fee schedule,1766.47,5299.41,2944.12
Outpatient Medical Services,OUTPATIENT SERVICES,59610,59610- Total OB care/VBAC,960,5555.92,5000.33,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2222.37,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2532.06,100% of CMS fee schedule,2792.3,100% of CMS fee schedule,N/A,not seperately reimbursable,3140.59,100% of CMS fee schedule,3140.59,100% of CMS fee schedule,3463.31,150% of CMS fee schedule,3463.31,150% of CMS fee schedule,1666.78,70% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,3832.72,100% of CMS fee schedule,3000.52,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,2723.36,100% of CMS fee schedule,N/A,not seperately reimbursable,4089.52,100% of CMS fee schedule,4089.52,100% of CMS fee schedule,1666.78,5000.33,2777.96
Outpatient Medical Services,AMBULATORY SURGERY,64483,64483- Inj/anes/steroid/lumbar/sacral/sng,960,231.78,208.6,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.04,100% of CMS fee schedule,92.71,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,106.32,100% of CMS fee schedule,158.96,100% of CMS fee schedule,N/A,not seperately reimbursable,178.79,100% of CMS fee schedule,178.79,100% of CMS fee schedule,167.43,150% of CMS fee schedule,167.43,150% of CMS fee schedule,100.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,197.56,100% of CMS fee schedule,124.15,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.04,100% of CMS fee schedule,347.26,100% of CMS fee schedule,N/A,not seperately reimbursable,432.48,100% of CMS fee schedule,432.48,100% of CMS fee schedule,92.71,432.48,115.89
Outpatient Medical Services,EMERGENCY ROOM,69209,69209-PF Remove Impacted Ear Wax Uni,981,30.23,27.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.09,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13.87,100% of CMS fee schedule,18.53,100% of CMS fee schedule,N/A,not seperately reimbursable,20.84,100% of CMS fee schedule,20.84,100% of CMS fee schedule,18.77,150% of CMS fee schedule,18.77,150% of CMS fee schedule,11.27,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.14,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.27,27.21,15.12
Outpatient Medical Services,RADIOLOGY,71045,Read,972,17.71,15.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.48,100% of CMS fee schedule,7.08,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.02,100% of CMS fee schedule,43.96,100% of CMS fee schedule,N/A,not seperately reimbursable,49.44,100% of CMS fee schedule,49.44,100% of CMS fee schedule,35.22,150% of CMS fee schedule,35.22,150% of CMS fee schedule,17.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20.51,140% of UHC fee schedule,N/A,not seperately reimbursable,20.51,140% of CMS fee schedule,20.51,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.48,100% of CMS fee schedule,21.22,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.08,49.44,8.86
Outpatient Medical Services,RADIOLOGY,71045,Read,972,17.71,15.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.48,100% of CMS fee schedule,7.08,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.02,100% of CMS fee schedule,43.96,100% of CMS fee schedule,N/A,not seperately reimbursable,49.44,100% of CMS fee schedule,49.44,100% of CMS fee schedule,35.22,150% of CMS fee schedule,35.22,150% of CMS fee schedule,17.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20.51,140% of UHC fee schedule,N/A,not seperately reimbursable,20.51,140% of CMS fee schedule,20.51,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.48,100% of CMS fee schedule,21.22,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.08,49.44,8.86
Outpatient Medical Services,RADIOLOGY,71046,Read,972,17.71,15.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.64,100% of CMS fee schedule,7.08,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,56.16,100% of CMS fee schedule,N/A,not seperately reimbursable,63.17,100% of CMS fee schedule,63.17,100% of CMS fee schedule,44.81,150% of CMS fee schedule,44.81,150% of CMS fee schedule,26.61,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.79,140% of UHC fee schedule,N/A,not seperately reimbursable,24.79,140% of CMS fee schedule,24.79,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.64,100% of CMS fee schedule,32.43,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.08,63.17,8.86
Outpatient Medical Services,RADIOLOGY,71046,Read,972,17.71,15.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.64,100% of CMS fee schedule,7.08,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,56.16,100% of CMS fee schedule,N/A,not seperately reimbursable,63.17,100% of CMS fee schedule,63.17,100% of CMS fee schedule,44.81,150% of CMS fee schedule,44.81,150% of CMS fee schedule,26.61,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.79,140% of UHC fee schedule,N/A,not seperately reimbursable,24.79,140% of CMS fee schedule,24.79,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.64,100% of CMS fee schedule,32.43,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,7.08,63.17,8.86
Outpatient Medical Services,RADIOLOGY,72170,72170-PF PELVIS AP,960,17.6,15.84,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.5,100% of CMS fee schedule,7.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.02,100% of CMS fee schedule,48.84,100% of CMS fee schedule,N/A,not seperately reimbursable,54.93,100% of CMS fee schedule,54.93,100% of CMS fee schedule,38.85,150% of CMS fee schedule,38.85,150% of CMS fee schedule,25.4,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.6,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.24,140% of UHC fee schedule,N/A,not seperately reimbursable,23.24,140% of CMS fee schedule,23.24,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,17.5,100% of CMS fee schedule,29,100% of CMS fee schedule,N/A,not seperately reimbursable,51.12,100% of CMS fee schedule,51.12,100% of CMS fee schedule,7.04,54.93,8.80
Outpatient Medical Services,RADIOLOGY,76536,Read,972,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76536,SCMP US Exam,972,693.83,624.45,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,277.53,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,72.27,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,127.04,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.23,140% of UHC fee schedule,N/A,not seperately reimbursable,97.23,140% of CMS fee schedule,97.23,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,72.27,624.45,346.92
Outpatient Medical Services,RADIOLOGY,76536,Read,972,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76536,SCMP US Exam,972,693.83,624.45,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,277.53,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,72.27,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,127.04,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.23,140% of UHC fee schedule,N/A,not seperately reimbursable,97.23,140% of CMS fee schedule,97.23,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,72.27,624.45,346.92
Outpatient Medical Services,RADIOLOGY,76536,SCMP US Exam,972,693.83,624.45,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,277.53,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,72.27,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,127.04,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.23,140% of UHC fee schedule,N/A,not seperately reimbursable,97.23,140% of CMS fee schedule,97.23,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,72.27,624.45,346.92
Outpatient Medical Services,RADIOLOGY,76536,76536-PF US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,981,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76536,Read,972,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76536,Read,972,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76536,Read,960,55.79,50.21,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,22.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,208.96,100% of CMS fee schedule,N/A,not seperately reimbursable,235.02,100% of CMS fee schedule,235.02,100% of CMS fee schedule,156.89,150% of CMS fee schedule,156.89,150% of CMS fee schedule,93.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,55.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,78.11,140% of UHC fee schedule,N/A,not seperately reimbursable,78.11,140% of CMS fee schedule,78.11,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.35,100% of CMS fee schedule,105,100% of CMS fee schedule,N/A,not seperately reimbursable,228.08,100% of CMS fee schedule,228.08,100% of CMS fee schedule,22.32,235.02,27.90
Outpatient Medical Services,RADIOLOGY,76700,Read,972,79.79,71.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,31.92,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,31.92,263.47,39.90
Outpatient Medical Services,RADIOLOGY,76700,Read,983,79.79,71.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,31.92,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,31.92,263.47,39.90
Outpatient Medical Services,RADIOLOGY,76700,Read,972,79.79,71.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,31.92,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,31.92,263.47,39.90
Outpatient Medical Services,RADIOLOGY,76700,Read,983,79.79,71.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,31.92,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,31.92,263.47,39.90
Outpatient Medical Services,RADIOLOGY,76700,SCSN US Exam,983,638.04,574.24,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,255.22,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,118.83,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,67.83,574.24,319.02
Outpatient Medical Services,RADIOLOGY,76700,"76700 (26) Ultrasound, abdominal, real time with image documentation; complete",983,79.79,71.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,31.92,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.83,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,168.53,150% of CMS fee schedule,168.53,150% of CMS fee schedule,102.56,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.99,140% of UHC fee schedule,N/A,not seperately reimbursable,90.99,140% of CMS fee schedule,90.99,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.27,100% of CMS fee schedule,119,100% of CMS fee schedule,N/A,not seperately reimbursable,263.47,100% of CMS fee schedule,263.47,100% of CMS fee schedule,31.92,263.47,39.90
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,972,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,"76705 (26) Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, qua",960,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,76705-PF US ABDOMINAL REAL TIME W/IMAGE LIMITED,981,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,960,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76705,Read,960,57.96,52.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,23.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,51.37,100% of CMS fee schedule,164.23,100% of CMS fee schedule,N/A,not seperately reimbursable,184.71,100% of CMS fee schedule,184.71,100% of CMS fee schedule,124.64,150% of CMS fee schedule,124.64,150% of CMS fee schedule,76.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57.96,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.3,140% of UHC fee schedule,N/A,not seperately reimbursable,69.3,140% of CMS fee schedule,69.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.5,100% of CMS fee schedule,102.51,100% of CMS fee schedule,N/A,not seperately reimbursable,200.55,100% of CMS fee schedule,200.55,100% of CMS fee schedule,23.18,200.55,28.98
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,972,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76770,Read,960,73.5,66.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,29.4,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.4,100% of CMS fee schedule,203.84,100% of CMS fee schedule,N/A,not seperately reimbursable,229.27,100% of CMS fee schedule,229.27,100% of CMS fee schedule,154.56,150% of CMS fee schedule,154.56,150% of CMS fee schedule,98.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,73.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.9,140% of UHC fee schedule,N/A,not seperately reimbursable,85.9,140% of CMS fee schedule,85.9,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.5,100% of CMS fee schedule,111,100% of CMS fee schedule,N/A,not seperately reimbursable,247.74,100% of CMS fee schedule,247.74,100% of CMS fee schedule,29.4,247.74,36.75
Outpatient Medical Services,RADIOLOGY,76801,76801 Ob us < 14 wks single fetus,983,97.78,88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,84.09,100% of CMS fee schedule,39.11,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,61.11,100% of CMS fee schedule,210.63,100% of CMS fee schedule,N/A,not seperately reimbursable,236.9,100% of CMS fee schedule,236.9,100% of CMS fee schedule,168.99,150% of CMS fee schedule,168.99,150% of CMS fee schedule,101.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.78,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,81.79,140% of UHC fee schedule,N/A,not seperately reimbursable,81.79,140% of CMS fee schedule,81.79,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,84.09,100% of CMS fee schedule,133,100% of CMS fee schedule,N/A,not seperately reimbursable,239.22,100% of CMS fee schedule,239.22,100% of CMS fee schedule,39.11,239.22,48.89
Outpatient Medical Services,RADIOLOGY,76805,76805 Ob us >/= 14 wks sngl fetus,983,98.41,88.57,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77.5,100% of CMS fee schedule,39.36,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.7,100% of CMS fee schedule,241.16,100% of CMS fee schedule,N/A,not seperately reimbursable,271.24,100% of CMS fee schedule,271.24,100% of CMS fee schedule,192.18,150% of CMS fee schedule,192.18,150% of CMS fee schedule,114.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,98.41,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,102.3,140% of UHC fee schedule,N/A,not seperately reimbursable,102.3,140% of CMS fee schedule,102.3,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77.5,100% of CMS fee schedule,144.93,100% of CMS fee schedule,N/A,not seperately reimbursable,279.2,100% of CMS fee schedule,279.2,100% of CMS fee schedule,39.36,279.2,49.21
Outpatient Medical Services,RADIOLOGY,76815,76815 Ob us limited fetus(s),983,64.17,57.75,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64,100% of CMS fee schedule,25.67,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,43.64,100% of CMS fee schedule,144.69,100% of CMS fee schedule,N/A,not seperately reimbursable,162.74,100% of CMS fee schedule,162.74,100% of CMS fee schedule,115.83,150% of CMS fee schedule,115.83,150% of CMS fee schedule,70.37,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,58.76,140% of UHC fee schedule,N/A,not seperately reimbursable,58.76,140% of CMS fee schedule,58.76,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64,100% of CMS fee schedule,116,100% of CMS fee schedule,N/A,not seperately reimbursable,169.75,100% of CMS fee schedule,169.75,100% of CMS fee schedule,25.67,169.75,32.09
Outpatient Medical Services,RADIOLOGY,76815,76815-PF US PREGNANT UTERUS LIMITED 1/> FETUSES,981,64.17,57.75,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64,100% of CMS fee schedule,25.67,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,43.64,100% of CMS fee schedule,144.69,100% of CMS fee schedule,N/A,not seperately reimbursable,162.74,100% of CMS fee schedule,162.74,100% of CMS fee schedule,115.83,150% of CMS fee schedule,115.83,150% of CMS fee schedule,70.37,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,58.76,140% of UHC fee schedule,N/A,not seperately reimbursable,58.76,140% of CMS fee schedule,58.76,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,64,100% of CMS fee schedule,116,100% of CMS fee schedule,N/A,not seperately reimbursable,169.75,100% of CMS fee schedule,169.75,100% of CMS fee schedule,25.67,169.75,32.09
Outpatient Medical Services,RADIOLOGY,76816,76816 Ob us follow-up per fetus,983,83.87,75.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,72.28,100% of CMS fee schedule,33.55,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,60.25,100% of CMS fee schedule,194.76,100% of CMS fee schedule,N/A,not seperately reimbursable,219.05,100% of CMS fee schedule,219.05,100% of CMS fee schedule,155.42,150% of CMS fee schedule,155.42,150% of CMS fee schedule,93.02,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,83.87,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.23,140% of UHC fee schedule,N/A,not seperately reimbursable,80.23,140% of CMS fee schedule,80.23,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,72.28,100% of CMS fee schedule,108,100% of CMS fee schedule,N/A,not seperately reimbursable,225.46,100% of CMS fee schedule,225.46,100% of CMS fee schedule,33.55,225.46,41.94
Outpatient Medical Services,RADIOLOGY,76817,76817-PF US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,981,74.5,67.05,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,87.59,100% of CMS fee schedule,29.8,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.37,100% of CMS fee schedule,164.84,100% of CMS fee schedule,N/A,not seperately reimbursable,185.4,100% of CMS fee schedule,185.4,100% of CMS fee schedule,131.91,150% of CMS fee schedule,131.91,150% of CMS fee schedule,78.03,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,66.18,140% of UHC fee schedule,N/A,not seperately reimbursable,66.18,140% of CMS fee schedule,66.18,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,87.59,100% of CMS fee schedule,120,100% of CMS fee schedule,N/A,not seperately reimbursable,192.69,100% of CMS fee schedule,192.69,100% of CMS fee schedule,29.8,192.69,37.25
Outpatient Medical Services,RADIOLOGY,76830,76830-PF US TRANSVAGINAL,981,68.29,61.46,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.5,100% of CMS fee schedule,27.32,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,68.29,100% of CMS fee schedule,221.74,100% of CMS fee schedule,N/A,not seperately reimbursable,249.4,100% of CMS fee schedule,249.4,100% of CMS fee schedule,167.18,150% of CMS fee schedule,167.18,150% of CMS fee schedule,98.06,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,68.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,95.61,140% of UHC fee schedule,N/A,not seperately reimbursable,95.61,140% of CMS fee schedule,95.61,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.5,100% of CMS fee schedule,130,100% of CMS fee schedule,N/A,not seperately reimbursable,236.6,100% of CMS fee schedule,236.6,100% of CMS fee schedule,27.32,249.4,34.15
Outpatient Medical Services,RADIOLOGY,76856,Read,972,67.68,60.91,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.5,100% of CMS fee schedule,27.07,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,63.11,100% of CMS fee schedule,197.46,100% of CMS fee schedule,N/A,not seperately reimbursable,222.09,100% of CMS fee schedule,222.09,100% of CMS fee schedule,149.54,150% of CMS fee schedule,149.54,150% of CMS fee schedule,88.45,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85.13,140% of UHC fee schedule,N/A,not seperately reimbursable,85.13,140% of CMS fee schedule,85.13,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.5,100% of CMS fee schedule,130,100% of CMS fee schedule,N/A,not seperately reimbursable,234.63,100% of CMS fee schedule,234.63,100% of CMS fee schedule,27.07,234.63,33.84
Outpatient Medical Services,RADIOLOGY,76857,Read,972,48.63,43.77,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,19.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.75,100% of CMS fee schedule,87.55,100% of CMS fee schedule,N/A,not seperately reimbursable,98.47,100% of CMS fee schedule,98.47,100% of CMS fee schedule,68.07,150% of CMS fee schedule,68.07,150% of CMS fee schedule,47.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,34.63,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.43,140% of UHC fee schedule,N/A,not seperately reimbursable,31.43,140% of CMS fee schedule,31.43,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,92.5,100% of CMS fee schedule,N/A,not seperately reimbursable,180.24,100% of CMS fee schedule,180.24,100% of CMS fee schedule,19.45,180.24,24.32
Outpatient Medical Services,RADIOLOGY,76857,Read,972,48.63,43.77,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,19.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.75,100% of CMS fee schedule,87.55,100% of CMS fee schedule,N/A,not seperately reimbursable,98.47,100% of CMS fee schedule,98.47,100% of CMS fee schedule,68.07,150% of CMS fee schedule,68.07,150% of CMS fee schedule,47.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,34.63,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.43,140% of UHC fee schedule,N/A,not seperately reimbursable,31.43,140% of CMS fee schedule,31.43,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,92.5,100% of CMS fee schedule,N/A,not seperately reimbursable,180.24,100% of CMS fee schedule,180.24,100% of CMS fee schedule,19.45,180.24,24.32
Outpatient Medical Services,RADIOLOGY,76857,Read,972,48.63,43.77,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,19.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.75,100% of CMS fee schedule,87.55,100% of CMS fee schedule,N/A,not seperately reimbursable,98.47,100% of CMS fee schedule,98.47,100% of CMS fee schedule,68.07,150% of CMS fee schedule,68.07,150% of CMS fee schedule,47.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,34.63,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.43,140% of UHC fee schedule,N/A,not seperately reimbursable,31.43,140% of CMS fee schedule,31.43,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,92.5,100% of CMS fee schedule,N/A,not seperately reimbursable,180.24,100% of CMS fee schedule,180.24,100% of CMS fee schedule,19.45,180.24,24.32
Outpatient Medical Services,RADIOLOGY,76857,Read,972,48.63,43.77,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,19.45,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,22.75,100% of CMS fee schedule,87.55,100% of CMS fee schedule,N/A,not seperately reimbursable,98.47,100% of CMS fee schedule,98.47,100% of CMS fee schedule,68.07,150% of CMS fee schedule,68.07,150% of CMS fee schedule,47.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,34.63,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.43,140% of UHC fee schedule,N/A,not seperately reimbursable,31.43,140% of CMS fee schedule,31.43,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32,100% of CMS fee schedule,92.5,100% of CMS fee schedule,N/A,not seperately reimbursable,180.24,100% of CMS fee schedule,180.24,100% of CMS fee schedule,19.45,180.24,24.32
Outpatient Medical Services,RADIOLOGY,76870,76870PF Us exam scrotum,972,62.82,56.54,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74,100% of CMS fee schedule,25.13,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,60.53,100% of CMS fee schedule,189.15,100% of CMS fee schedule,N/A,not seperately reimbursable,212.74,100% of CMS fee schedule,212.74,100% of CMS fee schedule,143.13,150% of CMS fee schedule,143.13,150% of CMS fee schedule,67.4,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,62.82,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,82,140% of UHC fee schedule,N/A,not seperately reimbursable,82,140% of CMS fee schedule,82,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74,100% of CMS fee schedule,113,100% of CMS fee schedule,N/A,not seperately reimbursable,232.01,100% of CMS fee schedule,232.01,100% of CMS fee schedule,25.13,232.01,31.41
Outpatient Medical Services,RADIOLOGY,77065,77065 (26) - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,983,80.42,72.38,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,102.41,100% of CMS fee schedule,32.17,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75.13,100% of CMS fee schedule,212.23,100% of CMS fee schedule,N/A,not seperately reimbursable,238.7,100% of CMS fee schedule,238.7,100% of CMS fee schedule,182.91,150% of CMS fee schedule,182.91,150% of CMS fee schedule,105.85,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,103.08,140% of UHC fee schedule,N/A,not seperately reimbursable,103.08,140% of CMS fee schedule,103.08,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,102.41,100% of CMS fee schedule,142.44,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.17,238.7,40.21
Outpatient Medical Services,RADIOLOGY,77066,77066 - Dx Mammo Incl Cad Bil,983,98.84,88.96,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,129.85,100% of CMS fee schedule,39.54,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,96.45,100% of CMS fee schedule,267.25,100% of CMS fee schedule,N/A,not seperately reimbursable,300.59,100% of CMS fee schedule,300.59,100% of CMS fee schedule,229.85,150% of CMS fee schedule,229.85,150% of CMS fee schedule,134.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,98.84,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,131.19,140% of UHC fee schedule,N/A,not seperately reimbursable,131.19,140% of CMS fee schedule,131.19,140% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,129.85,100% of CMS fee schedule,180.32,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,39.54,300.59,49.42
Outpatient Medical Services,LAB,80307,611S Steroid Testing,300,106,95.4,90% of total billed charges,62.14,100% of CMS fee schedule,84.8,80% of total billed charges,62.14,100% of CMS fee schedule,95.4,90% of total billed charges,70.24,100% of CMS fee schedule,102.82,97% of total billed charges,62.14,100% of CMS fee schedule,97.52,92% of total billed charges,62.14,100% of CMS fee schedule,252.07, 405.66% of CMS fee schedule,62.14,100% of CMS fee schedule,307.11,494.23% of CMS fee schedule,284.93, 458.54% of CMS fee schedule,95.4,90% of total billed charges,62.14,100% of CMS fee schedule,74.2,70% of total billed charges,95.4,90% of total billed charges,100.7,95% of total billed charges,100.7,95% of total billed charges,62.14,100% of CMS fee schedule,124.28,200% of CMS fee schedule,91.16,86% of total billed charges,84.8,80% of total billed charges,68.97,111% of CMS fee schedule,102.82,97% of total billed charges,95.4,90% of total billed charges,N/A,not seperately reimbursable,102.82,97% of total billed charges,98.58,93% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,63.85,100% of CMS fee schedule,102.82,97% of total billed charges,62.14,100% of CMS fee schedule,62.14,100% of CMS fee schedule,52.81,85% of CMS fee schedule,52.81,307.11,53.00
Outpatient Medical Services,EMERGENCY ROOM,90471,90471-PF IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,981,40.64,36.58,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.26,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18.67,100% of CMS fee schedule,20.8,100% of CMS fee schedule,N/A,not seperately reimbursable,23.39,100% of CMS fee schedule,23.39,100% of CMS fee schedule,20.09,150% of CMS fee schedule,21.66,150% of CMS fee schedule,12.19,70% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,21,100% of CMS fee schedule,N/A,not seperately reimbursable,38.77,100% of CMS fee schedule,38.77,100% of CMS fee schedule,12.19,38.77,20.32
Outpatient Medical Services,BEHAVIORAL,90832,"90832- Psychotherapy, 30 Minutes",983,202.09,181.88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.84,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,67.65,100% of CMS fee schedule,68.27,100% of CMS fee schedule,N/A,not seperately reimbursable,76.79,100% of CMS fee schedule,76.79,100% of CMS fee schedule,95,150% of CMS fee schedule,95,150% of CMS fee schedule,66.66,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,38,pays based on per visit rate,38,pays based on per visit rate,66.77,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,56.93,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,38,181.88,101.05
Outpatient Medical Services,BEHAVIORAL,90834,"90834- Psychotherapy, 45 Minutes",983,266.6,239.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,106.64,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.34,100% of CMS fee schedule,91.04,100% of CMS fee schedule,N/A,not seperately reimbursable,102.39,100% of CMS fee schedule,102.39,100% of CMS fee schedule,126.66,150% of CMS fee schedule,126.66,150% of CMS fee schedule,88.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57,pays based on per visit rate,57,pays based on per visit rate,89.14,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,57,239.94,133.30
Outpatient Medical Services,BEHAVIORAL,90837,90837- Psychotherapy Add-on,983,390.97,351.87,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,156.39,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,131.89,100% of CMS fee schedule,136.17,100% of CMS fee schedule,N/A,not seperately reimbursable,153.15,100% of CMS fee schedule,153.15,100% of CMS fee schedule,189.32,150% of CMS fee schedule,189.32,150% of CMS fee schedule,132.66,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75,pays based on per visit rate,75,pays based on per visit rate,132.45,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,108.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75,351.87,195.49
Outpatient Medical Services,BEHAVIORAL,90837,"90837- Psychotherapy, 60 Minutes",983,390.97,351.87,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,156.39,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,131.89,100% of CMS fee schedule,136.17,100% of CMS fee schedule,N/A,not seperately reimbursable,153.15,100% of CMS fee schedule,153.15,100% of CMS fee schedule,189.32,150% of CMS fee schedule,189.32,150% of CMS fee schedule,132.66,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75,pays based on per visit rate,75,pays based on per visit rate,132.45,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,108.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,75,351.87,195.49
Outpatient Medical Services,BEHAVIORAL,90846,90846- Family Therapy W/O Patient,960,258.43,232.59,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,103.37,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,96.23,100% of CMS fee schedule,109.94,100% of CMS fee schedule,N/A,not seperately reimbursable,123.65,100% of CMS fee schedule,123.65,100% of CMS fee schedule,152.7,150% of CMS fee schedule,152.7,150% of CMS fee schedule,104.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77,pays based on per visit rate,77,pays based on per visit rate,106.83,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,105.69,100% of CMS fee schedule,N/A,not seperately reimbursable,136.28,100% of CMS fee schedule,136.28,100% of CMS fee schedule,77,232.59,129.22
Outpatient Medical Services,BEHAVIORAL,90846,"90846- Family, Couples Psychotherapy W/O Patient",960,258.43,232.59,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,103.37,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,96.23,100% of CMS fee schedule,109.94,100% of CMS fee schedule,N/A,not seperately reimbursable,123.65,100% of CMS fee schedule,123.65,100% of CMS fee schedule,152.7,150% of CMS fee schedule,152.7,150% of CMS fee schedule,104.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77,pays based on per visit rate,77,pays based on per visit rate,106.83,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,105.69,100% of CMS fee schedule,N/A,not seperately reimbursable,136.28,100% of CMS fee schedule,136.28,100% of CMS fee schedule,77,232.59,129.22
Outpatient Medical Services,BEHAVIORAL,90847,90847- Family Therapy with Patient,960,267.63,240.87,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,107.05,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,100.46,100% of CMS fee schedule,114.18,100% of CMS fee schedule,N/A,not seperately reimbursable,128.42,100% of CMS fee schedule,128.42,100% of CMS fee schedule,158.58,150% of CMS fee schedule,158.58,150% of CMS fee schedule,106.51,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77,pays based on per visit rate,77,pays based on per visit rate,110.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,113.84,100% of CMS fee schedule,N/A,not seperately reimbursable,170.49,100% of CMS fee schedule,170.49,100% of CMS fee schedule,77,240.87,133.82
Outpatient Medical Services,BEHAVIORAL,90847,"90847- Family, Couples Psychotherapy With Patient",960,267.63,240.87,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,107.05,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,100.46,100% of CMS fee schedule,114.18,100% of CMS fee schedule,N/A,not seperately reimbursable,128.42,100% of CMS fee schedule,128.42,100% of CMS fee schedule,158.58,150% of CMS fee schedule,158.58,150% of CMS fee schedule,106.51,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,77,pays based on per visit rate,77,pays based on per visit rate,110.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,113.84,100% of CMS fee schedule,N/A,not seperately reimbursable,170.49,100% of CMS fee schedule,170.49,100% of CMS fee schedule,77,240.87,133.82
Outpatient Medical Services,BEHAVIORAL,90853,90853- Group Therapy,960,70.71,63.64,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,28.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,23.77,100% of CMS fee schedule,27,100% of CMS fee schedule,N/A,not seperately reimbursable,30.37,100% of CMS fee schedule,30.37,100% of CMS fee schedule,37.47,150% of CMS fee schedule,37.47,150% of CMS fee schedule,23.93,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,27,pays based on per visit rate,27,pays based on per visit rate,25.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,45.44,100% of CMS fee schedule,N/A,not seperately reimbursable,53.6,100% of CMS fee schedule,53.6,100% of CMS fee schedule,23.77,63.64,35.36
Outpatient Medical Services,EMERGENCY ROOM,92950,92950-PF Cardiopulmonary Resuscitation,981,390.34,351.31,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,156.14,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,178.92,100% of CMS fee schedule,273.99,100% of CMS fee schedule,N/A,not seperately reimbursable,308.17,100% of CMS fee schedule,308.17,100% of CMS fee schedule,287.87,150% of CMS fee schedule,287.87,150% of CMS fee schedule,146.23,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,259.07,100% of CMS fee schedule,218.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,201.26,100% of CMS fee schedule,N/A,not seperately reimbursable,471.56,100% of CMS fee schedule,471.56,100% of CMS fee schedule,146.23,471.56,195.17
Outpatient Medical Services,CARDIAC,93306,"93306- Transthoracic Echo (TTE) Complete, w/2D, Doppler & Color (PRO FEE)",960,142.03,127.83,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,141.02,100% of CMS fee schedule,56.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,111.19,100% of CMS fee schedule,252.74,100% of CMS fee schedule,N/A,not seperately reimbursable,284.27,100% of CMS fee schedule,284.27,100% of CMS fee schedule,284.96,150% of CMS fee schedule,284.96,150% of CMS fee schedule,205.69,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,142.03,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,141.02,100% of CMS fee schedule,304,100% of CMS fee schedule,N/A,not seperately reimbursable,305.63,100% of CMS fee schedule,305.63,100% of CMS fee schedule,56.81,305.63,71.02
Outpatient Medical Services,CARDIAC,93452,93452- Lt heart cath/LV gram,960,502.79,452.51,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,201.12,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.79,100% of CMS fee schedule,1418.44,100% of CMS fee schedule,N/A,not seperately reimbursable,1595.36,100% of CMS fee schedule,1595.36,100% of CMS fee schedule,1254.62,150% of CMS fee schedule,1254.62,150% of CMS fee schedule,715.24,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,766.49,100% of CMS fee schedule,N/A,not seperately reimbursable,1422.65,100% of CMS fee schedule,1422.65,100% of CMS fee schedule,201.12,1595.36,251.40
Outpatient Medical Services,CARDIAC,93452,"93452-PF LHC, LV only",960,502.79,452.51,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,201.12,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.79,100% of CMS fee schedule,1418.44,100% of CMS fee schedule,N/A,not seperately reimbursable,1595.36,100% of CMS fee schedule,1595.36,100% of CMS fee schedule,1254.62,150% of CMS fee schedule,1254.62,150% of CMS fee schedule,715.24,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,502.79,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,766.49,100% of CMS fee schedule,N/A,not seperately reimbursable,1422.65,100% of CMS fee schedule,1422.65,100% of CMS fee schedule,201.12,1595.36,251.40
Outpatient Medical Services,CARDIAC,93458,93458- Lt Heart cath/LV/cors,960,627.09,564.38,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,250.84,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,1664.79,100% of CMS fee schedule,N/A,not seperately reimbursable,1872.44,100% of CMS fee schedule,1872.44,100% of CMS fee schedule,1476.98,150% of CMS fee schedule,1476.98,150% of CMS fee schedule,890.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,953.69,100% of CMS fee schedule,N/A,not seperately reimbursable,1770.47,100% of CMS fee schedule,1770.47,100% of CMS fee schedule,250.84,1872.44,313.55
Outpatient Medical Services,CARDIAC,93458,93458-Selective Coronary Angio (SCA) w/Left Heart Cath (LHC),960,627.09,564.38,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,250.84,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,1664.79,100% of CMS fee schedule,N/A,not seperately reimbursable,1872.44,100% of CMS fee schedule,1872.44,100% of CMS fee schedule,1476.98,150% of CMS fee schedule,1476.98,150% of CMS fee schedule,890.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,953.69,100% of CMS fee schedule,N/A,not seperately reimbursable,1770.47,100% of CMS fee schedule,1770.47,100% of CMS fee schedule,250.84,1872.44,313.55
Outpatient Medical Services,CARDIAC,93458,"93458-PF LEFT HEART CATH, LV, COR",960,627.09,564.38,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,250.84,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,1664.79,100% of CMS fee schedule,N/A,not seperately reimbursable,1872.44,100% of CMS fee schedule,1872.44,100% of CMS fee schedule,1476.98,150% of CMS fee schedule,1476.98,150% of CMS fee schedule,890.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,627.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,953.69,100% of CMS fee schedule,N/A,not seperately reimbursable,1770.47,100% of CMS fee schedule,1770.47,100% of CMS fee schedule,250.84,1872.44,313.55
Outpatient Medical Services,RADIOLOGY,93880,Read,972,80.09,72.08,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,32.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,360.41,100% of CMS fee schedule,N/A,not seperately reimbursable,405.36,100% of CMS fee schedule,405.36,100% of CMS fee schedule,269.54,150% of CMS fee schedule,269.54,150% of CMS fee schedule,162.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,327,100% of CMS fee schedule,N/A,not seperately reimbursable,392.3,100% of CMS fee schedule,392.3,100% of CMS fee schedule,32.04,405.36,40.05
Outpatient Medical Services,RADIOLOGY,93880,Read,972,80.09,72.08,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,32.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,360.41,100% of CMS fee schedule,N/A,not seperately reimbursable,405.36,100% of CMS fee schedule,405.36,100% of CMS fee schedule,269.54,150% of CMS fee schedule,269.54,150% of CMS fee schedule,162.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,327,100% of CMS fee schedule,N/A,not seperately reimbursable,392.3,100% of CMS fee schedule,392.3,100% of CMS fee schedule,32.04,405.36,40.05
Outpatient Medical Services,RADIOLOGY,93880,Read,972,80.09,72.08,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,32.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,360.41,100% of CMS fee schedule,N/A,not seperately reimbursable,405.36,100% of CMS fee schedule,405.36,100% of CMS fee schedule,269.54,150% of CMS fee schedule,269.54,150% of CMS fee schedule,162.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,327,100% of CMS fee schedule,N/A,not seperately reimbursable,392.3,100% of CMS fee schedule,392.3,100% of CMS fee schedule,32.04,405.36,40.05
Outpatient Medical Services,RADIOLOGY,93880,93880 - (26) Duplex scan of extracranial arteries; complete bilateral study,983,80.09,72.08,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,32.04,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,360.41,100% of CMS fee schedule,N/A,not seperately reimbursable,405.36,100% of CMS fee schedule,405.36,100% of CMS fee schedule,269.54,150% of CMS fee schedule,269.54,150% of CMS fee schedule,162.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,80.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,147.86,100% of CMS fee schedule,327,100% of CMS fee schedule,N/A,not seperately reimbursable,392.3,100% of CMS fee schedule,392.3,100% of CMS fee schedule,32.04,405.36,40.05
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,Read,972,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93926,93926 (26) Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited,960,49.02,44.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,19.61,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,270.94,100% of CMS fee schedule,N/A,not seperately reimbursable,304.74,100% of CMS fee schedule,304.74,100% of CMS fee schedule,202.05,150% of CMS fee schedule,202.05,150% of CMS fee schedule,108.47,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,49.02,100% of CMS fee schedule,134.62,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,97.16,100% of CMS fee schedule,129.8,100% of CMS fee schedule,N/A,not seperately reimbursable,330.15,100% of CMS fee schedule,330.15,100% of CMS fee schedule,19.61,330.15,24.51
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,Read,972,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,93970 (26) Duplex scan of extremity veins including responses to compression and other maneuvers; co,960,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93970,93970-PF Dup-Scan XTR Veins Complete Bilateral Study,983,69.42,62.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,27.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,352.1,100% of CMS fee schedule,N/A,not seperately reimbursable,396.02,100% of CMS fee schedule,396.02,100% of CMS fee schedule,262.74,150% of CMS fee schedule,262.74,150% of CMS fee schedule,158.01,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,69.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,146.66,100% of CMS fee schedule,273.5,100% of CMS fee schedule,N/A,not seperately reimbursable,411.68,100% of CMS fee schedule,411.68,100% of CMS fee schedule,27.77,411.68,34.71
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,Read,972,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,93971 (26) Duplex scan of extremity veins including responses to compression and other maneuvers; un,960,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,93971 - PF Duplex scan of extremity veins including responses to compression and other maneuvers; un,960,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,93971-PF DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,981,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93971,93971-PF Dup-Scan XTR Veins Unilat/Limited Study,983,44.12,39.71,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,17.65,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,219.82,100% of CMS fee schedule,N/A,not seperately reimbursable,247.24,100% of CMS fee schedule,247.24,100% of CMS fee schedule,163.92,150% of CMS fee schedule,163.92,150% of CMS fee schedule,96.2,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,44.12,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,99.8,100% of CMS fee schedule,180,100% of CMS fee schedule,N/A,not seperately reimbursable,268.56,100% of CMS fee schedule,268.56,100% of CMS fee schedule,17.65,268.56,22.06
Outpatient Medical Services,RADIOLOGY,93976,Read,972,79.42,71.48,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,131,100% of CMS fee schedule,31.77,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.42,100% of CMS fee schedule,296.51,100% of CMS fee schedule,N/A,not seperately reimbursable,333.49,100% of CMS fee schedule,333.49,100% of CMS fee schedule,222.93,150% of CMS fee schedule,222.93,150% of CMS fee schedule,161.85,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.42,100% of CMS fee schedule,151.22,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,131,100% of CMS fee schedule,213.52,100% of CMS fee schedule,N/A,not seperately reimbursable,343.26,100% of CMS fee schedule,343.26,100% of CMS fee schedule,31.77,343.26,39.71
Outpatient Medical Services,CARDIAC,94664,94664- Demo/eval/pt use aerosol/neb/IPPB,960,34.31,30.88,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.25,140% of CIGNA fee schedule,11.82,100% of CMS fee schedule,13.72,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,15.72,100% of CMS fee schedule,21.1,100% of CMS fee schedule,N/A,not seperately reimbursable,23.73,100% of CMS fee schedule,23.73,100% of CMS fee schedule,22.02,150% of CMS fee schedule,22.02,150% of CMS fee schedule,14,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,19.81,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.82,100% of CMS fee schedule,21.55,100% of CMS fee schedule,N/A,not seperately reimbursable,27.37,100% of CMS fee schedule,27.37,100% of CMS fee schedule,11.82,30.88,17.16
Outpatient Medical Services,EMERGENCY ROOM,96372,96372-PF Injection of drug/substance under skin or into muscle,983,28.82,25.94,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.7,100% of CMS fee schedule,11.53,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,13.23,100% of CMS fee schedule,15.45,100% of CMS fee schedule,N/A,not seperately reimbursable,17.38,100% of CMS fee schedule,17.38,100% of CMS fee schedule,20.09,150% of CMS fee schedule,20.09,150% of CMS fee schedule,15.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,18.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.7,100% of CMS fee schedule,23.42,100% of CMS fee schedule,N/A,not seperately reimbursable,38.77,100% of CMS fee schedule,38.77,100% of CMS fee schedule,11.53,38.77,14.41
Outpatient Medical Services,EMERGENCY ROOM,96374,96374-PF THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,981,70.96,63.86,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.02,100% of CMS fee schedule,28.38,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.59,100% of CMS fee schedule,42.87,100% of CMS fee schedule,N/A,not seperately reimbursable,48.22,100% of CMS fee schedule,48.22,100% of CMS fee schedule,53.31,150% of CMS fee schedule,53.31,150% of CMS fee schedule,43.57,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,47.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.02,100% of CMS fee schedule,53.64,100% of CMS fee schedule,N/A,not seperately reimbursable,85.53,100% of CMS fee schedule,85.53,100% of CMS fee schedule,28.38,85.53,35.48
Outpatient Medical Services,EMERGENCY ROOM,96374,PF Ther Proph/Dx Inj IVPush Sngl/1st Sbst/Drug,960,70.96,63.86,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.02,100% of CMS fee schedule,28.38,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,32.59,100% of CMS fee schedule,42.87,100% of CMS fee schedule,N/A,not seperately reimbursable,48.22,100% of CMS fee schedule,48.22,100% of CMS fee schedule,53.31,150% of CMS fee schedule,53.31,150% of CMS fee schedule,43.57,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,47.98,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,31.02,100% of CMS fee schedule,53.64,100% of CMS fee schedule,N/A,not seperately reimbursable,85.53,100% of CMS fee schedule,85.53,100% of CMS fee schedule,28.38,85.53,35.48
Outpatient Medical Services,THERAPY,97110,97110-PF Therapeutic Px 1/> Areas Each 15 Min Exercises,983,59.61,53.65,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.38,100% of CMS fee schedule,23.84,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,27.42,100% of CMS fee schedule,28.59,100% of CMS fee schedule,N/A,not seperately reimbursable,32.16,100% of CMS fee schedule,32.16,100% of CMS fee schedule,44.27,150% of CMS fee schedule,44.27,150% of CMS fee schedule,29.03,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,85,pays based on per visit rate,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.38,100% of CMS fee schedule,27.26,100% of CMS fee schedule,N/A,not seperately reimbursable,51.89,100% of CMS fee schedule,51.89,100% of CMS fee schedule,8.38,85,29.81
Outpatient Medical Services,AMBULATORY SURGERY,99152,"99152-PF Moderate Sedation, Initial 15 Minute",981,25.93,23.34,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,100% of CMS fee schedule,10.37,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.87,100% of CMS fee schedule,10.11,100% of CMS fee schedule,N/A,not seperately reimbursable,11.37,100% of CMS fee schedule,11.37,100% of CMS fee schedule,18.6,150% of CMS fee schedule,18.6,150% of CMS fee schedule,10.5,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.73,100% of CMS fee schedule,13.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,100% of CMS fee schedule,54.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,9.9,54.13,12.97
Outpatient Medical Services,AMBULATORY SURGERY,99153,"99153-PF Moderate Sedation, Each Add 15 Min",981,22.48,20.23,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,100% of CMS fee schedule,8.99,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,10.28,100% of CMS fee schedule,8.66,100% of CMS fee schedule,N/A,not seperately reimbursable,9.74,100% of CMS fee schedule,9.74,100% of CMS fee schedule,14.13,150% of CMS fee schedule,14.13,150% of CMS fee schedule,9.73,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,12.71,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,100% of CMS fee schedule,11.45,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,8.33,20.23,11.24
Outpatient Medical Services,VISIT,99203,99203- OCC Office/OP New SF 30 Minutes,983,173.32,155.99,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,154.1,140% of CIGNA fee schedule,54.25,100% of CMS fee schedule,69.33,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.46,100% of CMS fee schedule,78.4,100% of CMS fee schedule,N/A,not seperately reimbursable,88.18,100% of CMS fee schedule,88.18,100% of CMS fee schedule,113.03,150% of CMS fee schedule,113.03,150% of CMS fee schedule,77.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,101.71,100% of CMS fee schedule,84.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,54.25,100% of CMS fee schedule,108.1,100% of CMS fee schedule,N/A,not seperately reimbursable,156.5,100% of CMS fee schedule,156.5,100% of CMS fee schedule,54.25,156.5,86.66
Outpatient Medical Services,VISIT,99203,99203-PF Office/OP New SF MDM 30 Minutes,983,173.32,155.99,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,154.1,140% of CIGNA fee schedule,54.25,100% of CMS fee schedule,69.33,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,79.46,100% of CMS fee schedule,78.4,100% of CMS fee schedule,N/A,not seperately reimbursable,88.18,100% of CMS fee schedule,88.18,100% of CMS fee schedule,113.03,150% of CMS fee schedule,113.03,150% of CMS fee schedule,77.13,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,101.71,100% of CMS fee schedule,84.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,54.25,100% of CMS fee schedule,108.1,100% of CMS fee schedule,N/A,not seperately reimbursable,156.5,100% of CMS fee schedule,156.5,100% of CMS fee schedule,54.25,156.5,86.66
Outpatient Medical Services,VISIT,99204,99204- OCC Office/OP New SF 45 Minutes,983,281.28,253.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,237.94,140% of CIGNA fee schedule,90.37,100% of CMS fee schedule,112.51,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,129.01,100% of CMS fee schedule,134.09,100% of CMS fee schedule,N/A,not seperately reimbursable,150.82,100% of CMS fee schedule,150.82,100% of CMS fee schedule,193.26,150% of CMS fee schedule,193.26,150% of CMS fee schedule,130.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173.92,100% of CMS fee schedule,144,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.37,100% of CMS fee schedule,160.49,100% of CMS fee schedule,N/A,not seperately reimbursable,240,100% of CMS fee schedule,240,100% of CMS fee schedule,90.37,253.15,140.64
Outpatient Medical Services,VISIT,99204,99204-PF Office/OP New SF MDM 45 Minutes,983,281.28,253.15,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,237.94,140% of CIGNA fee schedule,90.37,100% of CMS fee schedule,112.51,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,129.01,100% of CMS fee schedule,134.09,100% of CMS fee schedule,N/A,not seperately reimbursable,150.82,100% of CMS fee schedule,150.82,100% of CMS fee schedule,193.26,150% of CMS fee schedule,193.26,150% of CMS fee schedule,130.42,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173.92,100% of CMS fee schedule,144,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.37,100% of CMS fee schedule,160.49,100% of CMS fee schedule,N/A,not seperately reimbursable,240,100% of CMS fee schedule,240,100% of CMS fee schedule,90.37,253.15,140.64
Outpatient Medical Services,VISIT,99205,99205- OCC Office/OP New SF 60 Minutes,983,382.35,344.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,301.45,140% of CIGNA fee schedule,117.54,100% of CMS fee schedule,152.94,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,175.35,100% of CMS fee schedule,175.13,100% of CMS fee schedule,N/A,not seperately reimbursable,196.97,100% of CMS fee schedule,196.97,100% of CMS fee schedule,252.21,150% of CMS fee schedule,252.21,150% of CMS fee schedule,170.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,226.98,100% of CMS fee schedule,187.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,117.54,100% of CMS fee schedule,200.56,100% of CMS fee schedule,N/A,not seperately reimbursable,297.5,100% of CMS fee schedule,297.5,100% of CMS fee schedule,117.54,344.12,191.18
Outpatient Medical Services,VISIT,99205,99205-PF Office/OP New SF MDM 60 Minutes,983,382.35,344.12,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,301.45,140% of CIGNA fee schedule,117.54,100% of CMS fee schedule,152.94,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,175.35,100% of CMS fee schedule,175.13,100% of CMS fee schedule,N/A,not seperately reimbursable,196.97,100% of CMS fee schedule,196.97,100% of CMS fee schedule,252.21,150% of CMS fee schedule,252.21,150% of CMS fee schedule,170.29,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,226.98,100% of CMS fee schedule,187.31,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,117.54,100% of CMS fee schedule,200.56,100% of CMS fee schedule,N/A,not seperately reimbursable,297.5,100% of CMS fee schedule,297.5,100% of CMS fee schedule,117.54,344.12,191.18
Outpatient Medical Services,OFFICE VISIT,99243,99243- Office Consult New/Est PT Low MDM Level 3 (30 min),983,585.55,527,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,179.4,140% of CIGNA fee schedule,76.93,100% of CMS fee schedule,234.22,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,84.87,100% of CMS fee schedule,120.9,100% of CMS fee schedule,N/A,not seperately reimbursable,135.98,100% of CMS fee schedule,135.98,100% of CMS fee schedule,144.84,150% of CMS fee schedule,144.84,150% of CMS fee schedule,97.38,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,130.35,100% of CMS fee schedule,106.83,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,76.93,100% of CMS fee schedule,136.45,100% of CMS fee schedule,N/A,not seperately reimbursable,176,100% of CMS fee schedule,176,100% of CMS fee schedule,76.93,527,292.78
Outpatient Medical Services,VISIT,99244,99244- Office Consult New/Est PT Mod MDM Level 4 (40 min),983,603.67,543.3,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,270.93,140% of CIGNA fee schedule,120.56,100% of CMS fee schedule,241.47,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,128.92,100% of CMS fee schedule,194.59,100% of CMS fee schedule,N/A,not seperately reimbursable,218.86,100% of CMS fee schedule,218.86,100% of CMS fee schedule,233.25,150% of CMS fee schedule,233.25,150% of CMS fee schedule,156.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,209.92,100% of CMS fee schedule,172.51,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,120.56,100% of CMS fee schedule,199.65,100% of CMS fee schedule,N/A,not seperately reimbursable,260,100% of CMS fee schedule,260,100% of CMS fee schedule,120.56,543.3,301.84
Outpatient Medical Services,VISIT,99244,99244-PF Office Consult New/Est PT Mod MDM Level 4 (40 min),983,603.67,543.3,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,270.93,140% of CIGNA fee schedule,120.56,100% of CMS fee schedule,241.47,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,128.92,100% of CMS fee schedule,194.59,100% of CMS fee schedule,N/A,not seperately reimbursable,218.86,100% of CMS fee schedule,218.86,100% of CMS fee schedule,233.25,150% of CMS fee schedule,233.25,150% of CMS fee schedule,156.8,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,209.92,100% of CMS fee schedule,172.51,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,120.56,100% of CMS fee schedule,199.65,100% of CMS fee schedule,N/A,not seperately reimbursable,260,100% of CMS fee schedule,260,100% of CMS fee schedule,120.56,543.3,301.84
Outpatient Medical Services,EMERGENCY ROOM,99281,99281- Emergency dept visit,983,24.67,22.2,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,9.87,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.3,100% of CMS fee schedule,28.36,100% of CMS fee schedule,N/A,not seperately reimbursable,31.9,100% of CMS fee schedule,31.9,100% of CMS fee schedule,34.47,150% of CMS fee schedule,34.47,150% of CMS fee schedule,22.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.67,100% of CMS fee schedule,26.35,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,27.49,100% of CMS fee schedule,N/A,not seperately reimbursable,31,100% of CMS fee schedule,31,100% of CMS fee schedule,9.87,34.47,12.34
Outpatient Medical Services,EMERGENCY ROOM,99281,99281-PF Emergency Room Brief W/Mod,981,24.67,22.2,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,9.87,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.3,100% of CMS fee schedule,28.36,100% of CMS fee schedule,N/A,not seperately reimbursable,31.9,100% of CMS fee schedule,31.9,100% of CMS fee schedule,34.47,150% of CMS fee schedule,34.47,150% of CMS fee schedule,22.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.67,100% of CMS fee schedule,26.35,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,27.49,100% of CMS fee schedule,N/A,not seperately reimbursable,31,100% of CMS fee schedule,31,100% of CMS fee schedule,9.87,34.47,12.34
Outpatient Medical Services,EMERGENCY ROOM,99281,99281-PF Emergency Room Brief,981,24.67,22.2,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,9.87,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,11.3,100% of CMS fee schedule,28.36,100% of CMS fee schedule,N/A,not seperately reimbursable,31.9,100% of CMS fee schedule,31.9,100% of CMS fee schedule,34.47,150% of CMS fee schedule,34.47,150% of CMS fee schedule,22.76,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,24.67,100% of CMS fee schedule,26.35,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,16.19,100% of CMS fee schedule,27.49,100% of CMS fee schedule,N/A,not seperately reimbursable,31,100% of CMS fee schedule,31,100% of CMS fee schedule,9.87,34.47,12.34
Outpatient Medical Services,EMERGENCY ROOM,99282,99282- Emergency dept visit,983,89.88,80.89,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,66.08,140% of CIGNA fee schedule,26.85,100% of CMS fee schedule,35.95,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,41.18,100% of CMS fee schedule,54.51,100% of CMS fee schedule,N/A,not seperately reimbursable,61.31,100% of CMS fee schedule,61.31,100% of CMS fee schedule,66.17,150% of CMS fee schedule,66.17,150% of CMS fee schedule,43.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,59.54,100% of CMS fee schedule,50.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,26.85,100% of CMS fee schedule,50.87,100% of CMS fee schedule,N/A,not seperately reimbursable,61,100% of CMS fee schedule,61,100% of CMS fee schedule,26.85,80.89,44.94
Outpatient Medical Services,EMERGENCY ROOM,99282,99282-PF Emer Room Routine W/Mod,981,89.88,80.89,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,66.08,140% of CIGNA fee schedule,26.85,100% of CMS fee schedule,35.95,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,41.18,100% of CMS fee schedule,54.51,100% of CMS fee schedule,N/A,not seperately reimbursable,61.31,100% of CMS fee schedule,61.31,100% of CMS fee schedule,66.17,150% of CMS fee schedule,66.17,150% of CMS fee schedule,43.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,59.54,100% of CMS fee schedule,50.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,26.85,100% of CMS fee schedule,50.87,100% of CMS fee schedule,N/A,not seperately reimbursable,61,100% of CMS fee schedule,61,100% of CMS fee schedule,26.85,80.89,44.94
Outpatient Medical Services,EMERGENCY ROOM,99282,99282-PF Emer Room Routine,981,89.88,80.89,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,66.08,140% of CIGNA fee schedule,26.85,100% of CMS fee schedule,35.95,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,41.18,100% of CMS fee schedule,54.51,100% of CMS fee schedule,N/A,not seperately reimbursable,61.31,100% of CMS fee schedule,61.31,100% of CMS fee schedule,66.17,150% of CMS fee schedule,66.17,150% of CMS fee schedule,43.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,59.54,100% of CMS fee schedule,50.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,26.85,100% of CMS fee schedule,50.87,100% of CMS fee schedule,N/A,not seperately reimbursable,61,100% of CMS fee schedule,61,100% of CMS fee schedule,26.85,80.89,44.94
Outpatient Medical Services,EMERGENCY ROOM,99283,99283- Emergency dept visit,983,153.12,137.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,98.97,140% of CIGNA fee schedule,35,100% of CMS fee schedule,61.25,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,70.15,100% of CMS fee schedule,81.55,100% of CMS fee schedule,N/A,not seperately reimbursable,91.72,100% of CMS fee schedule,91.72,100% of CMS fee schedule,99.11,150% of CMS fee schedule,99.11,150% of CMS fee schedule,65.25,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.19,100% of CMS fee schedule,75.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,35,100% of CMS fee schedule,86.47,100% of CMS fee schedule,N/A,not seperately reimbursable,91.5,100% of CMS fee schedule,91.5,100% of CMS fee schedule,35,137.81,76.56
Outpatient Medical Services,EMERGENCY ROOM,99283,99283-PF Emer Room Moderate W/Mod,981,153.12,137.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,98.97,140% of CIGNA fee schedule,35,100% of CMS fee schedule,61.25,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,70.15,100% of CMS fee schedule,81.55,100% of CMS fee schedule,N/A,not seperately reimbursable,91.72,100% of CMS fee schedule,91.72,100% of CMS fee schedule,99.11,150% of CMS fee schedule,99.11,150% of CMS fee schedule,65.25,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.19,100% of CMS fee schedule,75.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,35,100% of CMS fee schedule,86.47,100% of CMS fee schedule,N/A,not seperately reimbursable,91.5,100% of CMS fee schedule,91.5,100% of CMS fee schedule,35,137.81,76.56
Outpatient Medical Services,EMERGENCY ROOM,99283,99283-PF Emer Room Moderate,981,153.12,137.81,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,98.97,140% of CIGNA fee schedule,35,100% of CMS fee schedule,61.25,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,70.15,100% of CMS fee schedule,81.55,100% of CMS fee schedule,N/A,not seperately reimbursable,91.72,100% of CMS fee schedule,91.72,100% of CMS fee schedule,99.11,150% of CMS fee schedule,99.11,150% of CMS fee schedule,65.25,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,89.19,100% of CMS fee schedule,75.07,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,35,100% of CMS fee schedule,86.47,100% of CMS fee schedule,N/A,not seperately reimbursable,91.5,100% of CMS fee schedule,91.5,100% of CMS fee schedule,35,137.81,76.56
Outpatient Medical Services,EMERGENCY ROOM,99284,99284- Emergency dept visit,983,260.7,234.63,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,182.39,140% of CIGNA fee schedule,50,100% of CMS fee schedule,104.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.46,100% of CMS fee schedule,149.8,100% of CMS fee schedule,N/A,not seperately reimbursable,168.49,100% of CMS fee schedule,168.49,100% of CMS fee schedule,182.64,150% of CMS fee schedule,182.64,150% of CMS fee schedule,120.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,164.37,100% of CMS fee schedule,140.39,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,140.77,100% of CMS fee schedule,N/A,not seperately reimbursable,172.5,100% of CMS fee schedule,172.5,100% of CMS fee schedule,50,234.63,130.35
Outpatient Medical Services,EMERGENCY ROOM,99284,99284-PF EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY-MOD 25,981,260.7,234.63,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,182.39,140% of CIGNA fee schedule,50,100% of CMS fee schedule,104.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.46,100% of CMS fee schedule,149.8,100% of CMS fee schedule,N/A,not seperately reimbursable,168.49,100% of CMS fee schedule,168.49,100% of CMS fee schedule,182.64,150% of CMS fee schedule,182.64,150% of CMS fee schedule,120.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,164.37,100% of CMS fee schedule,140.39,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,140.77,100% of CMS fee schedule,N/A,not seperately reimbursable,172.5,100% of CMS fee schedule,172.5,100% of CMS fee schedule,50,234.63,130.35
Outpatient Medical Services,EMERGENCY ROOM,99284,99284-PF Emer Room Intermediate,981,260.7,234.63,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,182.39,140% of CIGNA fee schedule,50,100% of CMS fee schedule,104.28,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,119.46,100% of CMS fee schedule,149.8,100% of CMS fee schedule,N/A,not seperately reimbursable,168.49,100% of CMS fee schedule,168.49,100% of CMS fee schedule,182.64,150% of CMS fee schedule,182.64,150% of CMS fee schedule,120.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,164.37,100% of CMS fee schedule,140.39,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,140.77,100% of CMS fee schedule,N/A,not seperately reimbursable,172.5,100% of CMS fee schedule,172.5,100% of CMS fee schedule,50,234.63,130.35
Outpatient Medical Services,EMERGENCY ROOM,99285,99285- Emergency dept visit,983,377.95,340.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,151.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173.17,100% of CMS fee schedule,217.62,100% of CMS fee schedule,N/A,not seperately reimbursable,244.76,100% of CMS fee schedule,244.76,100% of CMS fee schedule,265.65,150% of CMS fee schedule,265.65,150% of CMS fee schedule,174.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,239.08,100% of CMS fee schedule,204.99,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,203.16,100% of CMS fee schedule,N/A,not seperately reimbursable,250.5,100% of CMS fee schedule,250.5,100% of CMS fee schedule,50,340.16,188.98
Outpatient Medical Services,EMERGENCY ROOM,99285,99285-PF Emer Room Extended/Comple W/Mod,981,377.95,340.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,151.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173.17,100% of CMS fee schedule,217.62,100% of CMS fee schedule,N/A,not seperately reimbursable,244.76,100% of CMS fee schedule,244.76,100% of CMS fee schedule,265.65,150% of CMS fee schedule,265.65,150% of CMS fee schedule,174.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,239.08,100% of CMS fee schedule,204.99,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,203.16,100% of CMS fee schedule,N/A,not seperately reimbursable,250.5,100% of CMS fee schedule,250.5,100% of CMS fee schedule,50,340.16,188.98
Outpatient Medical Services,EMERGENCY ROOM,99285,99285-PF Emer Room Extended/Complex,981,377.95,340.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,151.18,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,173.17,100% of CMS fee schedule,217.62,100% of CMS fee schedule,N/A,not seperately reimbursable,244.76,100% of CMS fee schedule,244.76,100% of CMS fee schedule,265.65,150% of CMS fee schedule,265.65,150% of CMS fee schedule,174.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,239.08,100% of CMS fee schedule,204.99,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,50,100% of CMS fee schedule,203.16,100% of CMS fee schedule,N/A,not seperately reimbursable,250.5,100% of CMS fee schedule,250.5,100% of CMS fee schedule,50,340.16,188.98
Outpatient Medical Services,EMERGENCY ROOM,99291,99291- Critical care first hour,983,452.03,406.83,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,408.77,140% of CIGNA fee schedule,151.63,100% of CMS fee schedule,180.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,207.28,100% of CMS fee schedule,278.33,100% of CMS fee schedule,N/A,not seperately reimbursable,313.05,100% of CMS fee schedule,313.05,100% of CMS fee schedule,334.64,150% of CMS fee schedule,334.64,150% of CMS fee schedule,223.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,301.16,100% of CMS fee schedule,250.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,151.63,100% of CMS fee schedule,279.31,100% of CMS fee schedule,N/A,not seperately reimbursable,393,100% of CMS fee schedule,393,100% of CMS fee schedule,151.63,408.77,226.02
Outpatient Medical Services,EMERGENCY ROOM,99291,99291-PF Emer Room Critical Care,981,452.03,406.83,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,408.77,140% of CIGNA fee schedule,151.63,100% of CMS fee schedule,180.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,207.28,100% of CMS fee schedule,278.33,100% of CMS fee schedule,N/A,not seperately reimbursable,313.05,100% of CMS fee schedule,313.05,100% of CMS fee schedule,334.64,150% of CMS fee schedule,334.64,150% of CMS fee schedule,223.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,301.16,100% of CMS fee schedule,250.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,151.63,100% of CMS fee schedule,279.31,100% of CMS fee schedule,N/A,not seperately reimbursable,393,100% of CMS fee schedule,393,100% of CMS fee schedule,151.63,408.77,226.02
Outpatient Medical Services,EMERGENCY ROOM,99291,99291-PF Emer Room Critical Care - MOD 25,981,452.03,406.83,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,408.77,140% of CIGNA fee schedule,151.63,100% of CMS fee schedule,180.81,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,207.28,100% of CMS fee schedule,278.33,100% of CMS fee schedule,N/A,not seperately reimbursable,313.05,100% of CMS fee schedule,313.05,100% of CMS fee schedule,334.64,150% of CMS fee schedule,334.64,150% of CMS fee schedule,223.19,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,301.16,100% of CMS fee schedule,250.46,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,151.63,100% of CMS fee schedule,279.31,100% of CMS fee schedule,N/A,not seperately reimbursable,393,100% of CMS fee schedule,393,100% of CMS fee schedule,151.63,408.77,226.02
Outpatient Medical Services,EMERGENCY ROOM,99292,99292- Critical care addl 30 min,983,228.26,205.43,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,100% of CMS fee schedule,91.3,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,104.62,100% of CMS fee schedule,140.05,100% of CMS fee schedule,N/A,not seperately reimbursable,157.52,100% of CMS fee schedule,157.52,100% of CMS fee schedule,168.45,150% of CMS fee schedule,168.45,150% of CMS fee schedule,112.4,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,151.6,100% of CMS fee schedule,126.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,100% of CMS fee schedule,127,100% of CMS fee schedule,N/A,not seperately reimbursable,177.5,100% of CMS fee schedule,177.5,100% of CMS fee schedule,74.4,205.43,114.13
Outpatient Medical Services,EMERGENCY ROOM,99292,99292-PF Emer Room Critical Care Add 30Min,981,228.26,205.43,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,100% of CMS fee schedule,91.3,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,104.62,100% of CMS fee schedule,140.05,100% of CMS fee schedule,N/A,not seperately reimbursable,157.52,100% of CMS fee schedule,157.52,100% of CMS fee schedule,168.45,150% of CMS fee schedule,168.45,150% of CMS fee schedule,112.4,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,151.6,100% of CMS fee schedule,126.68,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,74.4,100% of CMS fee schedule,127,100% of CMS fee schedule,N/A,not seperately reimbursable,177.5,100% of CMS fee schedule,177.5,100% of CMS fee schedule,74.4,205.43,114.13
Outpatient Medical Services,OFFICE VISIT,99385,99385- Initial Comp Preventive Med 18 to 39 years New,983,329.86,296.87,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20,100% of CMS fee schedule,131.94,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,90.15,100% of CMS fee schedule,102.95,100% of CMS fee schedule,N/A,not seperately reimbursable,115.79,100% of CMS fee schedule,115.79,100% of CMS fee schedule,148.4,150% of CMS fee schedule,148.4,150% of CMS fee schedule,99.86,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,133.55,100% of CMS fee schedule,108.99,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20,100% of CMS fee schedule,127.34,100% of CMS fee schedule,N/A,not seperately reimbursable,159.5,100% of CMS fee schedule,159.5,100% of CMS fee schedule,20,296.87,164.93
Outpatient Medical Services,OFFICE VISIT,99386,99386- Initial Comp Preventive Med 40 to 64 years New,983,384.62,346.16,90% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20,100% of CMS fee schedule,153.85,40% of total billed charges,N/A,not seperately reimbursable,N/A,not seperately reimbursable,109.22,100% of CMS fee schedule,124.94,100% of CMS fee schedule,N/A,not seperately reimbursable,140.52,100% of CMS fee schedule,140.52,100% of CMS fee schedule,180.05,150% of CMS fee schedule,180.05,150% of CMS fee schedule,121.17,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,162.03,100% of CMS fee schedule,132.09,100% of CMS fee schedule,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,N/A,not seperately reimbursable,20,100% of CMS fee schedule,146.88,100% of CMS fee schedule,N/A,not seperately reimbursable,185.5,100% of CMS fee schedule,185.5,100% of CMS fee schedule,20,346.16,192.31
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,N/A,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,service not provided,N/A,N/A,N/A