hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Candler County Hospital,2024-06-26,2.0.0,Candler County Hospital,"400 Cedar St, Metter, GA 30439",586004640,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AMERIGROUP PLAN,AMERIGROUP REIMBURSEMENT METHOD,BCBS HMO PLAN,BCBS HMO REIMBURSEMENT METHOD,BCBS HPN PLAN,BCBS HPN REIMBURSEMENT METHOD,BCBS MEDICARE PLAN,BCBS MEDICARE REIMBURSEMENT METHOD,BCBS PATHWAY PLAN,BCBS PATHWAY REIMBURSEMENT METHOD,BCBS PPO PLAN,BCBS PPO REIMBURSEMENT METHOD,CHOICECARE PLAN,CHOICECARE REIMBURSEMENT METHOD,CHOICECARE MEDICARE PLAN,CHOICECARE MEDICARE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,COVENTRY PLAN,COVENTRY REIMBURSEMENT METHOD,COVENTRY MEDICARE PLAN,COVENTRY MEDICARE REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,PEACHSTATE PLAN,PEACHSTATE REIMBURSEMENT METHOD,UHC HMO PLAN,UHC HMO REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,VACCN PLAN,VACCN REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,AMBULATORY,13132,COLONOSCOPY W/ BIOPSY,360,1688,453.4,26.86% of total billed charges,1266,75% of total billed charges,1266,75% of total billed charges,405.12,24% of total billed charges,1266,75% of total billed charges,1266,75% of total billed charges,1350.4,80% of total billed charges,409.17,24.24% of total billed charges,850.75,50.4% of total billed charges,1266,75% of total billed charges,413.22,24.48% of total billed charges,453.4,26.86% of total billed charges,405.12,24% of total billed charges,526.66,31.2% of total billed charges,1350.4,80% of total billed charges,405.12,24% of total billed charges,405.12,24% of total billed charges,405.12,1350.4,844
Outpatient Medical Services,AMBULATORY,19081,ULTRASOUND GUIDANCE NEEDLE WIRE IN BREAS,360,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,AMBULATORY,19083,US BREAST BIOPSY,360,3395,911.9,26.86% of total billed charges,2546.25,75% of total billed charges,2546.25,75% of total billed charges,814.8,24% of total billed charges,2546.25,75% of total billed charges,2546.25,75% of total billed charges,2716,80% of total billed charges,822.95,24.24% of total billed charges,1711.08,50.4% of total billed charges,2546.25,75% of total billed charges,831.1,24.48% of total billed charges,911.9,26.86% of total billed charges,814.8,24% of total billed charges,1059.24,31.2% of total billed charges,2716,80% of total billed charges,814.8,24% of total billed charges,814.8,24% of total billed charges,814.8,2716,1697.5
Outpatient Medical Services,AMBULATORY,20520,REMOVAL FOREIGN BODY,360,377,101.26,26.86% of total billed charges,282.75,75% of total billed charges,282.75,75% of total billed charges,90.48,24% of total billed charges,282.75,75% of total billed charges,282.75,75% of total billed charges,301.6,80% of total billed charges,91.38,24.24% of total billed charges,190.01,50.4% of total billed charges,282.75,75% of total billed charges,92.29,24.48% of total billed charges,101.26,26.86% of total billed charges,90.48,24% of total billed charges,117.62,31.2% of total billed charges,301.6,80% of total billed charges,90.48,24% of total billed charges,90.48,24% of total billed charges,90.48,301.6,188.5
Outpatient Medical Services,AMBULATORY,21930,EXCISION TUMOR SOFT TISSU OF BACK,360,1692.5,454.61,26.86% of total billed charges,1269.38,75% of total billed charges,1269.38,75% of total billed charges,406.2,24% of total billed charges,1269.38,75% of total billed charges,1269.38,75% of total billed charges,1354,80% of total billed charges,410.26,24.24% of total billed charges,853.02,50.4% of total billed charges,1269.38,75% of total billed charges,414.32,24.48% of total billed charges,454.61,26.86% of total billed charges,406.2,24% of total billed charges,528.06,31.2% of total billed charges,1354,80% of total billed charges,406.2,24% of total billed charges,406.2,24% of total billed charges,406.2,1354,846.25
Outpatient Medical Services,AMBULATORY,24075,EXCISION TUMOR SOFT TISSUE OF UPPER ARM,360,1866.5,501.34,26.86% of total billed charges,1399.88,75% of total billed charges,1399.88,75% of total billed charges,447.96,24% of total billed charges,1399.88,75% of total billed charges,1399.88,75% of total billed charges,1493.2,80% of total billed charges,452.44,24.24% of total billed charges,940.72,50.4% of total billed charges,1399.88,75% of total billed charges,456.92,24.48% of total billed charges,501.34,26.86% of total billed charges,447.96,24% of total billed charges,582.35,31.2% of total billed charges,1493.2,80% of total billed charges,447.96,24% of total billed charges,447.96,24% of total billed charges,447.96,1493.2,933.25
Outpatient Medical Services,AMBULATORY,35011,REPAIR ANEURYSM,360,2824.5,758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,35266,REP BLD VESS W/GRAFT,360,2259,606.77,26.86% of total billed charges,1694.25,75% of total billed charges,1694.25,75% of total billed charges,542.16,24% of total billed charges,1694.25,75% of total billed charges,1694.25,75% of total billed charges,1807.2,80% of total billed charges,547.58,24.24% of total billed charges,1138.54,50.4% of total billed charges,1694.25,75% of total billed charges,553,24.48% of total billed charges,606.77,26.86% of total billed charges,542.16,24% of total billed charges,704.81,31.2% of total billed charges,1807.2,80% of total billed charges,542.16,24% of total billed charges,542.16,24% of total billed charges,542.16,1807.2,1129.5
Outpatient Medical Services,AMBULATORY,35881,REV ART BYPASS W/O,360,1883,505.77,26.86% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,451.92,24% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,1506.4,80% of total billed charges,456.44,24.24% of total billed charges,949.03,50.4% of total billed charges,1412.25,75% of total billed charges,460.96,24.48% of total billed charges,505.77,26.86% of total billed charges,451.92,24% of total billed charges,587.5,31.2% of total billed charges,1506.4,80% of total billed charges,451.92,24% of total billed charges,451.92,24% of total billed charges,451.92,1506.4,941.5
Outpatient Medical Services,AMBULATORY,36005,INJ EXT VENOGRAPHY,360,564.5,151.62,26.86% of total billed charges,423.38,75% of total billed charges,423.38,75% of total billed charges,135.48,24% of total billed charges,423.38,75% of total billed charges,423.38,75% of total billed charges,451.6,80% of total billed charges,136.83,24.24% of total billed charges,284.51,50.4% of total billed charges,423.38,75% of total billed charges,138.19,24.48% of total billed charges,151.62,26.86% of total billed charges,135.48,24% of total billed charges,176.12,31.2% of total billed charges,451.6,80% of total billed charges,135.48,24% of total billed charges,135.48,24% of total billed charges,135.48,451.6,282.25
Outpatient Medical Services,AMBULATORY,36010,SVC OR IVC PLACEMENT,360,1883,505.77,26.86% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,451.92,24% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,1506.4,80% of total billed charges,456.44,24.24% of total billed charges,949.03,50.4% of total billed charges,1412.25,75% of total billed charges,460.96,24.48% of total billed charges,505.77,26.86% of total billed charges,451.92,24% of total billed charges,587.5,31.2% of total billed charges,1506.4,80% of total billed charges,451.92,24% of total billed charges,451.92,24% of total billed charges,451.92,1506.4,941.5
Outpatient Medical Services,AMBULATORY,36010,REVISION AV FISTULA,360,1317.5,353.88,26.86% of total billed charges,988.13,75% of total billed charges,988.13,75% of total billed charges,316.2,24% of total billed charges,988.13,75% of total billed charges,988.13,75% of total billed charges,1054,80% of total billed charges,319.36,24.24% of total billed charges,664.02,50.4% of total billed charges,988.13,75% of total billed charges,322.52,24.48% of total billed charges,353.88,26.86% of total billed charges,316.2,24% of total billed charges,411.06,31.2% of total billed charges,1054,80% of total billed charges,316.2,24% of total billed charges,316.2,24% of total billed charges,316.2,1054,658.75
Outpatient Medical Services,AMBULATORY,36010,INTRO OF CATHETER SUPERIOR OR VENA CAVA,360,836.5,224.68,26.86% of total billed charges,627.38,75% of total billed charges,627.38,75% of total billed charges,200.76,24% of total billed charges,627.38,75% of total billed charges,627.38,75% of total billed charges,669.2,80% of total billed charges,202.77,24.24% of total billed charges,421.6,50.4% of total billed charges,627.38,75% of total billed charges,204.78,24.48% of total billed charges,224.68,26.86% of total billed charges,200.76,24% of total billed charges,260.99,31.2% of total billed charges,669.2,80% of total billed charges,200.76,24% of total billed charges,200.76,24% of total billed charges,200.76,669.2,418.25
Outpatient Medical Services,AMBULATORY,36200,INTRO CATH AORTA,360,1835.5,493.02,26.86% of total billed charges,1376.63,75% of total billed charges,1376.63,75% of total billed charges,440.52,24% of total billed charges,1376.63,75% of total billed charges,1376.63,75% of total billed charges,1468.4,80% of total billed charges,444.93,24.24% of total billed charges,925.09,50.4% of total billed charges,1376.63,75% of total billed charges,449.33,24.48% of total billed charges,493.02,26.86% of total billed charges,440.52,24% of total billed charges,572.68,31.2% of total billed charges,1468.4,80% of total billed charges,440.52,24% of total billed charges,440.52,24% of total billed charges,440.52,1468.4,917.75
Outpatient Medical Services,AMBULATORY,36246,CATH ART PLACEMENT,360,1883,505.77,26.86% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,451.92,24% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,1506.4,80% of total billed charges,456.44,24.24% of total billed charges,949.03,50.4% of total billed charges,1412.25,75% of total billed charges,460.96,24.48% of total billed charges,505.77,26.86% of total billed charges,451.92,24% of total billed charges,587.5,31.2% of total billed charges,1506.4,80% of total billed charges,451.92,24% of total billed charges,451.92,24% of total billed charges,451.92,1506.4,941.5
Outpatient Medical Services,AMBULATORY,36478,ENDOVENOUS ABLATION,360,753,202.26,26.86% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,180.72,24% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,602.4,80% of total billed charges,182.53,24.24% of total billed charges,379.51,50.4% of total billed charges,564.75,75% of total billed charges,184.33,24.48% of total billed charges,202.26,26.86% of total billed charges,180.72,24% of total billed charges,234.94,31.2% of total billed charges,602.4,80% of total billed charges,180.72,24% of total billed charges,180.72,24% of total billed charges,180.72,602.4,376.5
Outpatient Medical Services,AMBULATORY,36558,INSERT VEN ACC DEVIC,360,2824.5,758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,36565,INSERT TUNNELED CVA,360,1883,505.77,26.86% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,451.92,24% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,1506.4,80% of total billed charges,456.44,24.24% of total billed charges,949.03,50.4% of total billed charges,1412.25,75% of total billed charges,460.96,24.48% of total billed charges,505.77,26.86% of total billed charges,451.92,24% of total billed charges,587.5,31.2% of total billed charges,1506.4,80% of total billed charges,451.92,24% of total billed charges,451.92,24% of total billed charges,451.92,1506.4,941.5
Outpatient Medical Services,AMBULATORY,36569,INSERTION PICC LINE,360,1412,379.26,26.86% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,338.88,24% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,1129.6,80% of total billed charges,342.27,24.24% of total billed charges,711.65,50.4% of total billed charges,1059,75% of total billed charges,345.66,24.48% of total billed charges,379.26,26.86% of total billed charges,338.88,24% of total billed charges,440.54,31.2% of total billed charges,1129.6,80% of total billed charges,338.88,24% of total billed charges,338.88,24% of total billed charges,338.88,1129.6,706
Outpatient Medical Services,AMBULATORY,36578,PARTIAL REPLACE VAD,360,1412,379.26,26.86% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,338.88,24% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,1129.6,80% of total billed charges,342.27,24.24% of total billed charges,711.65,50.4% of total billed charges,1059,75% of total billed charges,345.66,24.48% of total billed charges,379.26,26.86% of total billed charges,338.88,24% of total billed charges,440.54,31.2% of total billed charges,1129.6,80% of total billed charges,338.88,24% of total billed charges,338.88,24% of total billed charges,338.88,1129.6,706
Outpatient Medical Services,AMBULATORY,36581,REVISE VEN ACC DEVIC,360,1412,379.26,26.86% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,338.88,24% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,1129.6,80% of total billed charges,342.27,24.24% of total billed charges,711.65,50.4% of total billed charges,1059,75% of total billed charges,345.66,24.48% of total billed charges,379.26,26.86% of total billed charges,338.88,24% of total billed charges,440.54,31.2% of total billed charges,1129.6,80% of total billed charges,338.88,24% of total billed charges,338.88,24% of total billed charges,338.88,1129.6,706
Outpatient Medical Services,AMBULATORY,36589,REMOVE VEN ACC DEVIC,360,1412,379.26,26.86% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,338.88,24% of total billed charges,1059,75% of total billed charges,1059,75% of total billed charges,1129.6,80% of total billed charges,342.27,24.24% of total billed charges,711.65,50.4% of total billed charges,1059,75% of total billed charges,345.66,24.48% of total billed charges,379.26,26.86% of total billed charges,338.88,24% of total billed charges,440.54,31.2% of total billed charges,1129.6,80% of total billed charges,338.88,24% of total billed charges,338.88,24% of total billed charges,338.88,1129.6,706
Outpatient Medical Services,AMBULATORY,36590,REM TUNNELED CVAD W PORT/PUMP,360,3183.5,855.09,26.86% of total billed charges,2387.63,75% of total billed charges,2387.63,75% of total billed charges,764.04,24% of total billed charges,2387.63,75% of total billed charges,2387.63,75% of total billed charges,2546.8,80% of total billed charges,771.68,24.24% of total billed charges,1604.48,50.4% of total billed charges,2387.63,75% of total billed charges,779.32,24.48% of total billed charges,855.09,26.86% of total billed charges,764.04,24% of total billed charges,993.25,31.2% of total billed charges,2546.8,80% of total billed charges,764.04,24% of total billed charges,764.04,24% of total billed charges,764.04,2546.8,1591.75
Outpatient Medical Services,AMBULATORY,36593,DECLOT VAS ACC DEVIC,360,753,202.26,26.86% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,180.72,24% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,602.4,80% of total billed charges,182.53,24.24% of total billed charges,379.51,50.4% of total billed charges,564.75,75% of total billed charges,184.33,24.48% of total billed charges,202.26,26.86% of total billed charges,180.72,24% of total billed charges,234.94,31.2% of total billed charges,602.4,80% of total billed charges,180.72,24% of total billed charges,180.72,24% of total billed charges,180.72,602.4,376.5
Outpatient Medical Services,AMBULATORY,36595,MECH REMOVAL OBS MAT,360,753,202.26,26.86% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,180.72,24% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,602.4,80% of total billed charges,182.53,24.24% of total billed charges,379.51,50.4% of total billed charges,564.75,75% of total billed charges,184.33,24.48% of total billed charges,202.26,26.86% of total billed charges,180.72,24% of total billed charges,234.94,31.2% of total billed charges,602.4,80% of total billed charges,180.72,24% of total billed charges,180.72,24% of total billed charges,180.72,602.4,376.5
Outpatient Medical Services,AMBULATORY,36597,REPOSITION VENOUS CA,360,187.5,50.36,26.86% of total billed charges,140.63,75% of total billed charges,140.63,75% of total billed charges,45,24% of total billed charges,140.63,75% of total billed charges,140.63,75% of total billed charges,150,80% of total billed charges,45.45,24.24% of total billed charges,94.5,50.4% of total billed charges,140.63,75% of total billed charges,45.9,24.48% of total billed charges,50.36,26.86% of total billed charges,45,24% of total billed charges,58.5,31.2% of total billed charges,150,80% of total billed charges,45,24% of total billed charges,45,24% of total billed charges,45,150,93.75
Outpatient Medical Services,AMBULATORY,36598,CONTRAST INJ VEN DEV,360,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,AMBULATORY,36800,CANNULATION OF GRAFT,360,3388.5,910.15,26.86% of total billed charges,2541.38,75% of total billed charges,2541.38,75% of total billed charges,813.24,24% of total billed charges,2541.38,75% of total billed charges,2541.38,75% of total billed charges,2710.8,80% of total billed charges,821.37,24.24% of total billed charges,1707.8,50.4% of total billed charges,2541.38,75% of total billed charges,829.5,24.48% of total billed charges,910.15,26.86% of total billed charges,813.24,24% of total billed charges,1057.21,31.2% of total billed charges,2710.8,80% of total billed charges,813.24,24% of total billed charges,813.24,24% of total billed charges,813.24,2710.8,1694.25
Outpatient Medical Services,AMBULATORY,36818,A/V ANASTOMOSIS OPEN,360,1883,505.77,26.86% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,451.92,24% of total billed charges,1412.25,75% of total billed charges,1412.25,75% of total billed charges,1506.4,80% of total billed charges,456.44,24.24% of total billed charges,949.03,50.4% of total billed charges,1412.25,75% of total billed charges,460.96,24.48% of total billed charges,505.77,26.86% of total billed charges,451.92,24% of total billed charges,587.5,31.2% of total billed charges,1506.4,80% of total billed charges,451.92,24% of total billed charges,451.92,24% of total billed charges,451.92,1506.4,941.5
Outpatient Medical Services,AMBULATORY,36901,ACCESS AV DIAL GRAFT,360,4600,1235.56,26.86% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,1104,24% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,3680,80% of total billed charges,1115.04,24.24% of total billed charges,2318.4,50.4% of total billed charges,3450,75% of total billed charges,1126.08,24.48% of total billed charges,1235.56,26.86% of total billed charges,1104,24% of total billed charges,1435.2,31.2% of total billed charges,3680,80% of total billed charges,1104,24% of total billed charges,1104,24% of total billed charges,1104,3680,2300
Outpatient Medical Services,AMBULATORY,36901,ACCESS AV FISTULOGRAM,360,4600,1235.56,26.86% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,1104,24% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,3680,80% of total billed charges,1115.04,24.24% of total billed charges,2318.4,50.4% of total billed charges,3450,75% of total billed charges,1126.08,24.48% of total billed charges,1235.56,26.86% of total billed charges,1104,24% of total billed charges,1435.2,31.2% of total billed charges,3680,80% of total billed charges,1104,24% of total billed charges,1104,24% of total billed charges,1104,3680,2300
Outpatient Medical Services,AMBULATORY,36902,ANGIOPLASTY ART BLKG,360,2824.5,758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,36902,AV GRAFT DIAL PROC,360,2259,606.77,26.86% of total billed charges,1694.25,75% of total billed charges,1694.25,75% of total billed charges,542.16,24% of total billed charges,1694.25,75% of total billed charges,1694.25,75% of total billed charges,1807.2,80% of total billed charges,547.58,24.24% of total billed charges,1138.54,50.4% of total billed charges,1694.25,75% of total billed charges,553,24.48% of total billed charges,606.77,26.86% of total billed charges,542.16,24% of total billed charges,704.81,31.2% of total billed charges,1807.2,80% of total billed charges,542.16,24% of total billed charges,542.16,24% of total billed charges,542.16,1807.2,1129.5
Outpatient Medical Services,AMBULATORY,36902,ANGIOPLASTY NO STENT,360,21627,5809.01,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,5190.48,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,17301.6,80% of total billed charges,5242.38,24.24% of total billed charges,10900.01,50.4% of total billed charges,16220.25,75% of total billed charges,5294.29,24.48% of total billed charges,5809.01,26.86% of total billed charges,5190.48,24% of total billed charges,6747.62,31.2% of total billed charges,17301.6,80% of total billed charges,5190.48,24% of total billed charges,5190.48,24% of total billed charges,4394,17301.6,10813.5
Outpatient Medical Services,AMBULATORY,36903,ANGIOPLASTY W/ STENT,360,43711,11740.77,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,10490.64,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,34968.8,80% of total billed charges,10595.55,24.24% of total billed charges,22030.34,50.4% of total billed charges,32783.25,75% of total billed charges,10700.45,24.48% of total billed charges,11740.77,26.86% of total billed charges,10490.64,24% of total billed charges,13637.83,31.2% of total billed charges,34968.8,80% of total billed charges,10490.64,24% of total billed charges,10490.64,24% of total billed charges,4394,34968.8,21855.5
Outpatient Medical Services,AMBULATORY,36904,THROMBECT AV FISTULA,360,3764.5,1011.14,26.86% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,903.48,24% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,3011.6,80% of total billed charges,912.51,24.24% of total billed charges,1897.31,50.4% of total billed charges,2823.38,75% of total billed charges,921.55,24.48% of total billed charges,1011.14,26.86% of total billed charges,903.48,24% of total billed charges,1174.52,31.2% of total billed charges,3011.6,80% of total billed charges,903.48,24% of total billed charges,903.48,24% of total billed charges,903.48,3011.6,1882.25
Outpatient Medical Services,AMBULATORY,36904,THROMBECTOMY,360,25595.5,6874.95,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,6142.92,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,20476.4,80% of total billed charges,6204.35,24.24% of total billed charges,12900.13,50.4% of total billed charges,19196.63,75% of total billed charges,6265.78,24.48% of total billed charges,6874.95,26.86% of total billed charges,6142.92,24% of total billed charges,7985.8,31.2% of total billed charges,20476.4,80% of total billed charges,6142.92,24% of total billed charges,6142.92,24% of total billed charges,4394,20476.4,12797.75
Outpatient Medical Services,AMBULATORY,36905,THROMBECTOMY W/ BALLOON,360,51732,13895.22,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,12415.68,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,41385.6,80% of total billed charges,12539.84,24.24% of total billed charges,26072.93,50.4% of total billed charges,38799,75% of total billed charges,12663.99,24.48% of total billed charges,13895.22,26.86% of total billed charges,12415.68,24% of total billed charges,16140.38,31.2% of total billed charges,41385.6,80% of total billed charges,12415.68,24% of total billed charges,12415.68,24% of total billed charges,4394,41385.6,25866
Outpatient Medical Services,AMBULATORY,36906,THROMBECTOMY W/ STENT,360,78411,21061.19,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,18818.64,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,62728.8,80% of total billed charges,19006.83,24.24% of total billed charges,39519.14,50.4% of total billed charges,58808.25,75% of total billed charges,19195.01,24.48% of total billed charges,21061.19,26.86% of total billed charges,18818.64,24% of total billed charges,24464.23,31.2% of total billed charges,62728.8,80% of total billed charges,18818.64,24% of total billed charges,18818.64,24% of total billed charges,4394,62728.8,39205.5
Outpatient Medical Services,AMBULATORY,36907,BALLOON ANGIOPLASTY,360,4600,1235.56,26.86% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,1104,24% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,3680,80% of total billed charges,1115.04,24.24% of total billed charges,2318.4,50.4% of total billed charges,3450,75% of total billed charges,1126.08,24.48% of total billed charges,1235.56,26.86% of total billed charges,1104,24% of total billed charges,1435.2,31.2% of total billed charges,3680,80% of total billed charges,1104,24% of total billed charges,1104,24% of total billed charges,1104,3680,2300
Outpatient Medical Services,AMBULATORY,36908,TRANSCATH STENT PLACEMENT,360,4600,1235.56,26.86% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,1104,24% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,3680,80% of total billed charges,1115.04,24.24% of total billed charges,2318.4,50.4% of total billed charges,3450,75% of total billed charges,1126.08,24.48% of total billed charges,1235.56,26.86% of total billed charges,1104,24% of total billed charges,1435.2,31.2% of total billed charges,3680,80% of total billed charges,1104,24% of total billed charges,1104,24% of total billed charges,1104,3680,2300
Outpatient Medical Services,AMBULATORY,36909,VEIN EMBOLIZATION,360,4600,1235.56,26.86% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,1104,24% of total billed charges,3450,75% of total billed charges,3450,75% of total billed charges,3680,80% of total billed charges,1115.04,24.24% of total billed charges,2318.4,50.4% of total billed charges,3450,75% of total billed charges,1126.08,24.48% of total billed charges,1235.56,26.86% of total billed charges,1104,24% of total billed charges,1435.2,31.2% of total billed charges,3680,80% of total billed charges,1104,24% of total billed charges,1104,24% of total billed charges,1104,3680,2300
Outpatient Medical Services,AMBULATORY,37182,SHUNT ARTERY TO VEIN,360,3764.5,1011.14,26.86% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,903.48,24% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,3011.6,80% of total billed charges,912.51,24.24% of total billed charges,1897.31,50.4% of total billed charges,2823.38,75% of total billed charges,921.55,24.48% of total billed charges,1011.14,26.86% of total billed charges,903.48,24% of total billed charges,1174.52,31.2% of total billed charges,3011.6,80% of total billed charges,903.48,24% of total billed charges,903.48,24% of total billed charges,903.48,3011.6,1882.25
Outpatient Medical Services,AMBULATORY,37191,INTER INF VENA CAVA,360,2824.5,758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,37197,TRANSCATH RETR FB,360,1835.5,493.02,26.86% of total billed charges,1376.63,75% of total billed charges,1376.63,75% of total billed charges,440.52,24% of total billed charges,1376.63,75% of total billed charges,1376.63,75% of total billed charges,1468.4,80% of total billed charges,444.93,24.24% of total billed charges,925.09,50.4% of total billed charges,1376.63,75% of total billed charges,449.33,24.48% of total billed charges,493.02,26.86% of total billed charges,440.52,24% of total billed charges,572.68,31.2% of total billed charges,1468.4,80% of total billed charges,440.52,24% of total billed charges,440.52,24% of total billed charges,440.52,1468.4,917.75
Outpatient Medical Services,AMBULATORY,37211,EXCH ART CATH,360,1317.5,353.88,26.86% of total billed charges,988.13,75% of total billed charges,988.13,75% of total billed charges,316.2,24% of total billed charges,988.13,75% of total billed charges,988.13,75% of total billed charges,1054,80% of total billed charges,319.36,24.24% of total billed charges,664.02,50.4% of total billed charges,988.13,75% of total billed charges,322.52,24.48% of total billed charges,353.88,26.86% of total billed charges,316.2,24% of total billed charges,411.06,31.2% of total billed charges,1054,80% of total billed charges,316.2,24% of total billed charges,316.2,24% of total billed charges,316.2,1054,658.75
Outpatient Medical Services,AMBULATORY,37224,ANGIOPLASTY FEM-POP,360,2730.5,733.41,26.86% of total billed charges,2047.88,75% of total billed charges,2047.88,75% of total billed charges,655.32,24% of total billed charges,2047.88,75% of total billed charges,2047.88,75% of total billed charges,2184.4,80% of total billed charges,661.87,24.24% of total billed charges,1376.17,50.4% of total billed charges,2047.88,75% of total billed charges,668.43,24.48% of total billed charges,733.41,26.86% of total billed charges,655.32,24% of total billed charges,851.92,31.2% of total billed charges,2184.4,80% of total billed charges,655.32,24% of total billed charges,655.32,24% of total billed charges,655.32,2184.4,1365.25
Outpatient Medical Services,AMBULATORY,37236,TRANSCATH PLACE STEN,360,3764.5,1011.14,26.86% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,903.48,24% of total billed charges,2823.38,75% of total billed charges,2823.38,75% of total billed charges,3011.6,80% of total billed charges,912.51,24.24% of total billed charges,1897.31,50.4% of total billed charges,2823.38,75% of total billed charges,921.55,24.48% of total billed charges,1011.14,26.86% of total billed charges,903.48,24% of total billed charges,1174.52,31.2% of total billed charges,3011.6,80% of total billed charges,903.48,24% of total billed charges,903.48,24% of total billed charges,903.48,3011.6,1882.25
Outpatient Medical Services,AMBULATORY,37236,STENT PLACED ON ARTERY,360,17119.5,4598.3,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,4108.68,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,13695.6,80% of total billed charges,4149.77,24.24% of total billed charges,8628.23,50.4% of total billed charges,12839.63,75% of total billed charges,4190.85,24.48% of total billed charges,4598.3,26.86% of total billed charges,4108.68,24% of total billed charges,5341.28,31.2% of total billed charges,13695.6,80% of total billed charges,4108.68,24% of total billed charges,4108.68,24% of total billed charges,4108.68,13695.6,8559.75
Outpatient Medical Services,AMBULATORY,37236,TRANSCATH INTR STENT,360,830,222.94,26.86% of total billed charges,622.5,75% of total billed charges,622.5,75% of total billed charges,199.2,24% of total billed charges,622.5,75% of total billed charges,622.5,75% of total billed charges,664,80% of total billed charges,201.19,24.24% of total billed charges,418.32,50.4% of total billed charges,622.5,75% of total billed charges,203.18,24.48% of total billed charges,222.94,26.86% of total billed charges,199.2,24% of total billed charges,258.96,31.2% of total billed charges,664,80% of total billed charges,199.2,24% of total billed charges,199.2,24% of total billed charges,199.2,664,415
Outpatient Medical Services,AMBULATORY,37237,ADDTL STENT PLACEMEN,360,3295,885.04,26.86% of total billed charges,2471.25,75% of total billed charges,2471.25,75% of total billed charges,790.8,24% of total billed charges,2471.25,75% of total billed charges,2471.25,75% of total billed charges,2636,80% of total billed charges,798.71,24.24% of total billed charges,1660.68,50.4% of total billed charges,2471.25,75% of total billed charges,806.62,24.48% of total billed charges,885.04,26.86% of total billed charges,790.8,24% of total billed charges,1028.04,31.2% of total billed charges,2636,80% of total billed charges,790.8,24% of total billed charges,790.8,24% of total billed charges,790.8,2636,1647.5
Outpatient Medical Services,AMBULATORY,37237,ADDTL STENT IN ARTERY,360,10376,2786.99,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,2490.24,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,8300.8,80% of total billed charges,2515.14,24.24% of total billed charges,5229.5,50.4% of total billed charges,7782,75% of total billed charges,2540.04,24.48% of total billed charges,2786.99,26.86% of total billed charges,2490.24,24% of total billed charges,3237.31,31.2% of total billed charges,8300.8,80% of total billed charges,2490.24,24% of total billed charges,2490.24,24% of total billed charges,2490.24,8300.8,5188
Outpatient Medical Services,AMBULATORY,37238,VENOUS STENT,360,18507,4970.98,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,4441.68,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,14805.6,80% of total billed charges,4486.1,24.24% of total billed charges,9327.53,50.4% of total billed charges,13880.25,75% of total billed charges,4530.51,24.48% of total billed charges,4970.98,26.86% of total billed charges,4441.68,24% of total billed charges,5774.18,31.2% of total billed charges,14805.6,80% of total billed charges,4441.68,24% of total billed charges,4441.68,24% of total billed charges,4394,14805.6,9253.5
Outpatient Medical Services,AMBULATORY,37239,ADDTL STENT IN VEIN,360,11826.5,3176.6,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,2838.36,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,9461.2,80% of total billed charges,2866.74,24.24% of total billed charges,5960.56,50.4% of total billed charges,8869.88,75% of total billed charges,2895.13,24.48% of total billed charges,3176.6,26.86% of total billed charges,2838.36,24% of total billed charges,3689.87,31.2% of total billed charges,9461.2,80% of total billed charges,2838.36,24% of total billed charges,2838.36,24% of total billed charges,2838.36,9461.2,5913.25
Outpatient Medical Services,AMBULATORY,37248,PT ANGIOPLAST VENOUS,360,3404,914.31,26.86% of total billed charges,2553,75% of total billed charges,2553,75% of total billed charges,816.96,24% of total billed charges,2553,75% of total billed charges,2553,75% of total billed charges,2723.2,80% of total billed charges,825.13,24.24% of total billed charges,1715.62,50.4% of total billed charges,2553,75% of total billed charges,833.3,24.48% of total billed charges,914.31,26.86% of total billed charges,816.96,24% of total billed charges,1062.05,31.2% of total billed charges,2723.2,80% of total billed charges,816.96,24% of total billed charges,816.96,24% of total billed charges,816.96,2723.2,1702
Outpatient Medical Services,AMBULATORY,37607,LIGATION AV FISTULA,360,2824.5,758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,37799,I&D PERIGRAFT SEROMA,360,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,AMBULATORY,37799,I&D HEMATOMA PERIGRA,360,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,AMBULATORY,38792,SENTINEL NODE INJECTION,360,212,56.94,26.86% of total billed charges,159,75% of total billed charges,159,75% of total billed charges,50.88,24% of total billed charges,159,75% of total billed charges,159,75% of total billed charges,169.6,80% of total billed charges,51.39,24.24% of total billed charges,106.85,50.4% of total billed charges,159,75% of total billed charges,51.9,24.48% of total billed charges,56.94,26.86% of total billed charges,50.88,24% of total billed charges,66.14,31.2% of total billed charges,169.6,80% of total billed charges,50.88,24% of total billed charges,50.88,24% of total billed charges,50.88,169.6,106
Outpatient Medical Services,AMBULATORY,400,BREAST BIOPSY,360,21.5,5.77,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,5.77,26.86% of total billed charges,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,AMBULATORY,400,BREAST BIOPSY,360,21.5,5.77,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,5.77,26.86% of total billed charges,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,AMBULATORY,43235,EGD UPPER GASTROINESTINAL EDOSCOPY DIAGN,360,826,221.86,26.86% of total billed charges,619.5,75% of total billed charges,619.5,75% of total billed charges,198.24,24% of total billed charges,619.5,75% of total billed charges,619.5,75% of total billed charges,660.8,80% of total billed charges,200.22,24.24% of total billed charges,416.3,50.4% of total billed charges,619.5,75% of total billed charges,202.2,24.48% of total billed charges,221.86,26.86% of total billed charges,198.24,24% of total billed charges,257.71,31.2% of total billed charges,660.8,80% of total billed charges,198.24,24% of total billed charges,198.24,24% of total billed charges,198.24,660.8,413
Outpatient Medical Services,AMBULATORY,43235,EGD DIAGNOSTIC BRUSH WASH,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43239,EGD WITH BIOPSY UPPER GASTROINTESTINAL E,360,958,257.32,26.86% of total billed charges,718.5,75% of total billed charges,718.5,75% of total billed charges,229.92,24% of total billed charges,718.5,75% of total billed charges,718.5,75% of total billed charges,766.4,80% of total billed charges,232.22,24.24% of total billed charges,482.83,50.4% of total billed charges,718.5,75% of total billed charges,234.52,24.48% of total billed charges,257.32,26.86% of total billed charges,229.92,24% of total billed charges,298.9,31.2% of total billed charges,766.4,80% of total billed charges,229.92,24% of total billed charges,229.92,24% of total billed charges,229.92,766.4,479
Outpatient Medical Services,AMBULATORY,43239,EGD BIOPSY SINGLE/MULTIPLE,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43239,EGD W/ BX,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,43244,EGD WITH BAND LIGATION OF ESOPHAGEAL AND,360,1226.5,329.44,26.86% of total billed charges,919.88,75% of total billed charges,919.88,75% of total billed charges,294.36,24% of total billed charges,919.88,75% of total billed charges,919.88,75% of total billed charges,981.2,80% of total billed charges,297.3,24.24% of total billed charges,618.16,50.4% of total billed charges,919.88,75% of total billed charges,300.25,24.48% of total billed charges,329.44,26.86% of total billed charges,294.36,24% of total billed charges,382.67,31.2% of total billed charges,981.2,80% of total billed charges,294.36,24% of total billed charges,294.36,24% of total billed charges,294.36,981.2,613.25
Outpatient Medical Services,AMBULATORY,43244,EGD VARICES LIGATION,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43245,UP GI ENDO W/DILAT GASTRIC OUT OBSTR (BA,360,984.5,264.44,26.86% of total billed charges,738.38,75% of total billed charges,738.38,75% of total billed charges,236.28,24% of total billed charges,738.38,75% of total billed charges,738.38,75% of total billed charges,787.6,80% of total billed charges,238.64,24.24% of total billed charges,496.19,50.4% of total billed charges,738.38,75% of total billed charges,241.01,24.48% of total billed charges,264.44,26.86% of total billed charges,236.28,24% of total billed charges,307.16,31.2% of total billed charges,787.6,80% of total billed charges,236.28,24% of total billed charges,236.28,24% of total billed charges,236.28,787.6,492.25
Outpatient Medical Services,AMBULATORY,43246,EGD WITH PEG TUBE PLACEMENT,360,1653,444,26.86% of total billed charges,1239.75,75% of total billed charges,1239.75,75% of total billed charges,396.72,24% of total billed charges,1239.75,75% of total billed charges,1239.75,75% of total billed charges,1322.4,80% of total billed charges,400.69,24.24% of total billed charges,833.11,50.4% of total billed charges,1239.75,75% of total billed charges,404.65,24.48% of total billed charges,444,26.86% of total billed charges,396.72,24% of total billed charges,515.74,31.2% of total billed charges,1322.4,80% of total billed charges,396.72,24% of total billed charges,396.72,24% of total billed charges,396.72,1322.4,826.5
Outpatient Medical Services,AMBULATORY,43247,UPPER GASTROINTESTINAL ENDOSCOPY WITH RE,360,984.5,264.44,26.86% of total billed charges,738.38,75% of total billed charges,738.38,75% of total billed charges,236.28,24% of total billed charges,738.38,75% of total billed charges,738.38,75% of total billed charges,787.6,80% of total billed charges,238.64,24.24% of total billed charges,496.19,50.4% of total billed charges,738.38,75% of total billed charges,241.01,24.48% of total billed charges,264.44,26.86% of total billed charges,236.28,24% of total billed charges,307.16,31.2% of total billed charges,787.6,80% of total billed charges,236.28,24% of total billed charges,236.28,24% of total billed charges,236.28,787.6,492.25
Outpatient Medical Services,AMBULATORY,43248,UP GI ENDO W/ INSERT GUIDE WIRE THEN DIL,360,956,256.78,26.86% of total billed charges,717,75% of total billed charges,717,75% of total billed charges,229.44,24% of total billed charges,717,75% of total billed charges,717,75% of total billed charges,764.8,80% of total billed charges,231.73,24.24% of total billed charges,481.82,50.4% of total billed charges,717,75% of total billed charges,234.03,24.48% of total billed charges,256.78,26.86% of total billed charges,229.44,24% of total billed charges,298.27,31.2% of total billed charges,764.8,80% of total billed charges,229.44,24% of total billed charges,229.44,24% of total billed charges,229.44,764.8,478
Outpatient Medical Services,AMBULATORY,43248,EGD W/ WIRE GUIDED DILITATION,360,2798.5,751.68,26.86% of total billed charges,2098.88,75% of total billed charges,2098.88,75% of total billed charges,671.64,24% of total billed charges,2098.88,75% of total billed charges,2098.88,75% of total billed charges,2238.8,80% of total billed charges,678.36,24.24% of total billed charges,1410.44,50.4% of total billed charges,2098.88,75% of total billed charges,685.07,24.48% of total billed charges,751.68,26.86% of total billed charges,671.64,24% of total billed charges,873.13,31.2% of total billed charges,2238.8,80% of total billed charges,671.64,24% of total billed charges,671.64,24% of total billed charges,671.64,2238.8,1399.25
Outpatient Medical Services,AMBULATORY,43249,UPPER GI ENDOSCOPY WITH BALLOON DILATION,360,1046.5,281.09,26.86% of total billed charges,784.88,75% of total billed charges,784.88,75% of total billed charges,251.16,24% of total billed charges,784.88,75% of total billed charges,784.88,75% of total billed charges,837.2,80% of total billed charges,253.67,24.24% of total billed charges,527.44,50.4% of total billed charges,784.88,75% of total billed charges,256.18,24.48% of total billed charges,281.09,26.86% of total billed charges,251.16,24% of total billed charges,326.51,31.2% of total billed charges,837.2,80% of total billed charges,251.16,24% of total billed charges,251.16,24% of total billed charges,251.16,837.2,523.25
Outpatient Medical Services,AMBULATORY,43249,ESOPH EGD DILATION <30 MM,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43251,UP GI ENDOSCOPY WITH REMOVAL OF TUMOR PO,360,1190.5,319.77,26.86% of total billed charges,892.88,75% of total billed charges,892.88,75% of total billed charges,285.72,24% of total billed charges,892.88,75% of total billed charges,892.88,75% of total billed charges,952.4,80% of total billed charges,288.58,24.24% of total billed charges,600.01,50.4% of total billed charges,892.88,75% of total billed charges,291.43,24.48% of total billed charges,319.77,26.86% of total billed charges,285.72,24% of total billed charges,371.44,31.2% of total billed charges,952.4,80% of total billed charges,285.72,24% of total billed charges,285.72,24% of total billed charges,285.72,952.4,595.25
Outpatient Medical Services,AMBULATORY,43251,EGD REMOVE LESION SNARE,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43255,EGD WITH CONTROL OF BLEEDING ANY METHOD,360,1263,339.24,26.86% of total billed charges,947.25,75% of total billed charges,947.25,75% of total billed charges,303.12,24% of total billed charges,947.25,75% of total billed charges,947.25,75% of total billed charges,1010.4,80% of total billed charges,306.15,24.24% of total billed charges,636.55,50.4% of total billed charges,947.25,75% of total billed charges,309.18,24.48% of total billed charges,339.24,26.86% of total billed charges,303.12,24% of total billed charges,394.06,31.2% of total billed charges,1010.4,80% of total billed charges,303.12,24% of total billed charges,303.12,24% of total billed charges,303.12,1010.4,631.5
Outpatient Medical Services,AMBULATORY,43450,DILATION OF ESOPHAGUS BY UNGUIDED SOUND,360,302,81.12,26.86% of total billed charges,226.5,75% of total billed charges,226.5,75% of total billed charges,72.48,24% of total billed charges,226.5,75% of total billed charges,226.5,75% of total billed charges,241.6,80% of total billed charges,73.2,24.24% of total billed charges,152.21,50.4% of total billed charges,226.5,75% of total billed charges,73.93,24.48% of total billed charges,81.12,26.86% of total billed charges,72.48,24% of total billed charges,94.22,31.2% of total billed charges,241.6,80% of total billed charges,72.48,24% of total billed charges,72.48,24% of total billed charges,72.48,241.6,151
Outpatient Medical Services,AMBULATORY,43450,DILATE ESOPHAGUS 1/MULT PASS,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,43450,EGD W/ UNGUIDED DILITATION,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,44388,COLONOSCOPY THRU STOMA SPX,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,44394,COLONOSCOPY THROUGH STOMA W/ REMOVAL OF,360,1796.5,482.54,26.86% of total billed charges,1347.38,75% of total billed charges,1347.38,75% of total billed charges,431.16,24% of total billed charges,1347.38,75% of total billed charges,1347.38,75% of total billed charges,1437.2,80% of total billed charges,435.47,24.24% of total billed charges,905.44,50.4% of total billed charges,1347.38,75% of total billed charges,439.78,24.48% of total billed charges,482.54,26.86% of total billed charges,431.16,24% of total billed charges,560.51,31.2% of total billed charges,1437.2,80% of total billed charges,431.16,24% of total billed charges,431.16,24% of total billed charges,431.16,1437.2,898.25
Outpatient Medical Services,AMBULATORY,44970,LAPAROSCOPY SURGICAL APPENDECTOMY,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45300,PROCTOSIGMOIDOSCOPY DX,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45330,DX SIGMOIDOSCOPY,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45331,SIGMOIDOSCOPY AND BIOPSY,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45331,FLEX SIG W/ BX,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,45350,SGMDSC W/BAND LIGATION,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45380,COLONOSCOPY W/ BIOPSY,360,1224.5,328.9,26.86% of total billed charges,918.38,75% of total billed charges,918.38,75% of total billed charges,293.88,24% of total billed charges,918.38,75% of total billed charges,918.38,75% of total billed charges,979.6,80% of total billed charges,296.82,24.24% of total billed charges,617.15,50.4% of total billed charges,918.38,75% of total billed charges,299.76,24.48% of total billed charges,328.9,26.86% of total billed charges,293.88,24% of total billed charges,382.04,31.2% of total billed charges,979.6,80% of total billed charges,293.88,24% of total billed charges,293.88,24% of total billed charges,293.88,979.6,612.25
Outpatient Medical Services,AMBULATORY,45380,COLOSCOPY BIOPSY,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45380,C-SCOPE W/ BX,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,45381,COLONOSCOPY W/ DIRECTED SUBMUCOSAL INJUE,360,1379,370.4,26.86% of total billed charges,1034.25,75% of total billed charges,1034.25,75% of total billed charges,330.96,24% of total billed charges,1034.25,75% of total billed charges,1034.25,75% of total billed charges,1103.2,80% of total billed charges,334.27,24.24% of total billed charges,695.02,50.4% of total billed charges,1034.25,75% of total billed charges,337.58,24.48% of total billed charges,370.4,26.86% of total billed charges,330.96,24% of total billed charges,430.25,31.2% of total billed charges,1103.2,80% of total billed charges,330.96,24% of total billed charges,330.96,24% of total billed charges,330.96,1103.2,689.5
Outpatient Medical Services,AMBULATORY,45381,COLONOSCOPY SUBMUCOUS NJX,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45382,COLONOSCOPY FLEXIBLE W/ CONTROL OF BLEED,360,1421.5,381.81,26.86% of total billed charges,1066.13,75% of total billed charges,1066.13,75% of total billed charges,341.16,24% of total billed charges,1066.13,75% of total billed charges,1066.13,75% of total billed charges,1137.2,80% of total billed charges,344.57,24.24% of total billed charges,716.44,50.4% of total billed charges,1066.13,75% of total billed charges,347.98,24.48% of total billed charges,381.81,26.86% of total billed charges,341.16,24% of total billed charges,443.51,31.2% of total billed charges,1137.2,80% of total billed charges,341.16,24% of total billed charges,341.16,24% of total billed charges,341.16,1137.2,710.75
Outpatient Medical Services,AMBULATORY,45382,COLOSCOPY W/CONTROL BLEED,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45384,COLONOSCOPY W/BIOPSY BY HOT BIOSPY FORCE,360,1577,423.58,26.86% of total billed charges,1182.75,75% of total billed charges,1182.75,75% of total billed charges,378.48,24% of total billed charges,1182.75,75% of total billed charges,1182.75,75% of total billed charges,1261.6,80% of total billed charges,382.26,24.24% of total billed charges,794.81,50.4% of total billed charges,1182.75,75% of total billed charges,386.05,24.48% of total billed charges,423.58,26.86% of total billed charges,378.48,24% of total billed charges,492.02,31.2% of total billed charges,1261.6,80% of total billed charges,378.48,24% of total billed charges,378.48,24% of total billed charges,378.48,1261.6,788.5
Outpatient Medical Services,AMBULATORY,45384,COLONOSCOPE W/LESION REMOVAL,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,45385,COLONOSCOPY W/BIOPSY SNARE,360,1577,423.58,26.86% of total billed charges,1182.75,75% of total billed charges,1182.75,75% of total billed charges,378.48,24% of total billed charges,1182.75,75% of total billed charges,1182.75,75% of total billed charges,1261.6,80% of total billed charges,382.26,24.24% of total billed charges,794.81,50.4% of total billed charges,1182.75,75% of total billed charges,386.05,24.48% of total billed charges,423.58,26.86% of total billed charges,378.48,24% of total billed charges,492.02,31.2% of total billed charges,1261.6,80% of total billed charges,378.48,24% of total billed charges,378.48,24% of total billed charges,378.48,1261.6,788.5
Outpatient Medical Services,AMBULATORY,45385,C-SCOPE W/ SNARE,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,45386,COLONOSCOPY W/ DILATION BY BALLOON 1 OR,360,1236,331.99,26.86% of total billed charges,927,75% of total billed charges,927,75% of total billed charges,296.64,24% of total billed charges,927,75% of total billed charges,927,75% of total billed charges,988.8,80% of total billed charges,299.61,24.24% of total billed charges,622.94,50.4% of total billed charges,927,75% of total billed charges,302.57,24.48% of total billed charges,331.99,26.86% of total billed charges,296.64,24% of total billed charges,385.63,31.2% of total billed charges,988.8,80% of total billed charges,296.64,24% of total billed charges,296.64,24% of total billed charges,296.64,988.8,618
Outpatient Medical Services,AMBULATORY,45388,COLONOSCOPY FLEXIBLE TO SPLENIC FLEXURE,360,1511,405.85,26.86% of total billed charges,1133.25,75% of total billed charges,1133.25,75% of total billed charges,362.64,24% of total billed charges,1133.25,75% of total billed charges,1133.25,75% of total billed charges,1208.8,80% of total billed charges,366.27,24.24% of total billed charges,761.54,50.4% of total billed charges,1133.25,75% of total billed charges,369.89,24.48% of total billed charges,405.85,26.86% of total billed charges,362.64,24% of total billed charges,471.43,31.2% of total billed charges,1208.8,80% of total billed charges,362.64,24% of total billed charges,362.64,24% of total billed charges,362.64,1208.8,755.5
Outpatient Medical Services,AMBULATORY,45398,COLONOSCOPY W/BAND LIGATION,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,46221,HEM BANDING,360,941.5,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,46270,SURGICAL TREATMENT OF ANAL FISTULA,360,1593.5,428.01,26.86% of total billed charges,1195.13,75% of total billed charges,1195.13,75% of total billed charges,382.44,24% of total billed charges,1195.13,75% of total billed charges,1195.13,75% of total billed charges,1274.8,80% of total billed charges,386.26,24.24% of total billed charges,803.12,50.4% of total billed charges,1195.13,75% of total billed charges,390.09,24.48% of total billed charges,428.01,26.86% of total billed charges,382.44,24% of total billed charges,497.17,31.2% of total billed charges,1274.8,80% of total billed charges,382.44,24% of total billed charges,382.44,24% of total billed charges,382.44,1274.8,796.75
Outpatient Medical Services,AMBULATORY,46947,PROCEDURE/PROLAPSE HEMORRH,360,2930.5,787.13,26.86% of total billed charges,2197.88,75% of total billed charges,2197.88,75% of total billed charges,703.32,24% of total billed charges,2197.88,75% of total billed charges,2197.88,75% of total billed charges,2344.4,80% of total billed charges,710.35,24.24% of total billed charges,1476.97,50.4% of total billed charges,2197.88,75% of total billed charges,717.39,24.48% of total billed charges,787.13,26.86% of total billed charges,703.32,24% of total billed charges,914.32,31.2% of total billed charges,2344.4,80% of total billed charges,703.32,24% of total billed charges,703.32,24% of total billed charges,703.32,2344.4,1465.25
Outpatient Medical Services,AMBULATORY,60220,PARTIAL REMOVAL OF THYROID,360,1847,496.1,26.86% of total billed charges,1385.25,75% of total billed charges,1385.25,75% of total billed charges,443.28,24% of total billed charges,1385.25,75% of total billed charges,1385.25,75% of total billed charges,1477.6,80% of total billed charges,447.71,24.24% of total billed charges,930.89,50.4% of total billed charges,1385.25,75% of total billed charges,452.15,24.48% of total billed charges,496.1,26.86% of total billed charges,443.28,24% of total billed charges,576.26,31.2% of total billed charges,1477.6,80% of total billed charges,443.28,24% of total billed charges,443.28,24% of total billed charges,443.28,1477.6,923.5
Outpatient Medical Services,AMBULATORY,65855,TRABECULOPLASTY ALT,360,660,177.28,26.86% of total billed charges,495,75% of total billed charges,495,75% of total billed charges,158.4,24% of total billed charges,495,75% of total billed charges,495,75% of total billed charges,528,80% of total billed charges,159.98,24.24% of total billed charges,332.64,50.4% of total billed charges,495,75% of total billed charges,161.57,24.48% of total billed charges,177.28,26.86% of total billed charges,158.4,24% of total billed charges,205.92,31.2% of total billed charges,528,80% of total billed charges,158.4,24% of total billed charges,158.4,24% of total billed charges,158.4,528,330
Outpatient Medical Services,AMBULATORY,66761,IRIDOTOMY,360,753,202.26,26.86% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,180.72,24% of total billed charges,564.75,75% of total billed charges,564.75,75% of total billed charges,602.4,80% of total billed charges,182.53,24.24% of total billed charges,379.51,50.4% of total billed charges,564.75,75% of total billed charges,184.33,24.48% of total billed charges,202.26,26.86% of total billed charges,180.72,24% of total billed charges,234.94,31.2% of total billed charges,602.4,80% of total billed charges,180.72,24% of total billed charges,180.72,24% of total billed charges,180.72,602.4,376.5
Outpatient Medical Services,AMBULATORY,67105,PHOTOCOAG REPAIR,360,1036,278.27,26.86% of total billed charges,777,75% of total billed charges,777,75% of total billed charges,248.64,24% of total billed charges,777,75% of total billed charges,777,75% of total billed charges,828.8,80% of total billed charges,251.13,24.24% of total billed charges,522.14,50.4% of total billed charges,777,75% of total billed charges,253.61,24.48% of total billed charges,278.27,26.86% of total billed charges,248.64,24% of total billed charges,323.23,31.2% of total billed charges,828.8,80% of total billed charges,248.64,24% of total billed charges,248.64,24% of total billed charges,248.64,828.8,518
Outpatient Medical Services,AMBULATORY,67145,PROPHYLAXIS OF RD,360,847.5,227.64,26.86% of total billed charges,635.63,75% of total billed charges,635.63,75% of total billed charges,203.4,24% of total billed charges,635.63,75% of total billed charges,635.63,75% of total billed charges,678,80% of total billed charges,205.43,24.24% of total billed charges,427.14,50.4% of total billed charges,635.63,75% of total billed charges,207.47,24.48% of total billed charges,227.64,26.86% of total billed charges,203.4,24% of total billed charges,264.42,31.2% of total billed charges,678,80% of total billed charges,203.4,24% of total billed charges,203.4,24% of total billed charges,203.4,678,423.75
Outpatient Medical Services,AMBULATORY,67210,PHOTOCOAG FOCAL/GRID,360,1224.5,328.9,26.86% of total billed charges,918.38,75% of total billed charges,918.38,75% of total billed charges,293.88,24% of total billed charges,918.38,75% of total billed charges,918.38,75% of total billed charges,979.6,80% of total billed charges,296.82,24.24% of total billed charges,617.15,50.4% of total billed charges,918.38,75% of total billed charges,299.76,24.48% of total billed charges,328.9,26.86% of total billed charges,293.88,24% of total billed charges,382.04,31.2% of total billed charges,979.6,80% of total billed charges,293.88,24% of total billed charges,293.88,24% of total billed charges,293.88,979.6,612.25
Outpatient Medical Services,AMBULATORY,67228,PHOTOCOAG LASER,360,1600.5,429.89,26.86% of total billed charges,1200.38,75% of total billed charges,1200.38,75% of total billed charges,384.12,24% of total billed charges,1200.38,75% of total billed charges,1200.38,75% of total billed charges,1280.4,80% of total billed charges,387.96,24.24% of total billed charges,806.65,50.4% of total billed charges,1200.38,75% of total billed charges,391.8,24.48% of total billed charges,429.89,26.86% of total billed charges,384.12,24% of total billed charges,499.36,31.2% of total billed charges,1280.4,80% of total billed charges,384.12,24% of total billed charges,384.12,24% of total billed charges,384.12,1280.4,800.25
Outpatient Medical Services,AMBULATORY,75825,VENOGRAPHY,360,758,203.6,26.86% of total billed charges,568.5,75% of total billed charges,568.5,75% of total billed charges,181.92,24% of total billed charges,568.5,75% of total billed charges,568.5,75% of total billed charges,606.4,80% of total billed charges,183.74,24.24% of total billed charges,382.03,50.4% of total billed charges,568.5,75% of total billed charges,185.56,24.48% of total billed charges,203.6,26.86% of total billed charges,181.92,24% of total billed charges,236.5,31.2% of total billed charges,606.4,80% of total billed charges,181.92,24% of total billed charges,181.92,24% of total billed charges,181.92,606.4,379
Outpatient Medical Services,AMBULATORY,75827,VENOGRAPHY,360,3628.5,974.62,26.86% of total billed charges,2721.38,75% of total billed charges,2721.38,75% of total billed charges,870.84,24% of total billed charges,2721.38,75% of total billed charges,2721.38,75% of total billed charges,2902.8,80% of total billed charges,879.55,24.24% of total billed charges,1828.76,50.4% of total billed charges,2721.38,75% of total billed charges,888.26,24.48% of total billed charges,974.62,26.86% of total billed charges,870.84,24% of total billed charges,1132.09,31.2% of total billed charges,2902.8,80% of total billed charges,870.84,24% of total billed charges,870.84,24% of total billed charges,870.84,2902.8,1814.25
Outpatient Medical Services,AMBULATORY,77001,FLUOROGUIDE FOR VEIN DEVICE,360,681,182.92,26.86% of total billed charges,510.75,75% of total billed charges,510.75,75% of total billed charges,163.44,24% of total billed charges,510.75,75% of total billed charges,510.75,75% of total billed charges,544.8,80% of total billed charges,165.07,24.24% of total billed charges,343.22,50.4% of total billed charges,510.75,75% of total billed charges,166.71,24.48% of total billed charges,182.92,26.86% of total billed charges,163.44,24% of total billed charges,212.47,31.2% of total billed charges,544.8,80% of total billed charges,163.44,24% of total billed charges,163.44,24% of total billed charges,163.44,544.8,340.5
Outpatient Medical Services,AMBULATORY,G0104,SCREENING FLEX SIGMOIDOSCOPY,360,402.5,108.11,26.86% of total billed charges,301.88,75% of total billed charges,301.88,75% of total billed charges,96.6,24% of total billed charges,301.88,75% of total billed charges,301.88,75% of total billed charges,322,80% of total billed charges,97.57,24.24% of total billed charges,202.86,50.4% of total billed charges,301.88,75% of total billed charges,98.53,24.48% of total billed charges,108.11,26.86% of total billed charges,96.6,24% of total billed charges,125.58,31.2% of total billed charges,322,80% of total billed charges,96.6,24% of total billed charges,96.6,24% of total billed charges,96.6,322,201.25
Outpatient Medical Services,AMBULATORY,G0105,SCREENING COLONOSCOPY/HIGH RISK,360,1279.5,343.67,26.86% of total billed charges,959.63,75% of total billed charges,959.63,75% of total billed charges,307.08,24% of total billed charges,959.63,75% of total billed charges,959.63,75% of total billed charges,1023.6,80% of total billed charges,310.15,24.24% of total billed charges,644.87,50.4% of total billed charges,959.63,75% of total billed charges,313.22,24.48% of total billed charges,343.67,26.86% of total billed charges,307.08,24% of total billed charges,399.2,31.2% of total billed charges,1023.6,80% of total billed charges,307.08,24% of total billed charges,307.08,24% of total billed charges,307.08,1023.6,639.75
Outpatient Medical Services,AMBULATORY,G0121,COLORECTAL CANCER SCREENING COLONOSCOPY,360,1172,314.8,26.86% of total billed charges,879,75% of total billed charges,879,75% of total billed charges,281.28,24% of total billed charges,879,75% of total billed charges,879,75% of total billed charges,937.6,80% of total billed charges,284.09,24.24% of total billed charges,590.69,50.4% of total billed charges,879,75% of total billed charges,286.91,24.48% of total billed charges,314.8,26.86% of total billed charges,281.28,24% of total billed charges,365.66,31.2% of total billed charges,937.6,80% of total billed charges,281.28,24% of total billed charges,281.28,24% of total billed charges,281.28,937.6,586
Outpatient Medical Services,AMBULATORY,G0328,COLORECTAL SCREENING WELCOME TO MEDICARE,360,84.5,16.28,Fee Schedule,63.38,75% of total billed charges,63.38,75% of total billed charges,20.28,24% of total billed charges,63.38,75% of total billed charges,63.38,75% of total billed charges,67.6,80% of total billed charges,20.48,24.24% of total billed charges,42.59,50.4% of total billed charges,63.38,75% of total billed charges,20.69,24.48% of total billed charges,16.28,Fee Schedule,20.28,24% of total billed charges,26.36,31.2% of total billed charges,67.6,80% of total billed charges,20.28,24% of total billed charges,20.28,24% of total billed charges,16.28,67.6,42.25
Outpatient Medical Services,AMBULATORY,360,"$1,112.50 ",360,"$1,112.50 ",298.82,26.86% of total billed charges,834.38,75% of total billed charges,834.38,75% of total billed charges,267,24% of total billed charges,834.38,75% of total billed charges,834.38,75% of total billed charges,890,80% of total billed charges,269.67,24.24% of total billed charges,560.7,50.4% of total billed charges,834.38,75% of total billed charges,272.34,24.48% of total billed charges,298.82,26.86% of total billed charges,267,24% of total billed charges,347.1,31.2% of total billed charges,890,80% of total billed charges,267,24% of total billed charges,267,24% of total billed charges,267,890,556.25
Outpatient Medical Services,AMBULATORY,360,"$2,555.50 ",360,"$2,555.50 ",686.41,26.86% of total billed charges,1916.63,75% of total billed charges,1916.63,75% of total billed charges,613.32,24% of total billed charges,1916.63,75% of total billed charges,1916.63,75% of total billed charges,2044.4,80% of total billed charges,619.45,24.24% of total billed charges,1287.97,50.4% of total billed charges,1916.63,75% of total billed charges,625.59,24.48% of total billed charges,686.41,26.86% of total billed charges,613.32,24% of total billed charges,797.32,31.2% of total billed charges,2044.4,80% of total billed charges,613.32,24% of total billed charges,613.32,24% of total billed charges,613.32,2044.4,1277.75
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,"$2,354.50 ",360,"$2,354.50 ",632.42,26.86% of total billed charges,1765.88,75% of total billed charges,1765.88,75% of total billed charges,565.08,24% of total billed charges,1765.88,75% of total billed charges,1765.88,75% of total billed charges,1883.6,80% of total billed charges,570.73,24.24% of total billed charges,1186.67,50.4% of total billed charges,1765.88,75% of total billed charges,576.38,24.48% of total billed charges,632.42,26.86% of total billed charges,565.08,24% of total billed charges,734.6,31.2% of total billed charges,1883.6,80% of total billed charges,565.08,24% of total billed charges,565.08,24% of total billed charges,565.08,1883.6,1177.25
Outpatient Medical Services,AMBULATORY,360,"$3,531.00 ",360,"$3,531.00 ",948.43,26.86% of total billed charges,2648.25,75% of total billed charges,2648.25,75% of total billed charges,847.44,24% of total billed charges,2648.25,75% of total billed charges,2648.25,75% of total billed charges,2824.8,80% of total billed charges,855.91,24.24% of total billed charges,1779.62,50.4% of total billed charges,2648.25,75% of total billed charges,864.39,24.48% of total billed charges,948.43,26.86% of total billed charges,847.44,24% of total billed charges,1101.67,31.2% of total billed charges,2824.8,80% of total billed charges,847.44,24% of total billed charges,847.44,24% of total billed charges,847.44,2824.8,1765.5
Outpatient Medical Services,AMBULATORY,360,$589.00 ,360,$589.00 ,158.21,26.86% of total billed charges,441.75,75% of total billed charges,441.75,75% of total billed charges,141.36,24% of total billed charges,441.75,75% of total billed charges,441.75,75% of total billed charges,471.2,80% of total billed charges,142.77,24.24% of total billed charges,296.86,50.4% of total billed charges,441.75,75% of total billed charges,144.19,24.48% of total billed charges,158.21,26.86% of total billed charges,141.36,24% of total billed charges,183.77,31.2% of total billed charges,471.2,80% of total billed charges,141.36,24% of total billed charges,141.36,24% of total billed charges,141.36,471.2,294.5
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,"$2,824.50 ",360,"$2,824.50 ",758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,360,"$2,824.50 ",360,"$2,824.50 ",758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,360,"$2,824.50 ",360,"$2,824.50 ",758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,360,"$5,870.00 ",360,"$5,870.00 ",1576.68,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,1408.8,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,4696,80% of total billed charges,1422.89,24.24% of total billed charges,2958.48,50.4% of total billed charges,4402.5,75% of total billed charges,1436.98,24.48% of total billed charges,1576.68,26.86% of total billed charges,1408.8,24% of total billed charges,1831.44,31.2% of total billed charges,4696,80% of total billed charges,1408.8,24% of total billed charges,1408.8,24% of total billed charges,1408.8,4696,2935
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,"$1,765.50 ",360,"$1,765.50 ",474.21,26.86% of total billed charges,1324.13,75% of total billed charges,1324.13,75% of total billed charges,423.72,24% of total billed charges,1324.13,75% of total billed charges,1324.13,75% of total billed charges,1412.4,80% of total billed charges,427.96,24.24% of total billed charges,889.81,50.4% of total billed charges,1324.13,75% of total billed charges,432.19,24.48% of total billed charges,474.21,26.86% of total billed charges,423.72,24% of total billed charges,550.84,31.2% of total billed charges,1412.4,80% of total billed charges,423.72,24% of total billed charges,423.72,24% of total billed charges,423.72,1412.4,882.75
Outpatient Medical Services,AMBULATORY,360,"$1,765.50 ",360,"$1,765.50 ",474.21,26.86% of total billed charges,1324.13,75% of total billed charges,1324.13,75% of total billed charges,423.72,24% of total billed charges,1324.13,75% of total billed charges,1324.13,75% of total billed charges,1412.4,80% of total billed charges,427.96,24.24% of total billed charges,889.81,50.4% of total billed charges,1324.13,75% of total billed charges,432.19,24.48% of total billed charges,474.21,26.86% of total billed charges,423.72,24% of total billed charges,550.84,31.2% of total billed charges,1412.4,80% of total billed charges,423.72,24% of total billed charges,423.72,24% of total billed charges,423.72,1412.4,882.75
Outpatient Medical Services,AMBULATORY,360,"$1,176.50 ",360,"$1,176.50 ",316.01,26.86% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,282.36,24% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,941.2,80% of total billed charges,285.18,24.24% of total billed charges,592.96,50.4% of total billed charges,882.38,75% of total billed charges,288.01,24.48% of total billed charges,316.01,26.86% of total billed charges,282.36,24% of total billed charges,367.07,31.2% of total billed charges,941.2,80% of total billed charges,282.36,24% of total billed charges,282.36,24% of total billed charges,282.36,941.2,588.25
Outpatient Medical Services,AMBULATORY,360,$941.50 ,360,$941.50 ,252.89,26.86% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,225.96,24% of total billed charges,706.13,75% of total billed charges,706.13,75% of total billed charges,753.2,80% of total billed charges,228.22,24.24% of total billed charges,474.52,50.4% of total billed charges,706.13,75% of total billed charges,230.48,24.48% of total billed charges,252.89,26.86% of total billed charges,225.96,24% of total billed charges,293.75,31.2% of total billed charges,753.2,80% of total billed charges,225.96,24% of total billed charges,225.96,24% of total billed charges,225.96,753.2,470.75
Outpatient Medical Services,AMBULATORY,360,"$1,176.50 ",360,"$1,176.50 ",316.01,26.86% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,282.36,24% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,941.2,80% of total billed charges,285.18,24.24% of total billed charges,592.96,50.4% of total billed charges,882.38,75% of total billed charges,288.01,24.48% of total billed charges,316.01,26.86% of total billed charges,282.36,24% of total billed charges,367.07,31.2% of total billed charges,941.2,80% of total billed charges,282.36,24% of total billed charges,282.36,24% of total billed charges,282.36,941.2,588.25
Outpatient Medical Services,AMBULATORY,360,"$1,176.50 ",360,"$1,176.50 ",316.01,26.86% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,282.36,24% of total billed charges,882.38,75% of total billed charges,882.38,75% of total billed charges,941.2,80% of total billed charges,285.18,24.24% of total billed charges,592.96,50.4% of total billed charges,882.38,75% of total billed charges,288.01,24.48% of total billed charges,316.01,26.86% of total billed charges,282.36,24% of total billed charges,367.07,31.2% of total billed charges,941.2,80% of total billed charges,282.36,24% of total billed charges,282.36,24% of total billed charges,282.36,941.2,588.25
Outpatient Medical Services,AMBULATORY,360,$95.00 ,360,$95.00 ,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,AMBULATORY,360,$95.00 ,360,$95.00 ,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,AMBULATORY,360,"$2,824.50 ",360,"$2,824.50 ",758.66,26.86% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,677.88,24% of total billed charges,2118.38,75% of total billed charges,2118.38,75% of total billed charges,2259.6,80% of total billed charges,684.66,24.24% of total billed charges,1423.55,50.4% of total billed charges,2118.38,75% of total billed charges,691.44,24.48% of total billed charges,758.66,26.86% of total billed charges,677.88,24% of total billed charges,881.24,31.2% of total billed charges,2259.6,80% of total billed charges,677.88,24% of total billed charges,677.88,24% of total billed charges,677.88,2259.6,1412.25
Outpatient Medical Services,AMBULATORY,360,$23.50 ,360,$23.50 ,6.31,26.86% of total billed charges,17.63,75% of total billed charges,17.63,75% of total billed charges,5.64,24% of total billed charges,17.63,75% of total billed charges,17.63,75% of total billed charges,18.8,80% of total billed charges,5.7,24.24% of total billed charges,11.84,50.4% of total billed charges,17.63,75% of total billed charges,5.75,24.48% of total billed charges,6.31,26.86% of total billed charges,5.64,24% of total billed charges,7.33,31.2% of total billed charges,18.8,80% of total billed charges,5.64,24% of total billed charges,5.64,24% of total billed charges,5.64,18.8,11.75
Outpatient Medical Services,AMBULATORY,360,$947.50 ,360,$947.50 ,254.5,26.86% of total billed charges,710.63,75% of total billed charges,710.63,75% of total billed charges,227.4,24% of total billed charges,710.63,75% of total billed charges,710.63,75% of total billed charges,758,80% of total billed charges,229.67,24.24% of total billed charges,477.54,50.4% of total billed charges,710.63,75% of total billed charges,231.95,24.48% of total billed charges,254.5,26.86% of total billed charges,227.4,24% of total billed charges,295.62,31.2% of total billed charges,758,80% of total billed charges,227.4,24% of total billed charges,227.4,24% of total billed charges,227.4,758,473.75
Outpatient Medical Services,AMBULATORY,360,"$2,507.00 ",360,"$2,507.00 ",673.38,26.86% of total billed charges,1880.25,75% of total billed charges,1880.25,75% of total billed charges,601.68,24% of total billed charges,1880.25,75% of total billed charges,1880.25,75% of total billed charges,2005.6,80% of total billed charges,607.7,24.24% of total billed charges,1263.53,50.4% of total billed charges,1880.25,75% of total billed charges,613.71,24.48% of total billed charges,673.38,26.86% of total billed charges,601.68,24% of total billed charges,782.18,31.2% of total billed charges,2005.6,80% of total billed charges,601.68,24% of total billed charges,601.68,24% of total billed charges,601.68,2005.6,1253.5
Outpatient Medical Services,AMBULATORY,360,$20.50 ,360,$20.50 ,5.51,26.86% of total billed charges,15.38,75% of total billed charges,15.38,75% of total billed charges,4.92,24% of total billed charges,15.38,75% of total billed charges,15.38,75% of total billed charges,16.4,80% of total billed charges,4.97,24.24% of total billed charges,10.33,50.4% of total billed charges,15.38,75% of total billed charges,5.02,24.48% of total billed charges,5.51,26.86% of total billed charges,4.92,24% of total billed charges,6.4,31.2% of total billed charges,16.4,80% of total billed charges,4.92,24% of total billed charges,4.92,24% of total billed charges,4.92,16.4,10.25
Outpatient Medical Services,AMBULATORY,360,$836.50 ,360,$836.50 ,224.68,26.86% of total billed charges,627.38,75% of total billed charges,627.38,75% of total billed charges,200.76,24% of total billed charges,627.38,75% of total billed charges,627.38,75% of total billed charges,669.2,80% of total billed charges,202.77,24.24% of total billed charges,421.6,50.4% of total billed charges,627.38,75% of total billed charges,204.78,24.48% of total billed charges,224.68,26.86% of total billed charges,200.76,24% of total billed charges,260.99,31.2% of total billed charges,669.2,80% of total billed charges,200.76,24% of total billed charges,200.76,24% of total billed charges,200.76,669.2,418.25
Outpatient Medical Services,AMBULATORY,360,"$2,172.50 ",360,"$2,172.50 ",583.53,26.86% of total billed charges,1629.38,75% of total billed charges,1629.38,75% of total billed charges,521.4,24% of total billed charges,1629.38,75% of total billed charges,1629.38,75% of total billed charges,1738,80% of total billed charges,526.61,24.24% of total billed charges,1094.94,50.4% of total billed charges,1629.38,75% of total billed charges,531.83,24.48% of total billed charges,583.53,26.86% of total billed charges,521.4,24% of total billed charges,677.82,31.2% of total billed charges,1738,80% of total billed charges,521.4,24% of total billed charges,521.4,24% of total billed charges,521.4,1738,1086.25
Outpatient Medical Services,AMBULATORY,360,$18.50 ,360,$18.50 ,4.97,26.86% of total billed charges,13.88,75% of total billed charges,13.88,75% of total billed charges,4.44,24% of total billed charges,13.88,75% of total billed charges,13.88,75% of total billed charges,14.8,80% of total billed charges,4.48,24.24% of total billed charges,9.32,50.4% of total billed charges,13.88,75% of total billed charges,4.53,24.48% of total billed charges,4.97,26.86% of total billed charges,4.44,24% of total billed charges,5.77,31.2% of total billed charges,14.8,80% of total billed charges,4.44,24% of total billed charges,4.44,24% of total billed charges,4.44,14.8,9.25
Outpatient Medical Services,AMBULATORY,360,$724.00 ,360,$724.00 ,194.47,26.86% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,173.76,24% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,579.2,80% of total billed charges,175.5,24.24% of total billed charges,364.9,50.4% of total billed charges,543,75% of total billed charges,177.24,24.48% of total billed charges,194.47,26.86% of total billed charges,173.76,24% of total billed charges,225.89,31.2% of total billed charges,579.2,80% of total billed charges,173.76,24% of total billed charges,173.76,24% of total billed charges,173.76,579.2,362
Outpatient Medical Services,AMBULATORY,360,"$1,838.50 ",360,"$1,838.50 ",493.82,26.86% of total billed charges,1378.88,75% of total billed charges,1378.88,75% of total billed charges,441.24,24% of total billed charges,1378.88,75% of total billed charges,1378.88,75% of total billed charges,1470.8,80% of total billed charges,445.65,24.24% of total billed charges,926.6,50.4% of total billed charges,1378.88,75% of total billed charges,450.06,24.48% of total billed charges,493.82,26.86% of total billed charges,441.24,24% of total billed charges,573.61,31.2% of total billed charges,1470.8,80% of total billed charges,441.24,24% of total billed charges,441.24,24% of total billed charges,441.24,1470.8,919.25
Outpatient Medical Services,AMBULATORY,360,$15.50 ,360,$15.50 ,4.16,26.86% of total billed charges,11.63,75% of total billed charges,11.63,75% of total billed charges,3.72,24% of total billed charges,11.63,75% of total billed charges,11.63,75% of total billed charges,12.4,80% of total billed charges,3.76,24.24% of total billed charges,7.81,50.4% of total billed charges,11.63,75% of total billed charges,3.79,24.48% of total billed charges,4.16,26.86% of total billed charges,3.72,24% of total billed charges,4.84,31.2% of total billed charges,12.4,80% of total billed charges,3.72,24% of total billed charges,3.72,24% of total billed charges,3.72,12.4,7.75
Outpatient Medical Services,AMBULATORY,360,$557.00 ,360,$557.00 ,149.61,26.86% of total billed charges,417.75,75% of total billed charges,417.75,75% of total billed charges,133.68,24% of total billed charges,417.75,75% of total billed charges,417.75,75% of total billed charges,445.6,80% of total billed charges,135.02,24.24% of total billed charges,280.73,50.4% of total billed charges,417.75,75% of total billed charges,136.35,24.48% of total billed charges,149.61,26.86% of total billed charges,133.68,24% of total billed charges,173.78,31.2% of total billed charges,445.6,80% of total billed charges,133.68,24% of total billed charges,133.68,24% of total billed charges,133.68,445.6,278.5
Outpatient Medical Services,AMBULATORY,360,"$1,520.50 ",360,"$1,520.50 ",408.41,26.86% of total billed charges,1140.38,75% of total billed charges,1140.38,75% of total billed charges,364.92,24% of total billed charges,1140.38,75% of total billed charges,1140.38,75% of total billed charges,1216.4,80% of total billed charges,368.57,24.24% of total billed charges,766.33,50.4% of total billed charges,1140.38,75% of total billed charges,372.22,24.48% of total billed charges,408.41,26.86% of total billed charges,364.92,24% of total billed charges,474.4,31.2% of total billed charges,1216.4,80% of total billed charges,364.92,24% of total billed charges,364.92,24% of total billed charges,364.92,1216.4,760.25
Outpatient Medical Services,AMBULATORY,360,$12.50 ,360,$12.50 ,3.36,26.86% of total billed charges,9.38,75% of total billed charges,9.38,75% of total billed charges,3,24% of total billed charges,9.38,75% of total billed charges,9.38,75% of total billed charges,10,80% of total billed charges,3.03,24.24% of total billed charges,6.3,50.4% of total billed charges,9.38,75% of total billed charges,3.06,24.48% of total billed charges,3.36,26.86% of total billed charges,3,24% of total billed charges,3.9,31.2% of total billed charges,10,80% of total billed charges,3,24% of total billed charges,3,24% of total billed charges,3,10,6.25
Outpatient Medical Services,AMBULATORY,360,$361.50 ,360,$361.50 ,97.1,26.86% of total billed charges,271.13,75% of total billed charges,271.13,75% of total billed charges,86.76,24% of total billed charges,271.13,75% of total billed charges,271.13,75% of total billed charges,289.2,80% of total billed charges,87.63,24.24% of total billed charges,182.2,50.4% of total billed charges,271.13,75% of total billed charges,88.5,24.48% of total billed charges,97.1,26.86% of total billed charges,86.76,24% of total billed charges,112.79,31.2% of total billed charges,289.2,80% of total billed charges,86.76,24% of total billed charges,86.76,24% of total billed charges,86.76,289.2,180.75
Outpatient Medical Services,AMBULATORY,360,N/A,360,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,AMBULATORY,360,$564.50 ,360,$564.50 ,151.62,26.86% of total billed charges,423.38,75% of total billed charges,423.38,75% of total billed charges,135.48,24% of total billed charges,423.38,75% of total billed charges,423.38,75% of total billed charges,451.6,80% of total billed charges,136.83,24.24% of total billed charges,284.51,50.4% of total billed charges,423.38,75% of total billed charges,138.19,24.48% of total billed charges,151.62,26.86% of total billed charges,135.48,24% of total billed charges,176.12,31.2% of total billed charges,451.6,80% of total billed charges,135.48,24% of total billed charges,135.48,24% of total billed charges,135.48,451.6,282.25
Outpatient Medical Services,AMBULATORY,360,$610.00 ,360,$610.00 ,163.85,26.86% of total billed charges,457.5,75% of total billed charges,457.5,75% of total billed charges,146.4,24% of total billed charges,457.5,75% of total billed charges,457.5,75% of total billed charges,488,80% of total billed charges,147.86,24.24% of total billed charges,307.44,50.4% of total billed charges,457.5,75% of total billed charges,149.33,24.48% of total billed charges,163.85,26.86% of total billed charges,146.4,24% of total billed charges,190.32,31.2% of total billed charges,488,80% of total billed charges,146.4,24% of total billed charges,146.4,24% of total billed charges,146.4,488,305
Outpatient Medical Services,AMBULATORY,360,$11.50 ,360,$11.50 ,3.09,26.86% of total billed charges,8.63,75% of total billed charges,8.63,75% of total billed charges,2.76,24% of total billed charges,8.63,75% of total billed charges,8.63,75% of total billed charges,9.2,80% of total billed charges,2.79,24.24% of total billed charges,5.8,50.4% of total billed charges,8.63,75% of total billed charges,2.82,24.48% of total billed charges,3.09,26.86% of total billed charges,2.76,24% of total billed charges,3.59,31.2% of total billed charges,9.2,80% of total billed charges,2.76,24% of total billed charges,2.76,24% of total billed charges,2.76,9.2,5.75
Outpatient Medical Services,AMBULATORY,19281,NEEDLE LOCALIZATION MAMMOGRAPHY,361,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,AMBULATORY,31500,INTUBATION,361,796,213.81,26.86% of total billed charges,597,75% of total billed charges,597,75% of total billed charges,191.04,24% of total billed charges,597,75% of total billed charges,597,75% of total billed charges,636.8,80% of total billed charges,192.95,24.24% of total billed charges,401.18,50.4% of total billed charges,597,75% of total billed charges,194.86,24.48% of total billed charges,213.81,26.86% of total billed charges,191.04,24% of total billed charges,248.35,31.2% of total billed charges,636.8,80% of total billed charges,191.04,24% of total billed charges,191.04,24% of total billed charges,191.04,636.8,398
Outpatient Medical Services,AMBULATORY,32555,THORACENTESIS W IMAGING GUIDANCE,361,3713,997.31,26.86% of total billed charges,2784.75,75% of total billed charges,2784.75,75% of total billed charges,891.12,24% of total billed charges,2784.75,75% of total billed charges,2784.75,75% of total billed charges,2970.4,80% of total billed charges,900.03,24.24% of total billed charges,1871.35,50.4% of total billed charges,2784.75,75% of total billed charges,908.94,24.48% of total billed charges,997.31,26.86% of total billed charges,891.12,24% of total billed charges,1158.46,31.2% of total billed charges,2970.4,80% of total billed charges,891.12,24% of total billed charges,891.12,24% of total billed charges,891.12,2970.4,1856.5
Outpatient Medical Services,AMBULATORY,37609,TEMPERAL ARTERY BIOPSY,361,543,145.85,26.86% of total billed charges,407.25,75% of total billed charges,407.25,75% of total billed charges,130.32,24% of total billed charges,407.25,75% of total billed charges,407.25,75% of total billed charges,434.4,80% of total billed charges,131.62,24.24% of total billed charges,273.67,50.4% of total billed charges,407.25,75% of total billed charges,132.93,24.48% of total billed charges,145.85,26.86% of total billed charges,130.32,24% of total billed charges,169.42,31.2% of total billed charges,434.4,80% of total billed charges,130.32,24% of total billed charges,130.32,24% of total billed charges,130.32,434.4,271.5
Outpatient Medical Services,AMBULATORY,49083,PARACENTESIS W IMAGING GUIDANCE,361,3713,997.31,26.86% of total billed charges,2784.75,75% of total billed charges,2784.75,75% of total billed charges,891.12,24% of total billed charges,2784.75,75% of total billed charges,2784.75,75% of total billed charges,2970.4,80% of total billed charges,900.03,24.24% of total billed charges,1871.35,50.4% of total billed charges,2784.75,75% of total billed charges,908.94,24.48% of total billed charges,997.31,26.86% of total billed charges,891.12,24% of total billed charges,1158.46,31.2% of total billed charges,2970.4,80% of total billed charges,891.12,24% of total billed charges,891.12,24% of total billed charges,891.12,2970.4,1856.5
Outpatient Medical Services,AMBULATORY,62270,SPINAL PUNCTURE LUMBARD DIAGNOSTIC,361,318.5,85.55,26.86% of total billed charges,238.88,75% of total billed charges,238.88,75% of total billed charges,76.44,24% of total billed charges,238.88,75% of total billed charges,238.88,75% of total billed charges,254.8,80% of total billed charges,77.2,24.24% of total billed charges,160.52,50.4% of total billed charges,238.88,75% of total billed charges,77.97,24.48% of total billed charges,85.55,26.86% of total billed charges,76.44,24% of total billed charges,99.37,31.2% of total billed charges,254.8,80% of total billed charges,76.44,24% of total billed charges,76.44,24% of total billed charges,76.44,254.8,159.25
Outpatient Medical Services,AMBULATORY,62321,CERVICAL EPIDURAL STEROID INJECTION,361,1167,313.46,26.86% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,280.08,24% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,933.6,80% of total billed charges,282.88,24.24% of total billed charges,588.17,50.4% of total billed charges,875.25,75% of total billed charges,285.68,24.48% of total billed charges,313.46,26.86% of total billed charges,280.08,24% of total billed charges,364.1,31.2% of total billed charges,933.6,80% of total billed charges,280.08,24% of total billed charges,280.08,24% of total billed charges,280.08,933.6,583.5
Outpatient Medical Services,AMBULATORY,64483,TRANSFORAMINAL EPIDURAL STEROID INJECTIO,361,6365.5,1709.77,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,1527.72,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,5092.4,80% of total billed charges,1543,24.24% of total billed charges,3208.21,50.4% of total billed charges,4774.13,75% of total billed charges,1558.27,24.48% of total billed charges,1709.77,26.86% of total billed charges,1527.72,24% of total billed charges,1986.04,31.2% of total billed charges,5092.4,80% of total billed charges,1527.72,24% of total billed charges,1527.72,24% of total billed charges,1527.72,5092.4,3182.75
Outpatient Medical Services,AMBULATORY,64483,LUMBAR EPIDURAL STEROID INJECTION,361,1167,313.46,26.86% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,280.08,24% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,933.6,80% of total billed charges,282.88,24.24% of total billed charges,588.17,50.4% of total billed charges,875.25,75% of total billed charges,285.68,24.48% of total billed charges,313.46,26.86% of total billed charges,280.08,24% of total billed charges,364.1,31.2% of total billed charges,933.6,80% of total billed charges,280.08,24% of total billed charges,280.08,24% of total billed charges,280.08,933.6,583.5
Outpatient Medical Services,EMERGENCY ROOM,10060,I&D ABSCESS SIMPLE,450,717,192.59,26.86% of total billed charges,710,Case rate,710,Case rate,172.08,24% of total billed charges,710,Case rate,710,Case rate,573.6,80% of total billed charges,173.8,24.24% of total billed charges,361.37,50.4% of total billed charges,537.75,75% of total billed charges,175.52,24.48% of total billed charges,192.59,26.86% of total billed charges,172.08,24% of total billed charges,223.7,31.2% of total billed charges,573.6,80% of total billed charges,172.08,24% of total billed charges,172.08,24% of total billed charges,172.08,710,358.5
Outpatient Medical Services,EMERGENCY ROOM,10061,I&D ABSCESS MULTIPLE COMPLICATED,450,1318.5,354.15,26.86% of total billed charges,710,Case rate,710,Case rate,316.44,24% of total billed charges,710,Case rate,710,Case rate,1054.8,80% of total billed charges,319.6,24.24% of total billed charges,664.52,50.4% of total billed charges,988.88,75% of total billed charges,322.77,24.48% of total billed charges,354.15,26.86% of total billed charges,316.44,24% of total billed charges,411.37,31.2% of total billed charges,1054.8,80% of total billed charges,316.44,24% of total billed charges,316.44,24% of total billed charges,316.44,1054.8,659.25
Outpatient Medical Services,EMERGENCY ROOM,10080,I&D PILONIDAL CYST,450,2431,652.97,26.86% of total billed charges,710,Case rate,710,Case rate,583.44,24% of total billed charges,710,Case rate,710,Case rate,1944.8,80% of total billed charges,589.27,24.24% of total billed charges,1225.22,50.4% of total billed charges,1823.25,75% of total billed charges,595.11,24.48% of total billed charges,652.97,26.86% of total billed charges,583.44,24% of total billed charges,758.47,31.2% of total billed charges,1944.8,80% of total billed charges,583.44,24% of total billed charges,583.44,24% of total billed charges,583.44,1944.8,1215.5
Outpatient Medical Services,EMERGENCY ROOM,10120,I&D FOREIGN BODY SUBQ SIMPLE,450,1318.5,354.15,26.86% of total billed charges,710,Case rate,710,Case rate,316.44,24% of total billed charges,710,Case rate,710,Case rate,1054.8,80% of total billed charges,319.6,24.24% of total billed charges,664.52,50.4% of total billed charges,988.88,75% of total billed charges,322.77,24.48% of total billed charges,354.15,26.86% of total billed charges,316.44,24% of total billed charges,411.37,31.2% of total billed charges,1054.8,80% of total billed charges,316.44,24% of total billed charges,316.44,24% of total billed charges,316.44,1054.8,659.25
Outpatient Medical Services,EMERGENCY ROOM,10121,REMOVE FOREIGN BODY SUBQ COMPLEX,450,1318.5,354.15,26.86% of total billed charges,710,Case rate,710,Case rate,316.44,24% of total billed charges,710,Case rate,710,Case rate,1054.8,80% of total billed charges,319.6,24.24% of total billed charges,664.52,50.4% of total billed charges,988.88,75% of total billed charges,322.77,24.48% of total billed charges,354.15,26.86% of total billed charges,316.44,24% of total billed charges,411.37,31.2% of total billed charges,1054.8,80% of total billed charges,316.44,24% of total billed charges,316.44,24% of total billed charges,316.44,1054.8,659.25
Outpatient Medical Services,EMERGENCY ROOM,10140,I&D HEMATOMA/FLUID,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,10160,PUNCTURE ASPIRATION HEMATOMA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11042,DEBRIDEMENT SUBCU FIRST 20CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11043,DEBRIDEMENT MUSCLE FIRST 20CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11044,DEBRIDEMENT BONE FIRST 20CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11045,DEBRIDEMENT SQ ADD'L 20CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11046,DEBRIDEMENT MUSCLE ADD'L 20CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11047,DEBRIDEMENT BONE ADDITIONAL 20CM,450,370,99.38,26.86% of total billed charges,710,Case rate,710,Case rate,88.8,24% of total billed charges,710,Case rate,710,Case rate,296,80% of total billed charges,89.69,24.24% of total billed charges,186.48,50.4% of total billed charges,277.5,75% of total billed charges,90.58,24.48% of total billed charges,99.38,26.86% of total billed charges,88.8,24% of total billed charges,115.44,31.2% of total billed charges,296,80% of total billed charges,88.8,24% of total billed charges,88.8,24% of total billed charges,88.8,710,185
Outpatient Medical Services,EMERGENCY ROOM,11720,"DEBRIDEMENT OF NAIL(S), ANY METHOD; 1-5",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11730,AVULSION NAIL PLATE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11732,AVULSION OF NAIL PLATE - EA  ADDITIONAL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11740,DRAIN BLOOD FROM UNDER NAIL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11750,REMOVAL NAIL BED,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11750,REMOVAL NAIL BED - PERMANENT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,11760,REPAIR NAIL BED,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12001,RPR S/N/AX/GEN/TRK <2.5 CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12002,RPR S/N/AX/GEN/TRK 2.6-7.5CM,450,717,192.59,26.86% of total billed charges,710,Case rate,710,Case rate,172.08,24% of total billed charges,710,Case rate,710,Case rate,573.6,80% of total billed charges,173.8,24.24% of total billed charges,361.37,50.4% of total billed charges,537.75,75% of total billed charges,175.52,24.48% of total billed charges,192.59,26.86% of total billed charges,172.08,24% of total billed charges,223.7,31.2% of total billed charges,573.6,80% of total billed charges,172.08,24% of total billed charges,172.08,24% of total billed charges,172.08,710,358.5
Outpatient Medical Services,EMERGENCY ROOM,12004,RPR S/N/AX/GEN/TRK 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12005,RPR S/N/A/GEN/TRK 12.6-20CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12006,RPR S/N/A/GEN/TRK 20.1 - 30CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12007,RPR SIMPLE S/N/A/GEN/TRK/EX >30,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12011,"RPR SIMPLE F/E/E/N/L/, <2.5 CM",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12013,RPR SIMPLE F/E/E/N/L/M 2.6-5CM,450,717,192.59,26.86% of total billed charges,710,Case rate,710,Case rate,172.08,24% of total billed charges,710,Case rate,710,Case rate,573.6,80% of total billed charges,173.8,24.24% of total billed charges,361.37,50.4% of total billed charges,537.75,75% of total billed charges,175.52,24.48% of total billed charges,192.59,26.86% of total billed charges,172.08,24% of total billed charges,223.7,31.2% of total billed charges,573.6,80% of total billed charges,172.08,24% of total billed charges,172.08,24% of total billed charges,172.08,710,358.5
Outpatient Medical Services,EMERGENCY ROOM,12014,"RPR SIMPLE F/E/E/N/L/, 5.1-7.5CM",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12015,RPR SIMPLE LAC F/E/E/N/L 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12015,RPR SIMPLE F/E/E/N/L/M 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12016,RPR SIMPLE LAC F/E/E/N/L 12.6-20CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12017,RPR SIMPLE LAC F/E/E/N/L 20.1-30CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12018,RPR SIMPLE LAC F/E/E/N/L >30CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12020,CLOSURE SPLIT WOUND,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12031,RPR INTER S/A/T/E 2.5CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12032,RPR INTER S/A/T/E 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12034,RPR INTER S/A/T/E 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12035,RPR INTER S/A/T/E 12.6-20CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12036,RPR INTER S/A/T/E 20.1-30CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12037,RPR INTER S/A/T/E >30CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12041,RPR INTER N/H/F/XTRNL 2.5CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12042,RPR INTER N/H/F/XTRNL 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12044,RPR INTER N/H/F/XTML 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12045,RPR INTER N/H/F/XTML 12.6-20.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12046,RPR INTER N/H/F/XTML 20.1-30.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12047,RPR INTER N/H/F/XTML >30.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12051,RPR INTER F/E/E/N/L 2.5CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12052,RPR INTER F/E/E/N/L 2.6-5.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12053,RPR INTER F/E/E/N/L 5.1-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12054,RPR INTER F/E/E/N/L 7.6-12.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12055,RPR INTER F/E/E/N/L 12.6-20.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12056,RPR INTER F/E/E/N/L 20.1-30.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,12057,RPR INTER F/E/E/N/L >30.0CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13100,RPR INTER TRUNK 1.1-2.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13101,RPR INTER TRUNK 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13102,RPR INTER TRUNK EA ADD'L 5CM OR LESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13120,RPR CMPLX SCALP/ARM/LEG 1.1-2.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13121,RPR CMPLX SCALP/ARM/LEG 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13122,RPR CMPLX SCALP/ARM/LEG EA ADD'L 5CM/<,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13131,RPR CMPLX F/C/C/M/N/AX/G/H/F 1.1-2.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13132,RPR CMPLX F/C/C/M/N/AX/G/H/F 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13133,RPR CMPLX F/C/C/M/N/AX/G/H/F ADDL 5CM/<,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13151,RPR CMPLX EYELID/NOSE/EAR LIP 1.1-2.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13152,RPR CMPLX EYELID/NOSE/EAR LIP 2.6-7.5CM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,13153,RPR CMPLX EYELID/NOSE/EAR LIPADDL 5CM/<,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,16000,BURN CARE FIRST DEGREE,450,108,29.01,26.86% of total billed charges,710,Case rate,710,Case rate,25.92,24% of total billed charges,710,Case rate,710,Case rate,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,29.01,26.86% of total billed charges,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,25.92,710,54
Outpatient Medical Services,EMERGENCY ROOM,16020,BURN CARE PART THICK SMALL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,16025,BURN CARE PART THICK MEDIUM,450,478,128.39,26.86% of total billed charges,710,Case rate,710,Case rate,114.72,24% of total billed charges,710,Case rate,710,Case rate,382.4,80% of total billed charges,115.87,24.24% of total billed charges,240.91,50.4% of total billed charges,358.5,75% of total billed charges,117.01,24.48% of total billed charges,128.39,26.86% of total billed charges,114.72,24% of total billed charges,149.14,31.2% of total billed charges,382.4,80% of total billed charges,114.72,24% of total billed charges,114.72,24% of total billed charges,114.72,710,239
Outpatient Medical Services,EMERGENCY ROOM,16030,BURN CARE PART THICK LARGE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20103,EXPLORE WOUND EXTREMITY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20103,EXPL PENETRATED WOUND,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20551,INJECTION SINGLE TENDON ORIGIN/INSERTION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20552,INJ TRIGGER POINT 1-2 MUSCLES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20553,INJ TRIGGER POINT 3/> MUSCLES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20600,ARTHROCENTESIS SMALL JOINT BURSA W/O US,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20604,ARTHROCENTESIS SMALL JOINT BURSA W/US,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20605,ARTHROCENTESIS JOINT BURSA W/O US,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20606,ARTHROCENTESIS INTERM JOINT BURSA W/US,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20610,ARTHOCENTESIS JOINT BURSA MAJOR,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20611,ARTHOCENTESIS MAJOR JOINT BURSA W/US,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,20612,ASPIRATION & INJ GANGLION CYST,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23330,"REMOVE FB SHOULDER, SUBQ",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23333,"REMOVE FB SHOULDER, DEEP",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23500,CLSD TX CLAVICULAR FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23505,CLSD TX CLAVICULAR FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23600,CL TX PROX HUMERAL FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23605,CL TX PROX HUMERAL FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23650,TRT SHOULDER DISLOCATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,23655,SHOULDER DISLOC W MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24200,RMVL FB UPPER ARM/ELBOW SUBQ,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24201,RMVL FB UPPER ARM/ELBOW DEEP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24500,CL TX HUMERAL SHAFT FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24505,CL TX HUMERAL SHAFT FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24530,CL TX SPRCND/TRANSCND HUMERAL FX W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24535,CL TX SPRCND/TRANSCND HUMERAL FX W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24600,TX ELBOW DISLOC W/O ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24605,TX ELBOW DISLOC W/ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24640,CL TX NURSEMAID ELBOW IN CHILDW/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24650,CL TX RADIAL HD/NECK FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24655,CL TX RADIAL HD/NECK FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24670,"CL TX ULNAR FX, PROX END W/O MANIP",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,24675,"CL TX ULNAR FX, PROX END W/MANIP",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25500,CL TX RADIAL SHAFT FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25505,CL TX RADIAL SHAFT FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25530,CL TX ULNAR SHAFT FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25535,CL TX ULNAR SHAFT FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25560,CL TX RADIAL & ULNAR SHAFT FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25565,CL TX RADIAL & ULNAR SHAFT FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25600,CL TX DISTAL RADIAL FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25605,CL TX DISTAL RADIAL FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,25622,CL TX CARPAL SCAPHOID FX W/O MANIP,450,1024,275.05,26.86% of total billed charges,710,Case rate,710,Case rate,245.76,24% of total billed charges,710,Case rate,710,Case rate,819.2,80% of total billed charges,248.22,24.24% of total billed charges,516.1,50.4% of total billed charges,768,75% of total billed charges,250.68,24.48% of total billed charges,275.05,26.86% of total billed charges,245.76,24% of total billed charges,319.49,31.2% of total billed charges,819.2,80% of total billed charges,245.76,24% of total billed charges,245.76,24% of total billed charges,245.76,819.2,512
Outpatient Medical Services,EMERGENCY ROOM,26010,I&D FINGER ABSCESS; SIMPLE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26410,RPR EXTSR TENDON HAND W/O GRAFT EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26418,RPR EXTSR TENDON FINGER W/O GRAFT EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26600,CL TX METACARPAL FX W/O MANIP EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26605,CL TX METACARPAL FX W/MANIP EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26700,TX FINGER DISLOCATION W/MANIP W/O ANESTH,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26705,TX FINGER DISLOCATION W/MANIP W/ANESTHIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26720,TX PHALANGEAL SHFT FX W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26725,TX PHALANGEAL SHFT FX W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26750,TX DISTAL PHALANGEAL FX W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26755,TX DISTAL PHALANGEAL FX W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26770,TREAT FINGER DISLOCATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,26775,FINGER DISLOC REQ ANESTH,450,1006.5,270.35,26.86% of total billed charges,710,Case rate,710,Case rate,241.56,24% of total billed charges,710,Case rate,710,Case rate,805.2,80% of total billed charges,243.98,24.24% of total billed charges,507.28,50.4% of total billed charges,754.88,75% of total billed charges,246.39,24.48% of total billed charges,270.35,26.86% of total billed charges,241.56,24% of total billed charges,314.03,31.2% of total billed charges,805.2,80% of total billed charges,241.56,24% of total billed charges,241.56,24% of total billed charges,241.56,805.2,503.25
Outpatient Medical Services,EMERGENCY ROOM,27086,RMVL FB PELVIS/HIP SUBQ,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27087,RMVL FB PELVIS/HIP DEEP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27096,INJECT SI JOINT W/IMAGE GUIDE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27250,TX HIP DISLOCATION TRAUMA W/O ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27252,TX HIP DISLOCATION TRAUMA W/ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27256,TX HIP DISLOCATION SPONT W/O MANIP/ANEST,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27257,TX HIP DISLOCATION SPONT W/MANIP/ANEST,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27265,TX POST HIP ARTHROPLASTY DISLOC W/O ANES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27266,TX POST HIP ARTHROPLASTY DISLOC W/ANES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27500,CL TX FEMORAL SHAFT FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27501,CL TX SPRCNDYLR/TRNS FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27502,CL TX FEM SHFT FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27503,CL TX SPRCNDYLR FX W/MAN W/WO TRACT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27508,CLTX FEM FX DST END MED/LAT CNDL W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27510,CLTX FEM FX DST END MED/LAT CNDL W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27550,TX KNEE DISLOCATION W/O ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27552,TX KNEE DISLOCATION W/ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27560,PATELLER DISLOC W/O ANESTH,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27562,PATELLER DISLOC W/ANESTH,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27750,TX TIBIAL SHAFT FX W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27752,TX TIBIAL SHAFT FX W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27760,TX MED MALLEOLUS FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27762,TX MED MALLEOLUS FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27767,TX POS MALLEOLUS FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27768,TX POS MALLEOLUS FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27780,TX FIBULA PROX/SHAFT FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27781,TX FIBULA PROX/SHAFT FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27786,TX FIBULA DISTAL FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27788,TX FIBULA DISTAL FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27808,TX BIMALLEOLAR ANKLE FX W/O MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27810,TX BIMALLEOLAR ANKLE FX W/MANIPULATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27816,TX TRIMALLEOLAR ANKLE FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27818,TX TRIMALLEOLAR ANKLE FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27824,TX WT BRG ARTCLR PRTN DSTL TIBIA W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27824,TX WT BRG ARTCLR PRTN DSTL TIBIA W/O MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27825,TX WT BRG ARTCLR PRTN DSTL TIBIA W/MAN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27840,TX ANKLE DISLOCATION W/O ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,27842,TX ANKLE DISLOCATION W/ANESTHESIA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28190,RMVL FB FOOT SUBQ,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28192,RMVL FB FOOT DEEP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28193,RMVL FB FOOT COMPLICATED,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28430,CLOSED TX TALUS FX W/O MANIPULATION,450,658,176.74,26.86% of total billed charges,710,Case rate,710,Case rate,157.92,24% of total billed charges,710,Case rate,710,Case rate,526.4,80% of total billed charges,159.5,24.24% of total billed charges,331.63,50.4% of total billed charges,493.5,75% of total billed charges,161.08,24.48% of total billed charges,176.74,26.86% of total billed charges,157.92,24% of total billed charges,205.3,31.2% of total billed charges,526.4,80% of total billed charges,157.92,24% of total billed charges,157.92,24% of total billed charges,157.92,710,329
Outpatient Medical Services,EMERGENCY ROOM,28470,TX METATARSAL FX W/O MANIP EA,450,658,176.74,26.86% of total billed charges,710,Case rate,710,Case rate,157.92,24% of total billed charges,710,Case rate,710,Case rate,526.4,80% of total billed charges,159.5,24.24% of total billed charges,331.63,50.4% of total billed charges,493.5,75% of total billed charges,161.08,24.48% of total billed charges,176.74,26.86% of total billed charges,157.92,24% of total billed charges,205.3,31.2% of total billed charges,526.4,80% of total billed charges,157.92,24% of total billed charges,157.92,24% of total billed charges,157.92,710,329
Outpatient Medical Services,EMERGENCY ROOM,28475,TX METATARSAL FX W/MANIP EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28490,TX GREAT TOE FX W/O MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28495,TX GREAT TOE FX W/MANIP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28510,TX PHALANGES FX W/O MANIP EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28515,TX PHALANGES FX W/MANIP EA,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28635,CL TX METATAR-PHALANG JNT DISLOC W/ANES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28660,TX INTERPHALANGEAL JNT DISLOC W/O ANESTH,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,28665,CL TX INTERPHALANG JNT DISLOC W/ANES,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29065,CAST LONG ARM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29075,CAST SHORT ARM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29105,SPLINT LONG ARM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29125,SPLINT SHORT ARM,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29130,FINGER SPLINT APPLICATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29200,THORAX STRAPPING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29240,SHOULDER STRAPPING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29260,STRAPPING ELBOW OR WRIST,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29280,STRAPPING HAND OR FINGER (BUDDY TAPE),450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29345,CAST LONG LEG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29405,CAST SHORT LEG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29505,SPLINT LONG LEG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29515,SPLINT SHORT LEG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29530,STRAPPING KNEE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29540,STRAPPING ANKLE/FOOT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29550,STRAPPING TOES (BUDDY TAPE),450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,29580,STRAPPING UNNA BOOT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,30300,RMV FB INTRANASAL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,30901,CONTROL OF NOSEBLEED,450,475,127.59,26.86% of total billed charges,710,Case rate,710,Case rate,114,24% of total billed charges,710,Case rate,710,Case rate,380,80% of total billed charges,115.14,24.24% of total billed charges,239.4,50.4% of total billed charges,356.25,75% of total billed charges,116.28,24.48% of total billed charges,127.59,26.86% of total billed charges,114,24% of total billed charges,148.2,31.2% of total billed charges,380,80% of total billed charges,114,24% of total billed charges,114,24% of total billed charges,114,710,237.5
Outpatient Medical Services,EMERGENCY ROOM,30903,NASAL HEMORRHAGE ANTERIOR COMPLEX,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,30905,NASAL HEMORRHAGE PACKS AND CAUTERY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,31500,INTUBATION BY PHYSICIAN,450,489.5,131.48,26.86% of total billed charges,710,Case rate,710,Case rate,117.48,24% of total billed charges,710,Case rate,710,Case rate,391.6,80% of total billed charges,118.65,24.24% of total billed charges,246.71,50.4% of total billed charges,367.13,75% of total billed charges,119.83,24.48% of total billed charges,131.48,26.86% of total billed charges,117.48,24% of total billed charges,152.72,31.2% of total billed charges,391.6,80% of total billed charges,117.48,24% of total billed charges,117.48,24% of total billed charges,117.48,710,244.75
Outpatient Medical Services,EMERGENCY ROOM,31605,"TRACHEOSTOMY, EMERGENT; CRICOTHYROID MEM",450,1039.5,279.21,26.86% of total billed charges,710,Case rate,710,Case rate,249.48,24% of total billed charges,710,Case rate,710,Case rate,831.6,80% of total billed charges,251.97,24.24% of total billed charges,523.91,50.4% of total billed charges,779.63,75% of total billed charges,254.47,24.48% of total billed charges,279.21,26.86% of total billed charges,249.48,24% of total billed charges,324.32,31.2% of total billed charges,831.6,80% of total billed charges,249.48,24% of total billed charges,249.48,24% of total billed charges,249.48,831.6,519.75
Outpatient Medical Services,EMERGENCY ROOM,32100,THORACOTOMY W/EXPLORATION,450,2499,671.23,26.86% of total billed charges,710,Case rate,710,Case rate,599.76,24% of total billed charges,710,Case rate,710,Case rate,1999.2,80% of total billed charges,605.76,24.24% of total billed charges,1259.5,50.4% of total billed charges,1874.25,75% of total billed charges,611.76,24.48% of total billed charges,671.23,26.86% of total billed charges,599.76,24% of total billed charges,779.69,31.2% of total billed charges,1999.2,80% of total billed charges,599.76,24% of total billed charges,599.76,24% of total billed charges,599.76,1999.2,1249.5
Outpatient Medical Services,EMERGENCY ROOM,32110,THORACOTOMY W/CNTRL HEMORRHAGE/RPR LUNG,450,4552.5,1222.8,26.86% of total billed charges,710,Case rate,710,Case rate,1092.6,24% of total billed charges,710,Case rate,710,Case rate,3642,80% of total billed charges,1103.53,24.24% of total billed charges,2294.46,50.4% of total billed charges,3414.38,75% of total billed charges,1114.45,24.48% of total billed charges,1222.8,26.86% of total billed charges,1092.6,24% of total billed charges,1420.38,31.2% of total billed charges,3642,80% of total billed charges,1092.6,24% of total billed charges,1092.6,24% of total billed charges,710,3642,2276.25
Outpatient Medical Services,EMERGENCY ROOM,32160,THORACOTOMY W/CARDIAC MASSAGE,450,2453.5,659.01,26.86% of total billed charges,710,Case rate,710,Case rate,588.84,24% of total billed charges,710,Case rate,710,Case rate,1962.8,80% of total billed charges,594.73,24.24% of total billed charges,1236.56,50.4% of total billed charges,1840.13,75% of total billed charges,600.62,24.48% of total billed charges,659.01,26.86% of total billed charges,588.84,24% of total billed charges,765.49,31.2% of total billed charges,1962.8,80% of total billed charges,588.84,24% of total billed charges,588.84,24% of total billed charges,588.84,1962.8,1226.75
Outpatient Medical Services,EMERGENCY ROOM,32551,CHEST TUBE INSERTION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,32554,THORACENTESIS W/O IMAGING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,32555,THORACENTESIS FOR ASPIRATION,450,529.5,142.22,26.86% of total billed charges,710,Case rate,710,Case rate,127.08,24% of total billed charges,710,Case rate,710,Case rate,423.6,80% of total billed charges,128.35,24.24% of total billed charges,266.87,50.4% of total billed charges,397.13,75% of total billed charges,129.62,24.48% of total billed charges,142.22,26.86% of total billed charges,127.08,24% of total billed charges,165.2,31.2% of total billed charges,423.6,80% of total billed charges,127.08,24% of total billed charges,127.08,24% of total billed charges,127.08,710,264.75
Outpatient Medical Services,EMERGENCY ROOM,32555,THORACENTESIS W/ IMAGING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,32556,THORACENTESIS W/WATER SEAL,450,557,149.61,26.86% of total billed charges,710,Case rate,710,Case rate,133.68,24% of total billed charges,710,Case rate,710,Case rate,445.6,80% of total billed charges,135.02,24.24% of total billed charges,280.73,50.4% of total billed charges,417.75,75% of total billed charges,136.35,24.48% of total billed charges,149.61,26.86% of total billed charges,133.68,24% of total billed charges,173.78,31.2% of total billed charges,445.6,80% of total billed charges,133.68,24% of total billed charges,133.68,24% of total billed charges,133.68,710,278.5
Outpatient Medical Services,EMERGENCY ROOM,35226,RPR BLOOD VESSEL LESION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,36430,BLOOD TRANSFUSION SERVICE,450,1128,302.98,26.86% of total billed charges,710,Case rate,710,Case rate,270.72,24% of total billed charges,710,Case rate,710,Case rate,902.4,80% of total billed charges,273.43,24.24% of total billed charges,568.51,50.4% of total billed charges,846,75% of total billed charges,276.13,24.48% of total billed charges,302.98,26.86% of total billed charges,270.72,24% of total billed charges,351.94,31.2% of total billed charges,902.4,80% of total billed charges,270.72,24% of total billed charges,270.72,24% of total billed charges,270.72,902.4,564
Outpatient Medical Services,EMERGENCY ROOM,36556,CENTRAL LINE INSERTION,450,1045.5,280.82,26.86% of total billed charges,710,Case rate,710,Case rate,250.92,24% of total billed charges,710,Case rate,710,Case rate,836.4,80% of total billed charges,253.43,24.24% of total billed charges,526.93,50.4% of total billed charges,784.13,75% of total billed charges,255.94,24.48% of total billed charges,280.82,26.86% of total billed charges,250.92,24% of total billed charges,326.2,31.2% of total billed charges,836.4,80% of total billed charges,250.92,24% of total billed charges,250.92,24% of total billed charges,250.92,836.4,522.75
Outpatient Medical Services,EMERGENCY ROOM,36569,PICC LINE INSERTION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,36591,PORT-A-CATH BLOOD DRAW,450,54.5,14.64,26.86% of total billed charges,710,Case rate,710,Case rate,13.08,24% of total billed charges,710,Case rate,710,Case rate,43.6,80% of total billed charges,13.21,24.24% of total billed charges,27.47,50.4% of total billed charges,40.88,75% of total billed charges,13.34,24.48% of total billed charges,14.64,26.86% of total billed charges,13.08,24% of total billed charges,17,31.2% of total billed charges,43.6,80% of total billed charges,13.08,24% of total billed charges,13.08,24% of total billed charges,13.08,710,27.25
Outpatient Medical Services,EMERGENCY ROOM,36592,COLLECT BLOOD FROM PICC,450,446,119.8,26.86% of total billed charges,710,Case rate,710,Case rate,107.04,24% of total billed charges,710,Case rate,710,Case rate,356.8,80% of total billed charges,108.11,24.24% of total billed charges,224.78,50.4% of total billed charges,334.5,75% of total billed charges,109.18,24.48% of total billed charges,119.8,26.86% of total billed charges,107.04,24% of total billed charges,139.15,31.2% of total billed charges,356.8,80% of total billed charges,107.04,24% of total billed charges,107.04,24% of total billed charges,107.04,710,223
Outpatient Medical Services,EMERGENCY ROOM,36620,ARTL CATH/CANNUL MNTR/XFUSE/SAMPLE SPX P,450,138,37.07,26.86% of total billed charges,710,Case rate,710,Case rate,33.12,24% of total billed charges,710,Case rate,710,Case rate,110.4,80% of total billed charges,33.45,24.24% of total billed charges,69.55,50.4% of total billed charges,103.5,75% of total billed charges,33.78,24.48% of total billed charges,37.07,26.86% of total billed charges,33.12,24% of total billed charges,43.06,31.2% of total billed charges,110.4,80% of total billed charges,33.12,24% of total billed charges,33.12,24% of total billed charges,33.12,710,69
Outpatient Medical Services,EMERGENCY ROOM,36680,IO PLACEMENT,450,443,118.99,26.86% of total billed charges,710,Case rate,710,Case rate,106.32,24% of total billed charges,710,Case rate,710,Case rate,354.4,80% of total billed charges,107.38,24.24% of total billed charges,223.27,50.4% of total billed charges,332.25,75% of total billed charges,108.45,24.48% of total billed charges,118.99,26.86% of total billed charges,106.32,24% of total billed charges,138.22,31.2% of total billed charges,354.4,80% of total billed charges,106.32,24% of total billed charges,106.32,24% of total billed charges,106.32,710,221.5
Outpatient Medical Services,EMERGENCY ROOM,37195,THROMBOLYSIS CEREBRAL  IV INFUSION,450,1196,321.25,26.86% of total billed charges,710,Case rate,710,Case rate,287.04,24% of total billed charges,710,Case rate,710,Case rate,956.8,80% of total billed charges,289.91,24.24% of total billed charges,602.78,50.4% of total billed charges,897,75% of total billed charges,292.78,24.48% of total billed charges,321.25,26.86% of total billed charges,287.04,24% of total billed charges,373.15,31.2% of total billed charges,956.8,80% of total billed charges,287.04,24% of total billed charges,287.04,24% of total billed charges,287.04,956.8,598
Outpatient Medical Services,EMERGENCY ROOM,40804,RMV FB VESTIBULE OF MOUTH SIMPLE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,40805,RMV FB VESTIBULE OF MOUTH COMPLICATED,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,41250,RPR LAC 2.5CM TONGUE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,41251,RPR LAC 2.5CM/< POSTERIOR TONGUE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,41252,RPR LAC TONGUE 2.6CM/> OR COMPLEX,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,41800,DRAINAGE GUM LESION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,42700,I&D PERITONSILLAR,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,42809,REM FB PHARYNX,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,43752,NG TUBE PLACEMENT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,43753,GASTRIC INTUBATION LAVAGE,450,355.5,95.49,26.86% of total billed charges,710,Case rate,710,Case rate,85.32,24% of total billed charges,710,Case rate,710,Case rate,284.4,80% of total billed charges,86.17,24.24% of total billed charges,179.17,50.4% of total billed charges,266.63,75% of total billed charges,87.03,24.48% of total billed charges,95.49,26.86% of total billed charges,85.32,24% of total billed charges,110.92,31.2% of total billed charges,284.4,80% of total billed charges,85.32,24% of total billed charges,85.32,24% of total billed charges,85.32,710,177.75
Outpatient Medical Services,EMERGENCY ROOM,43762,CHANGE GASTROSTOMY TUBE W/O IMAGING,450,687,184.53,26.86% of total billed charges,710,Case rate,710,Case rate,164.88,24% of total billed charges,710,Case rate,710,Case rate,549.6,80% of total billed charges,166.53,24.24% of total billed charges,346.25,50.4% of total billed charges,515.25,75% of total billed charges,168.18,24.48% of total billed charges,184.53,26.86% of total billed charges,164.88,24% of total billed charges,214.34,31.2% of total billed charges,549.6,80% of total billed charges,164.88,24% of total billed charges,164.88,24% of total billed charges,164.88,710,343.5
Outpatient Medical Services,EMERGENCY ROOM,46040,INCISION RECTAL ABCESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,46050,I&D PERIANAL ABSCESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,46083,INCISION EXT HEMORROID,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,46320,EXC THROMBOSED HEMORRHOID XTRNL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,46600,ANOSCOPY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,46608,ANOSCOPY W/RMVL FB,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,49082,PARACENTESIS,450,501.5,134.7,26.86% of total billed charges,710,Case rate,710,Case rate,120.36,24% of total billed charges,710,Case rate,710,Case rate,401.2,80% of total billed charges,121.56,24.24% of total billed charges,252.76,50.4% of total billed charges,376.13,75% of total billed charges,122.77,24.48% of total billed charges,134.7,26.86% of total billed charges,120.36,24% of total billed charges,156.47,31.2% of total billed charges,401.2,80% of total billed charges,120.36,24% of total billed charges,120.36,24% of total billed charges,120.36,710,250.75
Outpatient Medical Services,EMERGENCY ROOM,49082,ABD PARACENTESIS W/O IMAGING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,49083,ABD PARACENTESIS W/IMAGING,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,49084,PERITONEAL LAVAGE W/WO IMAGING,450,333.5,89.58,26.86% of total billed charges,710,Case rate,710,Case rate,80.04,24% of total billed charges,710,Case rate,710,Case rate,266.8,80% of total billed charges,80.84,24.24% of total billed charges,168.08,50.4% of total billed charges,250.13,75% of total billed charges,81.64,24.48% of total billed charges,89.58,26.86% of total billed charges,80.04,24% of total billed charges,104.05,31.2% of total billed charges,266.8,80% of total billed charges,80.04,24% of total billed charges,80.04,24% of total billed charges,80.04,710,166.75
Outpatient Medical Services,EMERGENCY ROOM,51701,INST NON DWELLING BLADDER CATH,450,136,36.53,26.86% of total billed charges,710,Case rate,710,Case rate,32.64,24% of total billed charges,710,Case rate,710,Case rate,108.8,80% of total billed charges,32.97,24.24% of total billed charges,68.54,50.4% of total billed charges,102,75% of total billed charges,33.29,24.48% of total billed charges,36.53,26.86% of total billed charges,32.64,24% of total billed charges,42.43,31.2% of total billed charges,108.8,80% of total billed charges,32.64,24% of total billed charges,32.64,24% of total billed charges,32.64,710,68
Outpatient Medical Services,EMERGENCY ROOM,51702,FOLEY CATH INSERTION,450,196.5,52.78,26.86% of total billed charges,710,Case rate,710,Case rate,47.16,24% of total billed charges,710,Case rate,710,Case rate,157.2,80% of total billed charges,47.63,24.24% of total billed charges,99.04,50.4% of total billed charges,147.38,75% of total billed charges,48.1,24.48% of total billed charges,52.78,26.86% of total billed charges,47.16,24% of total billed charges,61.31,31.2% of total billed charges,157.2,80% of total billed charges,47.16,24% of total billed charges,47.16,24% of total billed charges,47.16,710,98.25
Outpatient Medical Services,EMERGENCY ROOM,51703,URINARY CATHETER COMPLEX,450,455.5,122.35,26.86% of total billed charges,710,Case rate,710,Case rate,109.32,24% of total billed charges,710,Case rate,710,Case rate,364.4,80% of total billed charges,110.41,24.24% of total billed charges,229.57,50.4% of total billed charges,341.63,75% of total billed charges,111.51,24.48% of total billed charges,122.35,26.86% of total billed charges,109.32,24% of total billed charges,142.12,31.2% of total billed charges,364.4,80% of total billed charges,109.32,24% of total billed charges,109.32,24% of total billed charges,109.32,710,227.75
Outpatient Medical Services,EMERGENCY ROOM,51705,CYSTOSTOMY TUBE CHANGE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,51798,MEASURE BLADDER CAPACITY VIA US,450,37,9.94,26.86% of total billed charges,710,Case rate,710,Case rate,8.88,24% of total billed charges,710,Case rate,710,Case rate,29.6,80% of total billed charges,8.97,24.24% of total billed charges,18.65,50.4% of total billed charges,27.75,75% of total billed charges,9.06,24.48% of total billed charges,9.94,26.86% of total billed charges,8.88,24% of total billed charges,11.54,31.2% of total billed charges,29.6,80% of total billed charges,8.88,24% of total billed charges,8.88,24% of total billed charges,8.88,710,18.5
Outpatient Medical Services,EMERGENCY ROOM,52310,CYSTO W/STONE REM SIMPLE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,54235,NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,55100,I&D SCROTAL ABSCESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,56420,I&D BARHOLINS GLAND ABSCESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,59025,FETAL NON STRESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,59409,VAGINAL DELIVERY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,59414,PLACENTA DELIVERY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,62270,LUMBAR PUNCTURE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,62272,SPINAL TAP,450,557,149.61,26.86% of total billed charges,710,Case rate,710,Case rate,133.68,24% of total billed charges,710,Case rate,710,Case rate,445.6,80% of total billed charges,135.02,24.24% of total billed charges,280.73,50.4% of total billed charges,417.75,75% of total billed charges,136.35,24.48% of total billed charges,149.61,26.86% of total billed charges,133.68,24% of total billed charges,173.78,31.2% of total billed charges,445.6,80% of total billed charges,133.68,24% of total billed charges,133.68,24% of total billed charges,133.68,710,278.5
Outpatient Medical Services,EMERGENCY ROOM,62272,DRN CEREBRO SPINAL FLUID,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64400,INJ AA/STRD TRIGEMINAL NERVE EA BRANCH,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64405,INJ AA/STRD GRTR OCCIPITAL NERVE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64450,INJ AA/STRD PERIPHERAL NERVE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64490,INJ PVRT FACET JT CRV/THRC 1 LVL W/IMAG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64493,INJ PVRT FACET JT LUM/SAC 1 LVL W/IMAG,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,64999,NERVE BLOCK FACIAL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,65205,"RMV FB EXT EYE, CONJUNCTIVAL SUPERFICIAL",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,65210,"RMV FB EXT EYE, CONJUNCTIVAL EMBEDDED",450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,65220,RMV FB EXT EYE CORNEAL W/O SLIT LAMP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,65222,RMV FB EXT EYE CORNEAL W/SLIT LAMP,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,65435,RMV CORNEAL EPITHELIUM W/WO CHEMOCAUTERY,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,67938,RMV FB EYELID EMBEDDED,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69000,DRAIN EXT EAR LESION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69200,CLEAR OUTER EAR CANAL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69209,REMOVAL IMPACTED EAR WAX,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69209,REMOVAL IMPACTED EAR WAX BILAT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69210,REM EARWAX W INSTRUMENT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,69210,REMOVE EAR WAX BILAT W INSTRUMENT,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,76937,ULTRASOUND GUIDANCE FOR VASCULAR ACCESS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,76937,ULTRASOUND GUIDANCE,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,92950,CPR,450,762,204.67,26.86% of total billed charges,710,Case rate,710,Case rate,182.88,24% of total billed charges,710,Case rate,710,Case rate,609.6,80% of total billed charges,184.71,24.24% of total billed charges,384.05,50.4% of total billed charges,571.5,75% of total billed charges,186.54,24.48% of total billed charges,204.67,26.86% of total billed charges,182.88,24% of total billed charges,237.74,31.2% of total billed charges,609.6,80% of total billed charges,182.88,24% of total billed charges,182.88,24% of total billed charges,182.88,710,381
Outpatient Medical Services,EMERGENCY ROOM,92950,CARDIOPULMONARY RESUSCITATION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,92960,CARDIOVERSION EXTERNAL,450,790,212.19,26.86% of total billed charges,710,Case rate,710,Case rate,189.6,24% of total billed charges,710,Case rate,710,Case rate,632,80% of total billed charges,191.5,24.24% of total billed charges,398.16,50.4% of total billed charges,592.5,75% of total billed charges,193.39,24.48% of total billed charges,212.19,26.86% of total billed charges,189.6,24% of total billed charges,246.48,31.2% of total billed charges,632,80% of total billed charges,189.6,24% of total billed charges,189.6,24% of total billed charges,189.6,710,395
Outpatient Medical Services,EMERGENCY ROOM,92961,CARDIOVERSION INTERNAL,450,1011.5,271.69,26.86% of total billed charges,710,Case rate,710,Case rate,242.76,24% of total billed charges,710,Case rate,710,Case rate,809.2,80% of total billed charges,245.19,24.24% of total billed charges,509.8,50.4% of total billed charges,758.63,75% of total billed charges,247.62,24.48% of total billed charges,271.69,26.86% of total billed charges,242.76,24% of total billed charges,315.59,31.2% of total billed charges,809.2,80% of total billed charges,242.76,24% of total billed charges,242.76,24% of total billed charges,242.76,809.2,505.75
Outpatient Medical Services,EMERGENCY ROOM,92977,THROMBOLYSIS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,93583,TRANSVENOUS PACEMAKER INSERTION,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,95990,SPINE/BRAIN PUMP REFILL & MNTC,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,95991,SPINAL BRINA PUMP REFILL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,95992,EPLEY MANEUVER,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,96373,THER/PROPH INJ INTRA ARTERIAL,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,96377,APPLU ON BODY INJECTOR,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,97597,DEBRIDE OPEN WOUND < 20CM,450,717,192.59,26.86% of total billed charges,710,Case rate,710,Case rate,172.08,24% of total billed charges,710,Case rate,710,Case rate,573.6,80% of total billed charges,173.8,24.24% of total billed charges,361.37,50.4% of total billed charges,537.75,75% of total billed charges,175.52,24.48% of total billed charges,192.59,26.86% of total billed charges,172.08,24% of total billed charges,223.7,31.2% of total billed charges,573.6,80% of total billed charges,172.08,24% of total billed charges,172.08,24% of total billed charges,172.08,710,358.5
Outpatient Medical Services,EMERGENCY ROOM,99151,MODERATE SEDATION <5 YRS INITIAL 15 MIN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99152,CONSCIOUS SEDATION,450,557,149.61,26.86% of total billed charges,710,Case rate,710,Case rate,133.68,24% of total billed charges,710,Case rate,710,Case rate,445.6,80% of total billed charges,135.02,24.24% of total billed charges,280.73,50.4% of total billed charges,417.75,75% of total billed charges,136.35,24.48% of total billed charges,149.61,26.86% of total billed charges,133.68,24% of total billed charges,173.78,31.2% of total billed charges,445.6,80% of total billed charges,133.68,24% of total billed charges,133.68,24% of total billed charges,133.68,710,278.5
Outpatient Medical Services,EMERGENCY ROOM,99152,MODERATE SEDATION >5 YRS INITIAL 15 MIN,450,153.5,41.23,26.86% of total billed charges,710,Case rate,710,Case rate,36.84,24% of total billed charges,710,Case rate,710,Case rate,122.8,80% of total billed charges,37.21,24.24% of total billed charges,77.36,50.4% of total billed charges,115.13,75% of total billed charges,37.58,24.48% of total billed charges,41.23,26.86% of total billed charges,36.84,24% of total billed charges,47.89,31.2% of total billed charges,122.8,80% of total billed charges,36.84,24% of total billed charges,36.84,24% of total billed charges,36.84,710,76.75
Outpatient Medical Services,EMERGENCY ROOM,99153,MODERATE SEDATION EA ADDL 15 MIN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99155,MOD SEDATION <5YRS INIT 15 MIN OTHR PHYS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99156,MOD SEDATION <5YRS INIT 15 MIN OTHR PHYS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99157,MOD SEDATION EA ADDL15 MIN OTHR PHYS,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99281,ER SCREENING FEE,450,57.5,15.44,26.86% of total billed charges,710,Case rate,710,Case rate,13.8,24% of total billed charges,710,Case rate,710,Case rate,46,80% of total billed charges,13.94,24.24% of total billed charges,28.98,50.4% of total billed charges,43.13,75% of total billed charges,14.08,24.48% of total billed charges,15.44,26.86% of total billed charges,13.8,24% of total billed charges,17.94,31.2% of total billed charges,46,80% of total billed charges,13.8,24% of total billed charges,13.8,24% of total billed charges,13.8,710,28.75
Outpatient Medical Services,EMERGENCY ROOM,99281,EMERGENCY ROOM LEVEL I,450,414,111.2,26.86% of total billed charges,710,Case rate,710,Case rate,99.36,24% of total billed charges,710,Case rate,710,Case rate,331.2,80% of total billed charges,100.35,24.24% of total billed charges,208.66,50.4% of total billed charges,310.5,75% of total billed charges,101.35,24.48% of total billed charges,111.2,26.86% of total billed charges,99.36,24% of total billed charges,129.17,31.2% of total billed charges,331.2,80% of total billed charges,99.36,24% of total billed charges,99.36,24% of total billed charges,99.36,710,207
Outpatient Medical Services,EMERGENCY ROOM,99281,EMERGENCY ROOM LEVEL I -25,450,414,111.2,26.86% of total billed charges,710,Case rate,710,Case rate,99.36,24% of total billed charges,710,Case rate,710,Case rate,331.2,80% of total billed charges,100.35,24.24% of total billed charges,208.66,50.4% of total billed charges,310.5,75% of total billed charges,101.35,24.48% of total billed charges,111.2,26.86% of total billed charges,99.36,24% of total billed charges,129.17,31.2% of total billed charges,331.2,80% of total billed charges,99.36,24% of total billed charges,99.36,24% of total billed charges,99.36,710,207
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY ROOM LEVEL II,450,530.5,142.49,26.86% of total billed charges,710,Case rate,710,Case rate,127.32,24% of total billed charges,710,Case rate,710,Case rate,424.4,80% of total billed charges,128.59,24.24% of total billed charges,267.37,50.4% of total billed charges,397.88,75% of total billed charges,129.87,24.48% of total billed charges,142.49,26.86% of total billed charges,127.32,24% of total billed charges,165.52,31.2% of total billed charges,424.4,80% of total billed charges,127.32,24% of total billed charges,127.32,24% of total billed charges,127.32,710,265.25
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY ROOM LEVEL II -25,450,530.5,142.49,26.86% of total billed charges,710,Case rate,710,Case rate,127.32,24% of total billed charges,710,Case rate,710,Case rate,424.4,80% of total billed charges,128.59,24.24% of total billed charges,267.37,50.4% of total billed charges,397.88,75% of total billed charges,129.87,24.48% of total billed charges,142.49,26.86% of total billed charges,127.32,24% of total billed charges,165.52,31.2% of total billed charges,424.4,80% of total billed charges,127.32,24% of total billed charges,127.32,24% of total billed charges,127.32,710,265.25
Outpatient Medical Services,EMERGENCY ROOM,99283,EMERGENCY ROOM LEVEL III,450,721,193.66,26.86% of total billed charges,710,Case rate,710,Case rate,173.04,24% of total billed charges,710,Case rate,710,Case rate,576.8,80% of total billed charges,174.77,24.24% of total billed charges,363.38,50.4% of total billed charges,540.75,75% of total billed charges,176.5,24.48% of total billed charges,193.66,26.86% of total billed charges,173.04,24% of total billed charges,224.95,31.2% of total billed charges,576.8,80% of total billed charges,173.04,24% of total billed charges,173.04,24% of total billed charges,173.04,710,360.5
Outpatient Medical Services,EMERGENCY ROOM,99283,EMERGENCY ROOM LEVEL III -25,450,721,193.66,26.86% of total billed charges,710,Case rate,710,Case rate,173.04,24% of total billed charges,710,Case rate,710,Case rate,576.8,80% of total billed charges,174.77,24.24% of total billed charges,363.38,50.4% of total billed charges,540.75,75% of total billed charges,176.5,24.48% of total billed charges,193.66,26.86% of total billed charges,173.04,24% of total billed charges,224.95,31.2% of total billed charges,576.8,80% of total billed charges,173.04,24% of total billed charges,173.04,24% of total billed charges,173.04,710,360.5
Outpatient Medical Services,EMERGENCY ROOM,99284,EMERGENCY ROOM LEVEL IV,450,981.5,263.63,26.86% of total billed charges,710,Case rate,710,Case rate,235.56,24% of total billed charges,710,Case rate,710,Case rate,785.2,80% of total billed charges,237.92,24.24% of total billed charges,494.68,50.4% of total billed charges,736.13,75% of total billed charges,240.27,24.48% of total billed charges,263.63,26.86% of total billed charges,235.56,24% of total billed charges,306.23,31.2% of total billed charges,785.2,80% of total billed charges,235.56,24% of total billed charges,235.56,24% of total billed charges,235.56,785.2,490.75
Outpatient Medical Services,EMERGENCY ROOM,99284,EMERGENCY ROOM LEVEL IV -25,450,981.5,263.63,26.86% of total billed charges,710,Case rate,710,Case rate,235.56,24% of total billed charges,710,Case rate,710,Case rate,785.2,80% of total billed charges,237.92,24.24% of total billed charges,494.68,50.4% of total billed charges,736.13,75% of total billed charges,240.27,24.48% of total billed charges,263.63,26.86% of total billed charges,235.56,24% of total billed charges,306.23,31.2% of total billed charges,785.2,80% of total billed charges,235.56,24% of total billed charges,235.56,24% of total billed charges,235.56,785.2,490.75
Outpatient Medical Services,EMERGENCY ROOM,99285,EMERGENCY ROOM VISIT HIGH COMPLEXITY,450,744.5,199.97,26.86% of total billed charges,710,Case rate,710,Case rate,178.68,24% of total billed charges,710,Case rate,710,Case rate,595.6,80% of total billed charges,180.47,24.24% of total billed charges,375.23,50.4% of total billed charges,558.38,75% of total billed charges,182.25,24.48% of total billed charges,199.97,26.86% of total billed charges,178.68,24% of total billed charges,232.28,31.2% of total billed charges,595.6,80% of total billed charges,178.68,24% of total billed charges,178.68,24% of total billed charges,178.68,710,372.25
Outpatient Medical Services,EMERGENCY ROOM,99285,EMERGENCY ROOM LEVEL V,450,1326.5,356.3,26.86% of total billed charges,710,Case rate,710,Case rate,318.36,24% of total billed charges,710,Case rate,710,Case rate,1061.2,80% of total billed charges,321.54,24.24% of total billed charges,668.56,50.4% of total billed charges,994.88,75% of total billed charges,324.73,24.48% of total billed charges,356.3,26.86% of total billed charges,318.36,24% of total billed charges,413.87,31.2% of total billed charges,1061.2,80% of total billed charges,318.36,24% of total billed charges,318.36,24% of total billed charges,318.36,1061.2,663.25
Outpatient Medical Services,EMERGENCY ROOM,99285,EMERGENCY ROOM LEVEL V -25,450,1326.5,356.3,26.86% of total billed charges,710,Case rate,710,Case rate,318.36,24% of total billed charges,710,Case rate,710,Case rate,1061.2,80% of total billed charges,321.54,24.24% of total billed charges,668.56,50.4% of total billed charges,994.88,75% of total billed charges,324.73,24.48% of total billed charges,356.3,26.86% of total billed charges,318.36,24% of total billed charges,413.87,31.2% of total billed charges,1061.2,80% of total billed charges,318.36,24% of total billed charges,318.36,24% of total billed charges,318.36,1061.2,663.25
Outpatient Medical Services,EMERGENCY ROOM,99291,CRITICAL CARE 30-74 MIN,450,2089,561.11,26.86% of total billed charges,710,Case rate,710,Case rate,501.36,24% of total billed charges,710,Case rate,710,Case rate,1671.2,80% of total billed charges,506.37,24.24% of total billed charges,1052.86,50.4% of total billed charges,1566.75,75% of total billed charges,511.39,24.48% of total billed charges,561.11,26.86% of total billed charges,501.36,24% of total billed charges,651.77,31.2% of total billed charges,1671.2,80% of total billed charges,501.36,24% of total billed charges,501.36,24% of total billed charges,501.36,1671.2,1044.5
Outpatient Medical Services,EMERGENCY ROOM,99292,CRITICAL CARE > 74 MIN,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,99292,CRITICAL CARE EACH ADDTL 30 MIN,450,557,149.61,26.86% of total billed charges,710,Case rate,710,Case rate,133.68,24% of total billed charges,710,Case rate,710,Case rate,445.6,80% of total billed charges,135.02,24.24% of total billed charges,280.73,50.4% of total billed charges,417.75,75% of total billed charges,136.35,24.48% of total billed charges,149.61,26.86% of total billed charges,133.68,24% of total billed charges,173.78,31.2% of total billed charges,445.6,80% of total billed charges,133.68,24% of total billed charges,133.68,24% of total billed charges,133.68,710,278.5
Outpatient Medical Services,EMERGENCY ROOM,P9612,IN AND OUT CATH,450,57.5,15.44,26.86% of total billed charges,710,Case rate,710,Case rate,13.8,24% of total billed charges,710,Case rate,710,Case rate,46,80% of total billed charges,13.94,24.24% of total billed charges,28.98,50.4% of total billed charges,43.13,75% of total billed charges,14.08,24.48% of total billed charges,15.44,26.86% of total billed charges,13.8,24% of total billed charges,17.94,31.2% of total billed charges,46,80% of total billed charges,13.8,24% of total billed charges,13.8,24% of total billed charges,13.8,710,28.75
Outpatient Medical Services,LAB,36415,VENIPUNCTURE,300,21,5.64,26.86% of total billed charges,15.75,75% of total billed charges,15.75,75% of total billed charges,5.04,24% of total billed charges,15.75,75% of total billed charges,15.75,75% of total billed charges,16.8,80% of total billed charges,5.09,24.24% of total billed charges,10.58,50.4% of total billed charges,15.75,75% of total billed charges,5.14,24.48% of total billed charges,5.64,26.86% of total billed charges,5.04,24% of total billed charges,6.55,31.2% of total billed charges,16.8,80% of total billed charges,5.04,24% of total billed charges,5.04,24% of total billed charges,5.04,16.8,10.5
Outpatient Medical Services,LAB,36415,VENI PUNCTURE,300,30,8.06,26.86% of total billed charges,22.5,75% of total billed charges,22.5,75% of total billed charges,7.2,24% of total billed charges,22.5,75% of total billed charges,22.5,75% of total billed charges,24,80% of total billed charges,7.27,24.24% of total billed charges,15.12,50.4% of total billed charges,22.5,75% of total billed charges,7.34,24.48% of total billed charges,8.06,26.86% of total billed charges,7.2,24% of total billed charges,9.36,31.2% of total billed charges,24,80% of total billed charges,7.2,24% of total billed charges,7.2,24% of total billed charges,7.2,24,15
Outpatient Medical Services,LAB,80061,LIPID PANEL,300,255.5,16.85,Fee Schedule,191.63,75% of total billed charges,191.63,75% of total billed charges,61.32,24% of total billed charges,191.63,75% of total billed charges,191.63,75% of total billed charges,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,16.85,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,16.85,204.4,127.75
Outpatient Medical Services,LAB,80061,LIPID PANEL (SCP),300,50.5,16.85,Fee Schedule,37.88,75% of total billed charges,37.88,75% of total billed charges,12.12,24% of total billed charges,37.88,75% of total billed charges,37.88,75% of total billed charges,40.4,80% of total billed charges,12.24,24.24% of total billed charges,25.45,50.4% of total billed charges,37.88,75% of total billed charges,12.36,24.48% of total billed charges,16.85,Fee Schedule,12.12,24% of total billed charges,15.76,31.2% of total billed charges,40.4,80% of total billed charges,12.12,24% of total billed charges,12.12,24% of total billed charges,12.12,40.4,25.25
Outpatient Medical Services,LAB,80150,AMIKACIN PEAK,300,166,18.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.95,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.95,132.8,83
Outpatient Medical Services,LAB,80150,AMIKACIN TROUGH,300,166,18.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.95,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.95,132.8,83
Outpatient Medical Services,LAB,80168,ETHOSUXIMIDE,300,69,20.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,20.55,Fee Schedule,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,16.56,55.2,34.5
Outpatient Medical Services,LAB,80235,LACOSAMIDE,300,141,21.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,21.69,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,21.69,112.8,70.5
Outpatient Medical Services,LAB,80299,THIOPURINE METABOLITES,300,512,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,122.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,409.6,80% of total billed charges,124.11,24.24% of total billed charges,258.05,50.4% of total billed charges,384,75% of total billed charges,125.34,24.48% of total billed charges,15.14,Fee Schedule,122.88,24% of total billed charges,159.74,31.2% of total billed charges,409.6,80% of total billed charges,122.88,24% of total billed charges,122.88,24% of total billed charges,15.14,409.6,256
Outpatient Medical Services,LAB,80305,TOX/SEE URINE DRUG TEST,300,140,11.47,Fee Schedule,105,75% of total billed charges,105,75% of total billed charges,33.6,24% of total billed charges,105,75% of total billed charges,105,75% of total billed charges,112,80% of total billed charges,33.94,24.24% of total billed charges,70.56,50.4% of total billed charges,105,75% of total billed charges,34.27,24.48% of total billed charges,11.47,Fee Schedule,33.6,24% of total billed charges,43.68,31.2% of total billed charges,112,80% of total billed charges,33.6,24% of total billed charges,33.6,24% of total billed charges,11.47,112,70
Outpatient Medical Services,LAB,80307,ORAL FLUID DRUG SCREEN & CONFIRM.,300,243,61.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,61.16,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,58.32,194.4,121.5
Outpatient Medical Services,LAB,80307,URINE DRUG SCREEN,300,229.35,61.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,55.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,183.48,80% of total billed charges,55.59,24.24% of total billed charges,115.59,50.4% of total billed charges,172.01,75% of total billed charges,56.14,24.48% of total billed charges,61.16,Fee Schedule,55.04,24% of total billed charges,71.56,31.2% of total billed charges,183.48,80% of total billed charges,55.04,24% of total billed charges,55.04,24% of total billed charges,55.04,183.48,114.675
Outpatient Medical Services,LAB,80323,NICOTINE,300,356.5,37.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,37.75,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,37.75,285.2,178.25
Outpatient Medical Services,LAB,80358,METHADONE SCREEN,300,821,20.53,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,197.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,656.8,80% of total billed charges,199.01,24.24% of total billed charges,413.78,50.4% of total billed charges,615.75,75% of total billed charges,200.98,24.48% of total billed charges,20.53,Fee Schedule,197.04,24% of total billed charges,256.15,31.2% of total billed charges,656.8,80% of total billed charges,197.04,24% of total billed charges,197.04,24% of total billed charges,20.53,656.8,410.5
Outpatient Medical Services,LAB,80365,OXYCODONE BLOOD,300,284.5,76.42,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,76.42,26.86% of total billed charges,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,68.28,227.6,142.25
Outpatient Medical Services,LAB,80375,UDS CONFIRMATION,300,488,18.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,117.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,390.4,80% of total billed charges,118.29,24.24% of total billed charges,245.95,50.4% of total billed charges,366,75% of total billed charges,119.46,24.48% of total billed charges,18.25,Fee Schedule,117.12,24% of total billed charges,152.26,31.2% of total billed charges,390.4,80% of total billed charges,117.12,24% of total billed charges,117.12,24% of total billed charges,18.25,390.4,244
Outpatient Medical Services,LAB,80375,DRUG SCREEN BLOOD,300,143,18.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,18.25,Fee Schedule,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,18.25,114.4,71.5
Outpatient Medical Services,LAB,81001,URINE PROTEIN TEST STRIP,300,75,3.99,Fee Schedule,56.25,75% of total billed charges,56.25,75% of total billed charges,18,24% of total billed charges,56.25,75% of total billed charges,56.25,75% of total billed charges,60,80% of total billed charges,18.18,24.24% of total billed charges,37.8,50.4% of total billed charges,56.25,75% of total billed charges,18.36,24.48% of total billed charges,3.99,Fee Schedule,18,24% of total billed charges,23.4,31.2% of total billed charges,60,80% of total billed charges,18,24% of total billed charges,18,24% of total billed charges,3.99,60,37.5
Outpatient Medical Services,LAB,81003,URINE PH,300,72,2.83,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.83,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.83,57.6,36
Outpatient Medical Services,LAB,81025,PREG TEST URINE,300,101,7.96,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,7.96,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,7.96,80.8,50.5
Outpatient Medical Services,LAB,81162,"BRCA, COMPREHENSIVE",300,8211,1988.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,1970.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6568.8,80% of total billed charges,1990.35,24.24% of total billed charges,4138.34,50.4% of total billed charges,6158.25,75% of total billed charges,2010.05,24.48% of total billed charges,1988.69,Fee Schedule,1970.64,24% of total billed charges,2561.83,31.2% of total billed charges,6568.8,80% of total billed charges,1970.64,24% of total billed charges,1970.64,24% of total billed charges,1970.64,6568.8,4105.5
Outpatient Medical Services,LAB,81220,CYSTIC FIBROSIS SCREEN,300,69,960,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,960,Fee Schedule,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,16.56,960,34.5
Outpatient Medical Services,LAB,81240,FACTOR II (aka F2) GENE,300,451,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,108.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,360.8,80% of total billed charges,109.32,24.24% of total billed charges,227.3,50.4% of total billed charges,338.25,75% of total billed charges,110.4,24.48% of total billed charges,40,Fee Schedule,108.24,24% of total billed charges,140.71,31.2% of total billed charges,360.8,80% of total billed charges,108.24,24% of total billed charges,108.24,24% of total billed charges,40,360.8,225.5
Outpatient Medical Services,LAB,81241,FACTOR V (LEIDEN) MUTATION ANALYSIS,300,222.5,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,178,80% of total billed charges,53.93,24.24% of total billed charges,112.14,50.4% of total billed charges,166.88,75% of total billed charges,54.47,24.48% of total billed charges,40,Fee Schedule,53.4,24% of total billed charges,69.42,31.2% of total billed charges,178,80% of total billed charges,53.4,24% of total billed charges,53.4,24% of total billed charges,40,178,111.25
Outpatient Medical Services,LAB,81256,HEMOCHROMATOSIS PANEL,300,265.5,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,63.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,212.4,80% of total billed charges,64.36,24.24% of total billed charges,133.81,50.4% of total billed charges,199.13,75% of total billed charges,64.99,24.48% of total billed charges,40,Fee Schedule,63.72,24% of total billed charges,82.84,31.2% of total billed charges,212.4,80% of total billed charges,63.72,24% of total billed charges,63.72,24% of total billed charges,40,212.4,132.75
Outpatient Medical Services,LAB,81270,JAK2 V617F,300,64,72,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.2,80% of total billed charges,15.51,24.24% of total billed charges,32.26,50.4% of total billed charges,48,75% of total billed charges,15.67,24.48% of total billed charges,72,Fee Schedule,15.36,24% of total billed charges,19.97,31.2% of total billed charges,51.2,80% of total billed charges,15.36,24% of total billed charges,15.36,24% of total billed charges,15.36,72,32
Outpatient Medical Services,LAB,81327,COLOVANTAGE,300,766.5,66.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,183.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,613.2,80% of total billed charges,185.8,24.24% of total billed charges,386.32,50.4% of total billed charges,574.88,75% of total billed charges,187.64,24.48% of total billed charges,66.94,Fee Schedule,183.96,24% of total billed charges,239.15,31.2% of total billed charges,613.2,80% of total billed charges,183.96,24% of total billed charges,183.96,24% of total billed charges,66.94,613.2,383.25
Outpatient Medical Services,LAB,81332,ALPHA-1 ANTITRYPSIN (AAT) MUTATION ANYLS,300,206,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,49.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,164.8,80% of total billed charges,49.93,24.24% of total billed charges,103.82,50.4% of total billed charges,154.5,75% of total billed charges,50.43,24.48% of total billed charges,40,Fee Schedule,49.44,24% of total billed charges,64.27,31.2% of total billed charges,164.8,80% of total billed charges,49.44,24% of total billed charges,49.44,24% of total billed charges,40,164.8,103
Outpatient Medical Services,LAB,81382,HLA CELIAC DISEASE,300,297.5,164,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,164,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,71.4,238,148.75
Outpatient Medical Services,LAB,81479,G6PD GENE,300,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81599,HEP C VIRUS FIBROSURE,300,346,92.94,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,83.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,276.8,80% of total billed charges,83.87,24.24% of total billed charges,174.38,50.4% of total billed charges,259.5,75% of total billed charges,84.7,24.48% of total billed charges,92.94,26.86% of total billed charges,83.04,24% of total billed charges,107.95,31.2% of total billed charges,276.8,80% of total billed charges,83.04,24% of total billed charges,83.04,24% of total billed charges,83.04,276.8,173
Outpatient Medical Services,LAB,82042,"ALBUMIN, PERITONEAL FLUID",300,37,6.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,8.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.6,80% of total billed charges,8.97,24.24% of total billed charges,18.65,50.4% of total billed charges,27.75,75% of total billed charges,9.06,24.48% of total billed charges,6.51,Fee Schedule,8.88,24% of total billed charges,11.54,31.2% of total billed charges,29.6,80% of total billed charges,8.88,24% of total billed charges,8.88,24% of total billed charges,6.51,29.6,18.5
Outpatient Medical Services,LAB,82042,"ALBUMIN, PLEURAL FLUID",300,37,6.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,8.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.6,80% of total billed charges,8.97,24.24% of total billed charges,18.65,50.4% of total billed charges,27.75,75% of total billed charges,9.06,24.48% of total billed charges,6.51,Fee Schedule,8.88,24% of total billed charges,11.54,31.2% of total billed charges,29.6,80% of total billed charges,8.88,24% of total billed charges,8.88,24% of total billed charges,6.51,29.6,18.5
Outpatient Medical Services,LAB,82135,AMINOLEVULINIC ACID URINE,300,217.5,20.7,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,52.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,174,80% of total billed charges,52.72,24.24% of total billed charges,109.62,50.4% of total billed charges,163.13,75% of total billed charges,53.24,24.48% of total billed charges,20.7,Fee Schedule,52.2,24% of total billed charges,67.86,31.2% of total billed charges,174,80% of total billed charges,52.2,24% of total billed charges,52.2,24% of total billed charges,20.7,174,108.75
Outpatient Medical Services,LAB,82150,"AMYLASE, PERITONEAL FLUID",300,58.5,8.15,Fee Schedule,43.88,75% of total billed charges,43.88,75% of total billed charges,14.04,24% of total billed charges,43.88,75% of total billed charges,43.88,75% of total billed charges,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,8.15,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,8.15,46.8,29.25
Outpatient Medical Services,LAB,82150,"AMYLASE, PLEURAL FLUID",300,58.5,8.15,Fee Schedule,43.88,75% of total billed charges,43.88,75% of total billed charges,14.04,24% of total billed charges,43.88,75% of total billed charges,43.88,75% of total billed charges,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,8.15,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,8.15,46.8,29.25
Outpatient Medical Services,LAB,82157,ANDROSTENEDIONE,300,344,36.81,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,275.2,80% of total billed charges,83.39,24.24% of total billed charges,173.38,50.4% of total billed charges,258,75% of total billed charges,84.21,24.48% of total billed charges,36.81,Fee Schedule,82.56,24% of total billed charges,107.33,31.2% of total billed charges,275.2,80% of total billed charges,82.56,24% of total billed charges,82.56,24% of total billed charges,36.81,275.2,172
Outpatient Medical Services,LAB,82270,OCCULT BLOOD 2nd SPECIMEN,300,N/A,4.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.04,4.04,N/A
Outpatient Medical Services,LAB,82270,OCCULT BLOOD 3rd SPECIMEN,300,N/A,4.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.04,4.04,N/A
Outpatient Medical Services,LAB,82306,DO NOT USE(VIT D),300,188.5,37.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,37.22,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,37.22,150.8,94.25
Outpatient Medical Services,LAB,82306,VIT D 25 with D2 & D3 SUBSETS,300,140,37.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112,80% of total billed charges,33.94,24.24% of total billed charges,70.56,50.4% of total billed charges,105,75% of total billed charges,34.27,24.48% of total billed charges,37.22,Fee Schedule,33.6,24% of total billed charges,43.68,31.2% of total billed charges,112,80% of total billed charges,33.6,24% of total billed charges,33.6,24% of total billed charges,33.6,112,70
Outpatient Medical Services,LAB,82384,URINE 24 HR CATECHOLAMINES,300,356.5,31.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,31.75,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,31.75,285.2,178.25
Outpatient Medical Services,LAB,82438,BF CHLORIDE,300,121.5,6.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,97.2,80% of total billed charges,29.45,24.24% of total billed charges,61.24,50.4% of total billed charges,91.13,75% of total billed charges,29.74,24.48% of total billed charges,6.15,Fee Schedule,29.16,24% of total billed charges,37.91,31.2% of total billed charges,97.2,80% of total billed charges,29.16,24% of total billed charges,29.16,24% of total billed charges,6.15,97.2,60.75
Outpatient Medical Services,LAB,82480,CHOLINESTERASE,300,166,9.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,9.91,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,9.91,132.8,83
Outpatient Medical Services,LAB,82495,CHROMIUM,300,45.5,25.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,25.51,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,10.92,36.4,22.75
Outpatient Medical Services,LAB,82523,N-TELOPEPTIDE URINE,300,210,23.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,50.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,168,80% of total billed charges,50.9,24.24% of total billed charges,105.84,50.4% of total billed charges,157.5,75% of total billed charges,51.41,24.48% of total billed charges,23.5,Fee Schedule,50.4,24% of total billed charges,65.52,31.2% of total billed charges,168,80% of total billed charges,50.4,24% of total billed charges,50.4,24% of total billed charges,23.5,168,105
Outpatient Medical Services,LAB,82523,COLLAGEN TYPE I C-TELE,300,210,23.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,50.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,168,80% of total billed charges,50.9,24.24% of total billed charges,105.84,50.4% of total billed charges,157.5,75% of total billed charges,51.41,24.48% of total billed charges,23.5,Fee Schedule,50.4,24% of total billed charges,65.52,31.2% of total billed charges,168,80% of total billed charges,50.4,24% of total billed charges,50.4,24% of total billed charges,23.5,168,105
Outpatient Medical Services,LAB,82542,"IODINE, SERUM",300,397.5,7.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,318,80% of total billed charges,96.35,24.24% of total billed charges,200.34,50.4% of total billed charges,298.13,75% of total billed charges,97.31,24.48% of total billed charges,7.55,Fee Schedule,95.4,24% of total billed charges,124.02,31.2% of total billed charges,318,80% of total billed charges,95.4,24% of total billed charges,95.4,24% of total billed charges,7.55,318,198.75
Outpatient Medical Services,LAB,82570,"CREATININE, PERITONEAL FLUID",300,45.5,6.51,Fee Schedule,34.13,75% of total billed charges,34.13,75% of total billed charges,10.92,24% of total billed charges,34.13,75% of total billed charges,34.13,75% of total billed charges,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,6.51,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,6.51,36.4,22.75
Outpatient Medical Services,LAB,82570,URINE PROTEIN/CREATININE RATIO,300,89.5,6.51,Fee Schedule,67.13,75% of total billed charges,67.13,75% of total billed charges,21.48,24% of total billed charges,67.13,75% of total billed charges,67.13,75% of total billed charges,71.6,80% of total billed charges,21.69,24.24% of total billed charges,45.11,50.4% of total billed charges,67.13,75% of total billed charges,21.91,24.48% of total billed charges,6.51,Fee Schedule,21.48,24% of total billed charges,27.92,31.2% of total billed charges,71.6,80% of total billed charges,21.48,24% of total billed charges,21.48,24% of total billed charges,6.51,71.6,44.75
Outpatient Medical Services,LAB,82642,DIHYDROTESTOSTERONE,300,344,26.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,275.2,80% of total billed charges,83.39,24.24% of total billed charges,173.38,50.4% of total billed charges,258,75% of total billed charges,84.21,24.48% of total billed charges,26.02,Fee Schedule,82.56,24% of total billed charges,107.33,31.2% of total billed charges,275.2,80% of total billed charges,82.56,24% of total billed charges,82.56,24% of total billed charges,26.02,275.2,172
Outpatient Medical Services,LAB,82656,"PANCREATIC ELASTASE, STOOL",300,45.5,12.22,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,12.22,26.86% of total billed charges,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,10.92,36.4,22.75
Outpatient Medical Services,LAB,82657,THIOPURINE METHYLTR,300,766.5,7.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,183.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,613.2,80% of total billed charges,185.8,24.24% of total billed charges,386.32,50.4% of total billed charges,574.88,75% of total billed charges,187.64,24.48% of total billed charges,7.55,Fee Schedule,183.96,24% of total billed charges,239.15,31.2% of total billed charges,613.2,80% of total billed charges,183.96,24% of total billed charges,183.96,24% of total billed charges,7.55,613.2,383.25
Outpatient Medical Services,LAB,82657,RBC PORPHOBILINOGEN,300,101,7.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,7.55,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,7.55,80.8,50.5
Outpatient Medical Services,LAB,82657,"NEUTROPHIL FUNCTION, OXIDATIVE BURST",300,419,7.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,100.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,335.2,80% of total billed charges,101.57,24.24% of total billed charges,211.18,50.4% of total billed charges,314.25,75% of total billed charges,102.57,24.48% of total billed charges,7.55,Fee Schedule,100.56,24% of total billed charges,130.73,31.2% of total billed charges,335.2,80% of total billed charges,100.56,24% of total billed charges,100.56,24% of total billed charges,7.55,335.2,209.5
Outpatient Medical Services,LAB,82672,ESTROGEN,300,357.5,20.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,20.94,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,20.94,286,178.75
Outpatient Medical Services,LAB,82787,IGG SUBCLASS 2,300,N/A,10.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.08,10.08,N/A
Outpatient Medical Services,LAB,82941,GASTRIN,300,297.5,22.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,22.18,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,22.18,238,148.75
Outpatient Medical Services,LAB,82945,"GLUCOSE, SYNOVIAL FLUID",300,96,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.93,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.93,76.8,48
Outpatient Medical Services,LAB,82945,"GLUCOSE, PERITONEAL FLUID",300,96,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.93,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.93,76.8,48
Outpatient Medical Services,LAB,82945,"GLUCOSE, PLEURAL FLUID",300,96,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.93,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.93,76.8,48
Outpatient Medical Services,LAB,82945,"GLUCOSE, PERICARDIAL FLUID",300,96,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.93,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.93,76.8,48
Outpatient Medical Services,LAB,82947,GLUCOSE TOLERANCE 2 HR,300,119.5,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,4.93,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,4.93,95.6,59.75
Outpatient Medical Services,LAB,82947,GLUCOSE,300,101,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.93,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.93,80.8,50.5
Outpatient Medical Services,LAB,82947,ZZZFINGERSTICK GLUCOSE,300,64,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.2,80% of total billed charges,15.51,24.24% of total billed charges,32.26,50.4% of total billed charges,48,75% of total billed charges,15.67,24.48% of total billed charges,4.93,Fee Schedule,15.36,24% of total billed charges,19.97,31.2% of total billed charges,51.2,80% of total billed charges,15.36,24% of total billed charges,15.36,24% of total billed charges,4.93,51.2,32
Outpatient Medical Services,LAB,82947,BLOOD SUGAR LEVEL,300,53.5,4.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.8,80% of total billed charges,12.97,24.24% of total billed charges,26.96,50.4% of total billed charges,40.13,75% of total billed charges,13.1,24.48% of total billed charges,4.93,Fee Schedule,12.84,24% of total billed charges,16.69,31.2% of total billed charges,42.8,80% of total billed charges,12.84,24% of total billed charges,12.84,24% of total billed charges,4.93,42.8,26.75
Outpatient Medical Services,LAB,82950,2 HR PP GLUCOSE,300,166,5.98,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,5.98,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,5.98,132.8,83
Outpatient Medical Services,LAB,82951,GLUCOSE TOLERANCE 3HR,300,166,16.19,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.19,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.19,132.8,83
Outpatient Medical Services,LAB,82951,GLUCOSE TOLERANCE 4HR,300,213,16.19,Fee Schedule,159.75,75% of total billed charges,159.75,75% of total billed charges,51.12,24% of total billed charges,159.75,75% of total billed charges,159.75,75% of total billed charges,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,16.19,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,16.19,170.4,106.5
Outpatient Medical Services,LAB,82951,GLUCOSE TOLERANCE - 5 HR,300,284.5,16.19,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,16.19,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,16.19,227.6,142.25
Outpatient Medical Services,LAB,82951,6 HR GLU TOL,300,474,16.19,Fee Schedule,355.5,75% of total billed charges,355.5,75% of total billed charges,113.76,24% of total billed charges,355.5,75% of total billed charges,355.5,75% of total billed charges,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,16.19,Fee Schedule,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,16.19,379.2,237
Outpatient Medical Services,LAB,82951,GLUCOSE TOLERANCE 1 HOUR,300,53.5,16.19,Fee Schedule,40.13,75% of total billed charges,40.13,75% of total billed charges,12.84,24% of total billed charges,40.13,75% of total billed charges,40.13,75% of total billed charges,42.8,80% of total billed charges,12.97,24.24% of total billed charges,26.96,50.4% of total billed charges,40.13,75% of total billed charges,13.1,24.48% of total billed charges,16.19,Fee Schedule,12.84,24% of total billed charges,16.69,31.2% of total billed charges,42.8,80% of total billed charges,12.84,24% of total billed charges,12.84,24% of total billed charges,12.84,42.8,26.75
Outpatient Medical Services,LAB,82951,GTT 3 HOUR,300,N/A,16.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.19,16.19,N/A
Outpatient Medical Services,LAB,82955,G6PD,300,108,9.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,9.82,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,9.82,86.4,54
Outpatient Medical Services,LAB,82977,GGTP,300,144,6.35,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,6.35,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,6.35,115.2,72
Outpatient Medical Services,LAB,82977,GGTP (SCP),300,15.5,6.35,Fee Schedule,11.63,75% of total billed charges,11.63,75% of total billed charges,3.72,24% of total billed charges,11.63,75% of total billed charges,11.63,75% of total billed charges,12.4,80% of total billed charges,3.76,24.24% of total billed charges,7.81,50.4% of total billed charges,11.63,75% of total billed charges,3.79,24.48% of total billed charges,6.35,Fee Schedule,3.72,24% of total billed charges,4.84,31.2% of total billed charges,12.4,80% of total billed charges,3.72,24% of total billed charges,3.72,24% of total billed charges,3.72,12.4,7.75
Outpatient Medical Services,LAB,82985,FRUCTOSAMINE,300,96,18.95,Fee Schedule,72,75% of total billed charges,72,75% of total billed charges,23.04,24% of total billed charges,72,75% of total billed charges,72,75% of total billed charges,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,18.95,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,18.95,76.8,48
Outpatient Medical Services,LAB,83001,FSH,300,199,23.37,Fee Schedule,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,23.37,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,23.37,159.2,99.5
Outpatient Medical Services,LAB,83002,LH,300,199,23.29,Fee Schedule,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,23.29,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,23.29,159.2,99.5
Outpatient Medical Services,LAB,83003,HUMAN GROWTH HORMONE,300,166,17.9,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,17.9,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,17.9,132.8,83
Outpatient Medical Services,LAB,83010,HAPTOGLOBIN,300,178,4.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,4.69,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,4.69,142.4,89
Outpatient Medical Services,LAB,83013,H PYLORI BREATH TEST,300,238,66.53,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,190.4,80% of total billed charges,57.69,24.24% of total billed charges,119.95,50.4% of total billed charges,178.5,75% of total billed charges,58.26,24.48% of total billed charges,66.53,Fee Schedule,57.12,24% of total billed charges,74.26,31.2% of total billed charges,190.4,80% of total billed charges,57.12,24% of total billed charges,57.12,24% of total billed charges,57.12,190.4,119
Outpatient Medical Services,LAB,83018,COBALT,300,95,27.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,27.61,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,LAB,83020,HEMOGLOBIN ELECTROPHORESIS,300,213,12.29,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,12.29,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,12.29,170.4,106.5
Outpatient Medical Services,LAB,83036,HEMOGLOBIN A1C,300,144,12.2,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,12.2,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,12.2,115.2,72
Outpatient Medical Services,LAB,83088,HISTAMINE,300,237,37.13,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,37.13,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,37.13,189.6,118.5
Outpatient Medical Services,LAB,83090,HOMOCYSTEINE,300,384,21.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,92.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,307.2,80% of total billed charges,93.08,24.24% of total billed charges,193.54,50.4% of total billed charges,288,75% of total billed charges,94,24.48% of total billed charges,21.21,Fee Schedule,92.16,24% of total billed charges,119.81,31.2% of total billed charges,307.2,80% of total billed charges,92.16,24% of total billed charges,92.16,24% of total billed charges,21.21,307.2,192
Outpatient Medical Services,LAB,83491,URINE 24HR 17OHCS,300,166,22.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,22.02,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,22.02,132.8,83
Outpatient Medical Services,LAB,83497,URINE 5 HIAA,300,320.5,16.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,256.4,80% of total billed charges,77.69,24.24% of total billed charges,161.53,50.4% of total billed charges,240.38,75% of total billed charges,78.46,24.48% of total billed charges,16.21,Fee Schedule,76.92,24% of total billed charges,100,31.2% of total billed charges,256.4,80% of total billed charges,76.92,24% of total billed charges,76.92,24% of total billed charges,16.21,256.4,160.25
Outpatient Medical Services,LAB,83498,17 OH-PROGESTERONE,300,237,34.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,34.16,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,34.16,189.6,118.5
Outpatient Medical Services,LAB,83516,MITOCHONDRIAL ANTIBODY,300,284.5,13.45,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,13.45,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,13.45,227.6,142.25
Outpatient Medical Services,LAB,83516,TTG IGA AB,300,284.5,13.45,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,13.45,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,13.45,227.6,142.25
Outpatient Medical Services,LAB,83516,TTG IGG AB,300,103,13.45,Fee Schedule,77.25,75% of total billed charges,77.25,75% of total billed charges,24.72,24% of total billed charges,77.25,75% of total billed charges,77.25,75% of total billed charges,82.4,80% of total billed charges,24.97,24.24% of total billed charges,51.91,50.4% of total billed charges,77.25,75% of total billed charges,25.21,24.48% of total billed charges,13.45,Fee Schedule,24.72,24% of total billed charges,32.14,31.2% of total billed charges,82.4,80% of total billed charges,24.72,24% of total billed charges,24.72,24% of total billed charges,13.45,82.4,51.5
Outpatient Medical Services,LAB,83516,PL-7 AB,300,50,13.45,Fee Schedule,37.5,75% of total billed charges,37.5,75% of total billed charges,12,24% of total billed charges,37.5,75% of total billed charges,37.5,75% of total billed charges,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,13.45,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,83516,PL-12 AB,300,50,13.45,Fee Schedule,37.5,75% of total billed charges,37.5,75% of total billed charges,12,24% of total billed charges,37.5,75% of total billed charges,37.5,75% of total billed charges,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,13.45,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,83516,MI-2 AB,300,50,13.45,Fee Schedule,37.5,75% of total billed charges,37.5,75% of total billed charges,12,24% of total billed charges,37.5,75% of total billed charges,37.5,75% of total billed charges,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,13.45,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,83516,KU AB,300,50,13.45,Fee Schedule,37.5,75% of total billed charges,37.5,75% of total billed charges,12,24% of total billed charges,37.5,75% of total billed charges,37.5,75% of total billed charges,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,13.45,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,83516,EJ AB,300,50,13.45,Fee Schedule,37.5,75% of total billed charges,37.5,75% of total billed charges,12,24% of total billed charges,37.5,75% of total billed charges,37.5,75% of total billed charges,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,13.45,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,83516,"PARIETAL CELL ANTIBODY, ELISA",300,54.5,13.45,Fee Schedule,40.88,75% of total billed charges,40.88,75% of total billed charges,13.08,24% of total billed charges,40.88,75% of total billed charges,40.88,75% of total billed charges,43.6,80% of total billed charges,13.21,24.24% of total billed charges,27.47,50.4% of total billed charges,40.88,75% of total billed charges,13.34,24.48% of total billed charges,13.45,Fee Schedule,13.08,24% of total billed charges,17,31.2% of total billed charges,43.6,80% of total billed charges,13.08,24% of total billed charges,13.08,24% of total billed charges,13.08,43.6,27.25
Outpatient Medical Services,LAB,83516,RIBOSOMAL P ANTIBODY,300,123.5,13.45,Fee Schedule,92.63,75% of total billed charges,92.63,75% of total billed charges,29.64,24% of total billed charges,92.63,75% of total billed charges,92.63,75% of total billed charges,98.8,80% of total billed charges,29.94,24.24% of total billed charges,62.24,50.4% of total billed charges,92.63,75% of total billed charges,30.23,24.48% of total billed charges,13.45,Fee Schedule,29.64,24% of total billed charges,38.53,31.2% of total billed charges,98.8,80% of total billed charges,29.64,24% of total billed charges,29.64,24% of total billed charges,13.45,98.8,61.75
Outpatient Medical Services,LAB,83519,ACETYL REC BIND ANTIBODY,300,166,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.99,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.99,132.8,83
Outpatient Medical Services,LAB,83519,PANCREATIC POLYPEPTIDE,300,357.5,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,16.99,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,16.99,286,178.75
Outpatient Medical Services,LAB,83519,ACETYL REC BLOCK ANTIBODY,300,166,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.99,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.99,132.8,83
Outpatient Medical Services,LAB,83519,ACETYL REC MOD ANTIBODY,300,213,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,16.99,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,16.99,170.4,106.5
Outpatient Medical Services,LAB,83519,PTH RELATED PROTEIN,300,78.5,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62.8,80% of total billed charges,19.03,24.24% of total billed charges,39.56,50.4% of total billed charges,58.88,75% of total billed charges,19.22,24.48% of total billed charges,16.99,Fee Schedule,18.84,24% of total billed charges,24.49,31.2% of total billed charges,62.8,80% of total billed charges,18.84,24% of total billed charges,18.84,24% of total billed charges,16.99,62.8,39.25
Outpatient Medical Services,LAB,83519,TRAb (TSH Receptor Binding Aby),300,78.5,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62.8,80% of total billed charges,19.03,24.24% of total billed charges,39.56,50.4% of total billed charges,58.88,75% of total billed charges,19.22,24.48% of total billed charges,16.99,Fee Schedule,18.84,24% of total billed charges,24.49,31.2% of total billed charges,62.8,80% of total billed charges,18.84,24% of total billed charges,18.84,24% of total billed charges,16.99,62.8,39.25
Outpatient Medical Services,LAB,83519,MuSK ANTIBODY,300,4562,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,1094.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3649.6,80% of total billed charges,1105.83,24.24% of total billed charges,2299.25,50.4% of total billed charges,3421.5,75% of total billed charges,1116.78,24.48% of total billed charges,16.99,Fee Schedule,1094.88,24% of total billed charges,1423.34,31.2% of total billed charges,3649.6,80% of total billed charges,1094.88,24% of total billed charges,1094.88,24% of total billed charges,16.99,3649.6,2281
Outpatient Medical Services,LAB,83519,IGF BINDING PROTEIN 1,300,114.5,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,16.99,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,16.99,91.6,57.25
Outpatient Medical Services,LAB,83519,TRYPSIN SERUM,300,357.5,16.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,16.99,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,16.99,286,178.75
Outpatient Medical Services,LAB,83520,HISTONE,300,297.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,16.28,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,16.28,238,148.75
Outpatient Medical Services,LAB,83520,"GLOMERULAR BASEMENT MEMBRANE, IGG",300,178,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,16.28,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,16.28,142.4,89
Outpatient Medical Services,LAB,83520,IGF BINDING PROTEIN 3,300,114.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,16.28,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,16.28,91.6,57.25
Outpatient Medical Services,LAB,83520,TRYPTASE,300,372,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,89.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,297.6,80% of total billed charges,90.17,24.24% of total billed charges,187.49,50.4% of total billed charges,279,75% of total billed charges,91.07,24.48% of total billed charges,16.28,Fee Schedule,89.28,24% of total billed charges,116.06,31.2% of total billed charges,297.6,80% of total billed charges,89.28,24% of total billed charges,89.28,24% of total billed charges,16.28,297.6,186
Outpatient Medical Services,LAB,83520,OXIDIZED LDL,300,222.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,178,80% of total billed charges,53.93,24.24% of total billed charges,112.14,50.4% of total billed charges,166.88,75% of total billed charges,54.47,24.48% of total billed charges,16.28,Fee Schedule,53.4,24% of total billed charges,69.42,31.2% of total billed charges,178,80% of total billed charges,53.4,24% of total billed charges,53.4,24% of total billed charges,16.28,178,111.25
Outpatient Medical Services,LAB,83520,HUMAN TRANSFORMING GROWTH FACTOR,300,139,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.2,80% of total billed charges,33.69,24.24% of total billed charges,70.06,50.4% of total billed charges,104.25,75% of total billed charges,34.03,24.48% of total billed charges,16.28,Fee Schedule,33.36,24% of total billed charges,43.37,31.2% of total billed charges,111.2,80% of total billed charges,33.36,24% of total billed charges,33.36,24% of total billed charges,16.28,111.2,69.5
Outpatient Medical Services,LAB,83520,BULLOUS PEMPHIGOID ANTIBODY 180,300,54.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,43.6,80% of total billed charges,13.21,24.24% of total billed charges,27.47,50.4% of total billed charges,40.88,75% of total billed charges,13.34,24.48% of total billed charges,16.28,Fee Schedule,13.08,24% of total billed charges,17,31.2% of total billed charges,43.6,80% of total billed charges,13.08,24% of total billed charges,13.08,24% of total billed charges,13.08,43.6,27.25
Outpatient Medical Services,LAB,83520,BULLOUS PEMPHIGOID ANTIBODY 230,300,79.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,19.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,63.6,80% of total billed charges,19.27,24.24% of total billed charges,40.07,50.4% of total billed charges,59.63,75% of total billed charges,19.46,24.48% of total billed charges,16.28,Fee Schedule,19.08,24% of total billed charges,24.8,31.2% of total billed charges,63.6,80% of total billed charges,19.08,24% of total billed charges,19.08,24% of total billed charges,16.28,63.6,39.75
Outpatient Medical Services,LAB,83521,"KAPPA LAMBDA LT CHAINS, FREE, SERUM",300,108,13.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,13.82,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,13.82,86.4,54
Outpatient Medical Services,LAB,83521,"KAPPA LAMBDA LIGHT CHAINS FREE, URINE",300,108,13.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,13.82,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,13.82,86.4,54
Outpatient Medical Services,LAB,83525,INSULIN LEVEL,300,180.5,14.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,43.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,144.4,80% of total billed charges,43.75,24.24% of total billed charges,90.97,50.4% of total billed charges,135.38,75% of total billed charges,44.19,24.48% of total billed charges,14.38,Fee Schedule,43.32,24% of total billed charges,56.32,31.2% of total billed charges,144.4,80% of total billed charges,43.32,24% of total billed charges,43.32,24% of total billed charges,14.38,144.4,90.25
Outpatient Medical Services,LAB,83525,"INSULIN, 2 HOUR",300,180.5,14.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,43.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,144.4,80% of total billed charges,43.75,24.24% of total billed charges,90.97,50.4% of total billed charges,135.38,75% of total billed charges,44.19,24.48% of total billed charges,14.38,Fee Schedule,43.32,24% of total billed charges,56.32,31.2% of total billed charges,144.4,80% of total billed charges,43.32,24% of total billed charges,43.32,24% of total billed charges,14.38,144.4,90.25
Outpatient Medical Services,LAB,83540,IRON,300,170,8.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,8.15,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,8.15,136,85
Outpatient Medical Services,LAB,83540,IRON (SCP),300,14.5,8.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.6,80% of total billed charges,3.51,24.24% of total billed charges,7.31,50.4% of total billed charges,10.88,75% of total billed charges,3.55,24.48% of total billed charges,8.15,Fee Schedule,3.48,24% of total billed charges,4.52,31.2% of total billed charges,11.6,80% of total billed charges,3.48,24% of total billed charges,3.48,24% of total billed charges,3.48,11.6,7.25
Outpatient Medical Services,LAB,83550,TIBC,300,1,10.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,0.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,0.8,80% of total billed charges,0.24,24.24% of total billed charges,0.5,50.4% of total billed charges,0.75,75% of total billed charges,0.24,24.48% of total billed charges,10.99,Fee Schedule,0.24,24% of total billed charges,0.31,31.2% of total billed charges,0.8,80% of total billed charges,0.24,24% of total billed charges,0.24,24% of total billed charges,0.24,10.99,0.5
Outpatient Medical Services,LAB,83586,URINE 24HR 17 KETOSTERIODS,300,166,15.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,15.8,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,15.8,132.8,83
Outpatient Medical Services,LAB,83605,LACTIC ACID,300,141,13.43,Fee Schedule,105.75,75% of total billed charges,105.75,75% of total billed charges,33.84,24% of total billed charges,105.75,75% of total billed charges,105.75,75% of total billed charges,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,13.43,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,13.43,112.8,70.5
Outpatient Medical Services,LAB,83615,LDH,300,83.5,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,6.35,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,6.35,66.8,41.75
Outpatient Medical Services,LAB,83615,"LD, PERITONEAL FLUID",300,295.5,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,70.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,236.4,80% of total billed charges,71.63,24.24% of total billed charges,148.93,50.4% of total billed charges,221.63,75% of total billed charges,72.34,24.48% of total billed charges,6.35,Fee Schedule,70.92,24% of total billed charges,92.2,31.2% of total billed charges,236.4,80% of total billed charges,70.92,24% of total billed charges,70.92,24% of total billed charges,6.35,236.4,147.75
Outpatient Medical Services,LAB,83615,"LD, PLEURAL FLUID",300,295.5,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,70.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,236.4,80% of total billed charges,71.63,24.24% of total billed charges,148.93,50.4% of total billed charges,221.63,75% of total billed charges,72.34,24.48% of total billed charges,6.35,Fee Schedule,70.92,24% of total billed charges,92.2,31.2% of total billed charges,236.4,80% of total billed charges,70.92,24% of total billed charges,70.92,24% of total billed charges,6.35,236.4,147.75
Outpatient Medical Services,LAB,83625,LDH ISOENZYMES,300,166,14.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.55,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.55,132.8,83
Outpatient Medical Services,LAB,83630,"FECAL LACTOFERRIN, QUAL",300,199,13.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,13.45,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,13.45,159.2,99.5
Outpatient Medical Services,LAB,83655,LEAD,300,199,10,Fee Schedule,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,10,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,10,159.2,99.5
Outpatient Medical Services,LAB,83690,LIPASE,300,199,8.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,8.66,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,8.66,159.2,99.5
Outpatient Medical Services,LAB,83690,"LIPASE, PLEURAL FLUID",300,58.5,8.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,8.66,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,8.66,46.8,29.25
Outpatient Medical Services,LAB,83690,"LIPASE, PERITONEAL FLUID",300,58.5,8.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,8.66,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,8.66,46.8,29.25
Outpatient Medical Services,LAB,83690,LIPASE (SCP),300,15.5,8.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.4,80% of total billed charges,3.76,24.24% of total billed charges,7.81,50.4% of total billed charges,11.63,75% of total billed charges,3.79,24.48% of total billed charges,8.66,Fee Schedule,3.72,24% of total billed charges,4.84,31.2% of total billed charges,12.4,80% of total billed charges,3.72,24% of total billed charges,3.72,24% of total billed charges,3.72,12.4,7.75
Outpatient Medical Services,LAB,83695,LIPOPROTEIN A,300,166,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.28,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.28,132.8,83
Outpatient Medical Services,LAB,83698,LP-PLA2 ACTIVITY,300,164,42.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,131.2,80% of total billed charges,39.75,24.24% of total billed charges,82.66,50.4% of total billed charges,123,75% of total billed charges,40.15,24.48% of total billed charges,42.69,Fee Schedule,39.36,24% of total billed charges,51.17,31.2% of total billed charges,131.2,80% of total billed charges,39.36,24% of total billed charges,39.36,24% of total billed charges,39.36,131.2,82
Outpatient Medical Services,LAB,83701,VAP,300,297.5,31.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,31.21,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,31.21,238,148.75
Outpatient Medical Services,LAB,83704,NMR PROFILE,300,328.5,39.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,78.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,262.8,80% of total billed charges,79.63,24.24% of total billed charges,165.56,50.4% of total billed charges,246.38,75% of total billed charges,80.42,24.48% of total billed charges,39.67,Fee Schedule,78.84,24% of total billed charges,102.49,31.2% of total billed charges,262.8,80% of total billed charges,78.84,24% of total billed charges,78.84,24% of total billed charges,39.67,262.8,164.25
Outpatient Medical Services,LAB,83704,CARDIO IQ ADVANCED LIPID PANEL,300,474,39.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,113.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,39.67,Fee Schedule,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,39.67,379.2,237
Outpatient Medical Services,LAB,83718,HDL CHOLESTEROL,300,96,10.3,Fee Schedule,72,75% of total billed charges,72,75% of total billed charges,23.04,24% of total billed charges,72,75% of total billed charges,72,75% of total billed charges,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,10.3,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,10.3,76.8,48
Outpatient Medical Services,LAB,83718,HDL CHOLESTEROL (SCP),300,12.5,10.3,Fee Schedule,9.38,75% of total billed charges,9.38,75% of total billed charges,3,24% of total billed charges,9.38,75% of total billed charges,9.38,75% of total billed charges,10,80% of total billed charges,3.03,24.24% of total billed charges,6.3,50.4% of total billed charges,9.38,75% of total billed charges,3.06,24.48% of total billed charges,10.3,Fee Schedule,3,24% of total billed charges,3.9,31.2% of total billed charges,10,80% of total billed charges,3,24% of total billed charges,3,24% of total billed charges,3,10.3,6.25
Outpatient Medical Services,LAB,83721,DIRECT LDL,300,83.5,12,Fee Schedule,62.63,75% of total billed charges,62.63,75% of total billed charges,20.04,24% of total billed charges,62.63,75% of total billed charges,62.63,75% of total billed charges,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,12,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,12,66.8,41.75
Outpatient Medical Services,LAB,83735,URINE 24 HR MAGNESIUM,300,119.5,8.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,8.42,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,8.42,95.6,59.75
Outpatient Medical Services,LAB,83735,MAGNESIUM,300,130,8.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,31.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,8.42,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,8.42,104,65
Outpatient Medical Services,LAB,83735,RBC MAGNESIUM,300,96,8.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,8.42,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,8.42,76.8,48
Outpatient Medical Services,LAB,83825,MERCURY,300,114.5,20.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,20.45,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,20.45,91.6,57.25
Outpatient Medical Services,LAB,83835,METANEPHRINES PLASMA,300,237,21.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,21.3,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,21.3,189.6,118.5
Outpatient Medical Services,LAB,83872,SYNOVIAL FLUID MUCIN CLOT,300,76,12.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,60.8,80% of total billed charges,18.42,24.24% of total billed charges,38.3,50.4% of total billed charges,57,75% of total billed charges,18.6,24.48% of total billed charges,12.38,Fee Schedule,18.24,24% of total billed charges,23.71,31.2% of total billed charges,60.8,80% of total billed charges,18.24,24% of total billed charges,18.24,24% of total billed charges,12.38,60.8,38
Outpatient Medical Services,LAB,83874,MYOGLOBIN BLOOD,300,188.5,16.24,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,16.24,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,16.24,150.8,94.25
Outpatient Medical Services,LAB,83874,URINE MYOGLOBIN,300,188.5,16.24,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,16.24,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,16.24,150.8,94.25
Outpatient Medical Services,LAB,83880,BNP,300,427.5,42.69,Fee Schedule,320.63,75% of total billed charges,320.63,75% of total billed charges,102.6,24% of total billed charges,320.63,75% of total billed charges,320.63,75% of total billed charges,342,80% of total billed charges,103.63,24.24% of total billed charges,215.46,50.4% of total billed charges,320.63,75% of total billed charges,104.65,24.48% of total billed charges,42.69,Fee Schedule,102.6,24% of total billed charges,133.38,31.2% of total billed charges,342,80% of total billed charges,102.6,24% of total billed charges,102.6,24% of total billed charges,42.69,342,213.75
Outpatient Medical Services,LAB,83883,RETINOL BINDING PROTEIN,300,108,17.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,17.1,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,17.1,86.4,54
Outpatient Medical Services,LAB,83883,ALPHA2MACROGLOBULIN,300,108,17.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,17.1,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,17.1,86.4,54
Outpatient Medical Services,LAB,83915,NUCLEOTIDASE 5',300,119.5,14.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,14.02,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,14.02,95.6,59.75
Outpatient Medical Services,LAB,83921,METHYLMALONIC ACID,300,255.5,20.7,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,20.7,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,20.7,204.4,127.75
Outpatient Medical Services,LAB,83935,URINE OSMOLALITY,300,199,8.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,8.57,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,8.57,159.2,99.5
Outpatient Medical Services,LAB,83945,OXALATE SERUM,300,166,16.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.19,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.19,132.8,83
Outpatient Medical Services,LAB,83945,URINE 24 HR OXALATE,300,55.5,16.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,44.4,80% of total billed charges,13.45,24.24% of total billed charges,27.97,50.4% of total billed charges,41.63,75% of total billed charges,13.59,24.48% of total billed charges,16.19,Fee Schedule,13.32,24% of total billed charges,17.32,31.2% of total billed charges,44.4,80% of total billed charges,13.32,24% of total billed charges,13.32,24% of total billed charges,13.32,44.4,27.75
Outpatient Medical Services,LAB,83970,PTH INTACT W/O CALCIUM,300,456.5,51.9,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,109.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,365.2,80% of total billed charges,110.66,24.24% of total billed charges,230.08,50.4% of total billed charges,342.38,75% of total billed charges,111.75,24.48% of total billed charges,51.9,Fee Schedule,109.56,24% of total billed charges,142.43,31.2% of total billed charges,365.2,80% of total billed charges,109.56,24% of total billed charges,109.56,24% of total billed charges,51.9,365.2,228.25
Outpatient Medical Services,LAB,83986,PH BODY FLUID,300,227.5,4.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,182,80% of total billed charges,55.15,24.24% of total billed charges,114.66,50.4% of total billed charges,170.63,75% of total billed charges,55.69,24.48% of total billed charges,4.5,Fee Schedule,54.6,24% of total billed charges,70.98,31.2% of total billed charges,182,80% of total billed charges,54.6,24% of total billed charges,54.6,24% of total billed charges,4.5,182,113.75
Outpatient Medical Services,LAB,84066,PROSTATIC ACID PHOSPHATASE,300,108,12.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,12.15,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,12.15,86.4,54
Outpatient Medical Services,LAB,84075,ALP,300,72,6.35,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,6.35,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,6.35,57.6,36
Outpatient Medical Services,LAB,84080,ALK PHOS ISO,300,188.5,18.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,18.59,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,18.59,150.8,94.25
Outpatient Medical Services,LAB,84100,PHOSPHORUS,300,101,5.97,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,5.97,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,5.97,80.8,50.5
Outpatient Medical Services,LAB,84105,URINE 24 HR PHOSPHORUS,300,119.5,6.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,6.51,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,6.51,95.6,59.75
Outpatient Medical Services,LAB,84105,URINE PHOSPHORUS,300,108,6.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,6.51,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,6.51,86.4,54
Outpatient Medical Services,LAB,84106,PORPHOBILINOGEN,300,178,5.39,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,5.39,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,5.39,142.4,89
Outpatient Medical Services,LAB,84110,PORPHOBILINOGEN URINE,300,105,10.62,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,84,80% of total billed charges,25.45,24.24% of total billed charges,52.92,50.4% of total billed charges,78.75,75% of total billed charges,25.7,24.48% of total billed charges,10.62,Fee Schedule,25.2,24% of total billed charges,32.76,31.2% of total billed charges,84,80% of total billed charges,25.2,24% of total billed charges,25.2,24% of total billed charges,10.62,84,52.5
Outpatient Medical Services,LAB,84120,PORPHYRINS 24 HR URINE,300,237,18.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,18.5,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,18.5,189.6,118.5
Outpatient Medical Services,LAB,84120,"PORPHYRINS QUANT, URINE RANDOM",300,188.5,18.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,18.5,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,18.5,150.8,94.25
Outpatient Medical Services,LAB,84126,PORPHYRINS FECES,300,93.5,32.03,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74.8,80% of total billed charges,22.66,24.24% of total billed charges,47.12,50.4% of total billed charges,70.13,75% of total billed charges,22.89,24.48% of total billed charges,32.03,Fee Schedule,22.44,24% of total billed charges,29.17,31.2% of total billed charges,74.8,80% of total billed charges,22.44,24% of total billed charges,22.44,24% of total billed charges,22.44,74.8,46.75
Outpatient Medical Services,LAB,84132,POTASSIUM,300,101,5.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,5.78,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,5.78,80.8,50.5
Outpatient Medical Services,LAB,84133,POTASSIUM 24 HOUR URINE,300,119.5,5.41,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,5.41,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,5.41,95.6,59.75
Outpatient Medical Services,LAB,84133,POTASSIUM URINE,300,83.5,5.41,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,5.41,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,5.41,66.8,41.75
Outpatient Medical Services,LAB,84134,PREALBUMIN,300,114.5,18.34,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,18.34,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,18.34,91.6,57.25
Outpatient Medical Services,LAB,84140,PREGNENOLONE,300,276,26,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,220.8,80% of total billed charges,66.9,24.24% of total billed charges,139.1,50.4% of total billed charges,207,75% of total billed charges,67.56,24.48% of total billed charges,26,Fee Schedule,66.24,24% of total billed charges,86.11,31.2% of total billed charges,220.8,80% of total billed charges,66.24,24% of total billed charges,66.24,24% of total billed charges,26,220.8,138
Outpatient Medical Services,LAB,84143,17 OH-PREGNENOLONE,300,345,28.7,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,276,80% of total billed charges,83.63,24.24% of total billed charges,173.88,50.4% of total billed charges,258.75,75% of total billed charges,84.46,24.48% of total billed charges,28.7,Fee Schedule,82.8,24% of total billed charges,107.64,31.2% of total billed charges,276,80% of total billed charges,82.8,24% of total billed charges,82.8,24% of total billed charges,28.7,276,172.5
Outpatient Medical Services,LAB,84144,PROGESTERONE,300,170,25.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,25.61,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,25.61,136,85
Outpatient Medical Services,LAB,84145,PROCALCITONIN,300,631.5,24.06,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,151.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,505.2,80% of total billed charges,153.08,24.24% of total billed charges,318.28,50.4% of total billed charges,473.63,75% of total billed charges,154.59,24.48% of total billed charges,24.06,Fee Schedule,151.56,24% of total billed charges,197.03,31.2% of total billed charges,505.2,80% of total billed charges,151.56,24% of total billed charges,151.56,24% of total billed charges,24.06,505.2,315.75
Outpatient Medical Services,LAB,84146,PROLACTIN,300,226.5,24.37,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,181.2,80% of total billed charges,54.9,24.24% of total billed charges,114.16,50.4% of total billed charges,169.88,75% of total billed charges,55.45,24.48% of total billed charges,24.37,Fee Schedule,54.36,24% of total billed charges,70.67,31.2% of total billed charges,181.2,80% of total billed charges,54.36,24% of total billed charges,54.36,24% of total billed charges,24.37,181.2,113.25
Outpatient Medical Services,LAB,84153,"PSA, TOTAL",300,77.5,23.13,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62,80% of total billed charges,18.79,24.24% of total billed charges,39.06,50.4% of total billed charges,58.13,75% of total billed charges,18.97,24.48% of total billed charges,23.13,Fee Schedule,18.6,24% of total billed charges,24.18,31.2% of total billed charges,62,80% of total billed charges,18.6,24% of total billed charges,18.6,24% of total billed charges,18.6,62,38.75
Outpatient Medical Services,LAB,84154,PSA FREE,300,214,23.13,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,23.13,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,23.13,171.2,107
Outpatient Medical Services,LAB,84155,"PROTEIN ELECTROPH. W/ IFE REFLEX, SERUM",300,342,4.61,Fee Schedule,256.5,75% of total billed charges,256.5,75% of total billed charges,82.08,24% of total billed charges,256.5,75% of total billed charges,256.5,75% of total billed charges,273.6,80% of total billed charges,82.9,24.24% of total billed charges,172.37,50.4% of total billed charges,256.5,75% of total billed charges,83.72,24.48% of total billed charges,4.61,Fee Schedule,82.08,24% of total billed charges,106.7,31.2% of total billed charges,273.6,80% of total billed charges,82.08,24% of total billed charges,82.08,24% of total billed charges,4.61,273.6,171
Outpatient Medical Services,LAB,84155,"TOTAL PROTEIN, SERUM",300,83.5,4.61,Fee Schedule,62.63,75% of total billed charges,62.63,75% of total billed charges,20.04,24% of total billed charges,62.63,75% of total billed charges,62.63,75% of total billed charges,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,4.61,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,4.61,66.8,41.75
Outpatient Medical Services,LAB,84156,IMMUNOFIXATION ELECTROPHORESIS URINE,300,188.5,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,4.61,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,4.61,150.8,94.25
Outpatient Medical Services,LAB,84156,TOTAL PROTEIN 24 HOUR URINE,300,108,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,4.61,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,4.61,86.4,54
Outpatient Medical Services,LAB,84156,"TOTAL PROTEIN & CREAT., 24 HOUR URINE",300,108,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,4.61,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,4.61,86.4,54
Outpatient Medical Services,LAB,84157,CSF PROTEIN,300,96,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.61,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.61,76.8,48
Outpatient Medical Services,LAB,84157,"TOTAL PROTEIN, PLEURAL FLUID",300,96,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.61,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.61,76.8,48
Outpatient Medical Services,LAB,84157,"TOTAL PROTEIN, PERITONEAL FLUID",300,96,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.61,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.61,76.8,48
Outpatient Medical Services,LAB,84157,"TOTAL PROTEIN, PERICARDIAL FLUID",300,96,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.61,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.61,76.8,48
Outpatient Medical Services,LAB,84157,"TOTAL PROTEIN, SYNOVIAL FLUID",300,96,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,4.61,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,4.61,76.8,48
Outpatient Medical Services,LAB,84165,PROTEIN ELECTROPHORESIS SERUM,300,199,13.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,13.51,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,13.51,159.2,99.5
Outpatient Medical Services,LAB,84166,"PROTEIN ELECTROPHORESIS, URINE 24 HR",300,141,22.43,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,22.43,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,22.43,112.8,70.5
Outpatient Medical Services,LAB,84166,"PROTEIN ELECTROPHORESIS, URINE RANDOM",300,141,22.43,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,22.43,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,22.43,112.8,70.5
Outpatient Medical Services,LAB,84202,RBC PORPHYRINS,300,93.5,18.05,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74.8,80% of total billed charges,22.66,24.24% of total billed charges,47.12,50.4% of total billed charges,70.13,75% of total billed charges,22.89,24.48% of total billed charges,18.05,Fee Schedule,22.44,24% of total billed charges,29.17,31.2% of total billed charges,74.8,80% of total billed charges,22.44,24% of total billed charges,22.44,24% of total billed charges,18.05,74.8,46.75
Outpatient Medical Services,LAB,84206,PROINSULIN,300,474,22.4,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,113.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,22.4,Fee Schedule,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,22.4,379.2,237
Outpatient Medical Services,LAB,84207,VITAMIN B6,300,213,35.33,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,35.33,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,35.33,170.4,106.5
Outpatient Medical Services,LAB,84210,PYRUVIC ACID,300,140,13.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112,80% of total billed charges,33.94,24.24% of total billed charges,70.56,50.4% of total billed charges,105,75% of total billed charges,34.27,24.48% of total billed charges,13.65,Fee Schedule,33.6,24% of total billed charges,43.68,31.2% of total billed charges,112,80% of total billed charges,33.6,24% of total billed charges,33.6,24% of total billed charges,13.65,112,70
Outpatient Medical Services,LAB,84233,ESTROGEN RECEPTOR [MOLES/MASS] IN TISSUE,300,474,80.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,113.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,80.99,Fee Schedule,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,80.99,379.2,237
Outpatient Medical Services,LAB,84238,TRANSFERRIN RECEPTOR,300,260.5,45.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,208.4,80% of total billed charges,63.15,24.24% of total billed charges,131.29,50.4% of total billed charges,195.38,75% of total billed charges,63.77,24.48% of total billed charges,45.98,Fee Schedule,62.52,24% of total billed charges,81.28,31.2% of total billed charges,208.4,80% of total billed charges,62.52,24% of total billed charges,62.52,24% of total billed charges,45.98,208.4,130.25
Outpatient Medical Services,LAB,84244,RENIN,300,203,27.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,162.4,80% of total billed charges,49.21,24.24% of total billed charges,102.31,50.4% of total billed charges,152.25,75% of total billed charges,49.69,24.48% of total billed charges,27.66,Fee Schedule,48.72,24% of total billed charges,63.34,31.2% of total billed charges,162.4,80% of total billed charges,48.72,24% of total billed charges,48.72,24% of total billed charges,27.66,162.4,101.5
Outpatient Medical Services,LAB,84260,SEROTONIN,300,345,38.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,276,80% of total billed charges,83.63,24.24% of total billed charges,173.88,50.4% of total billed charges,258.75,75% of total billed charges,84.46,24.48% of total billed charges,38.95,Fee Schedule,82.8,24% of total billed charges,107.64,31.2% of total billed charges,276,80% of total billed charges,82.8,24% of total billed charges,82.8,24% of total billed charges,38.95,276,172.5
Outpatient Medical Services,LAB,84270,SEX HORMONE BIND GLOBULIN,300,87.5,27.32,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,70,80% of total billed charges,21.21,24.24% of total billed charges,44.1,50.4% of total billed charges,65.63,75% of total billed charges,21.42,24.48% of total billed charges,27.32,Fee Schedule,21,24% of total billed charges,27.3,31.2% of total billed charges,70,80% of total billed charges,21,24% of total billed charges,21,24% of total billed charges,21,70,43.75
Outpatient Medical Services,LAB,84295,SODIUM,300,83.5,6.05,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,6.05,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,6.05,66.8,41.75
Outpatient Medical Services,LAB,84300,URINE SODIUM,300,114.5,4.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,4.35,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,4.35,91.6,57.25
Outpatient Medical Services,LAB,84300,URINE 24 HR SODIUM,300,119.5,4.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,4.35,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,4.35,95.6,59.75
Outpatient Medical Services,LAB,84302,CSF SODIUM,300,121.5,4.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,97.2,80% of total billed charges,29.45,24.24% of total billed charges,61.24,50.4% of total billed charges,91.13,75% of total billed charges,29.74,24.48% of total billed charges,4.35,Fee Schedule,29.16,24% of total billed charges,37.91,31.2% of total billed charges,97.2,80% of total billed charges,29.16,24% of total billed charges,29.16,24% of total billed charges,4.35,97.2,60.75
Outpatient Medical Services,LAB,84305,SOMATOMEDIN C,300,188.5,26.73,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,26.73,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,26.73,150.8,94.25
Outpatient Medical Services,LAB,84311,CHYMOTRYPSIN STOOL,300,534.5,8.79,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,128.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,427.6,80% of total billed charges,129.56,24.24% of total billed charges,269.39,50.4% of total billed charges,400.88,75% of total billed charges,130.85,24.48% of total billed charges,8.79,Fee Schedule,128.28,24% of total billed charges,166.76,31.2% of total billed charges,427.6,80% of total billed charges,128.28,24% of total billed charges,128.28,24% of total billed charges,8.79,427.6,267.25
Outpatient Medical Services,LAB,84311,"CHOLESTEROL, PERITONEAL FLUID",300,45.5,8.79,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,8.79,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,8.79,36.4,22.75
Outpatient Medical Services,LAB,84311,"CHOLESTEROL, PLEURAL FLUID",300,45.5,8.79,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,8.79,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,8.79,36.4,22.75
Outpatient Medical Services,LAB,84315,"SPECIFIC GRAVITY, BODY FLUID",300,45.5,3.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,3.15,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,3.15,36.4,22.75
Outpatient Medical Services,LAB,84376,STOOL REDUCING SUBSTANCES,300,27,6.92,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,6.92,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,84378,GLYCOMARK,300,96,14.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,14.49,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,14.49,76.8,48
Outpatient Medical Services,LAB,84392,URINE 24 HR SULFATE,300,68,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.4,80% of total billed charges,16.48,24.24% of total billed charges,34.27,50.4% of total billed charges,51,75% of total billed charges,16.65,24.48% of total billed charges,5.98,Fee Schedule,16.32,24% of total billed charges,21.22,31.2% of total billed charges,54.4,80% of total billed charges,16.32,24% of total billed charges,16.32,24% of total billed charges,5.98,54.4,34
Outpatient Medical Services,LAB,84402,TESTOSTERONE FREE,300,272,32.01,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,32.01,Fee Schedule,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,32.01,217.6,136
Outpatient Medical Services,LAB,84403,TESTOSTERONE TOTAL,300,272,32.47,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,32.47,Fee Schedule,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,32.47,217.6,136
Outpatient Medical Services,LAB,84425,THIAMINE,300,166,26.7,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,26.7,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,26.7,132.8,83
Outpatient Medical Services,LAB,84431,11-DEHYDROTHROMBOXANE B2,300,82.5,22.16,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,19.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,LAB,84432,THYROGLOBULIN QUANTATIVE,300,82.5,20.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,19.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,20.2,Fee Schedule,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,LAB,84436,T4 TOTAL,300,144,8.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,8.65,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,8.65,115.2,72
Outpatient Medical Services,LAB,84436,T4 TOTAL (SCP),300,28,8.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.4,80% of total billed charges,6.79,24.24% of total billed charges,14.11,50.4% of total billed charges,21,75% of total billed charges,6.85,24.48% of total billed charges,8.65,Fee Schedule,6.72,24% of total billed charges,8.74,31.2% of total billed charges,22.4,80% of total billed charges,6.72,24% of total billed charges,6.72,24% of total billed charges,6.72,22.4,14
Outpatient Medical Services,LAB,84439,T4 FREE,300,144,11.34,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,11.34,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,11.34,115.2,72
Outpatient Medical Services,LAB,84439,T4 FREE (SCP),300,28,11.34,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.4,80% of total billed charges,6.79,24.24% of total billed charges,14.11,50.4% of total billed charges,21,75% of total billed charges,6.85,24.48% of total billed charges,11.34,Fee Schedule,6.72,24% of total billed charges,8.74,31.2% of total billed charges,22.4,80% of total billed charges,6.72,24% of total billed charges,6.72,24% of total billed charges,6.72,22.4,14
Outpatient Medical Services,LAB,84442,THYROID BINDING GLOBULIN,300,166,14.63,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.63,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.63,132.8,83
Outpatient Medical Services,LAB,84443,TSH3,300,199,21.12,Fee Schedule,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,21.12,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,21.12,159.2,99.5
Outpatient Medical Services,LAB,84443,TSH (SCP),300,37,21.12,Fee Schedule,27.75,75% of total billed charges,27.75,75% of total billed charges,8.88,24% of total billed charges,27.75,75% of total billed charges,27.75,75% of total billed charges,29.6,80% of total billed charges,8.97,24.24% of total billed charges,18.65,50.4% of total billed charges,27.75,75% of total billed charges,9.06,24.48% of total billed charges,21.12,Fee Schedule,8.88,24% of total billed charges,11.54,31.2% of total billed charges,29.6,80% of total billed charges,8.88,24% of total billed charges,8.88,24% of total billed charges,8.88,29.6,18.5
Outpatient Medical Services,LAB,84445,THYROID STIMULATING IMMUNOGLOBULINS,300,652,10.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,156.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,521.6,80% of total billed charges,158.04,24.24% of total billed charges,328.61,50.4% of total billed charges,489,75% of total billed charges,159.61,24.48% of total billed charges,10.65,Fee Schedule,156.48,24% of total billed charges,203.42,31.2% of total billed charges,521.6,80% of total billed charges,156.48,24% of total billed charges,156.48,24% of total billed charges,10.65,521.6,326
Outpatient Medical Services,LAB,84446,VITAMIN E,300,119.5,17.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,17.83,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,17.83,95.6,59.75
Outpatient Medical Services,LAB,84450,AST,300,101,6.35,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,6.35,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,6.35,80.8,50.5
Outpatient Medical Services,LAB,84460,ALT,300,101,6.35,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,6.35,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,6.35,80.8,50.5
Outpatient Medical Services,LAB,84466,TRANSFERRIN,300,186.5,16.06,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,44.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,149.2,80% of total billed charges,45.21,24.24% of total billed charges,94,50.4% of total billed charges,139.88,75% of total billed charges,45.66,24.48% of total billed charges,16.06,Fee Schedule,44.76,24% of total billed charges,58.19,31.2% of total billed charges,149.2,80% of total billed charges,44.76,24% of total billed charges,44.76,24% of total billed charges,16.06,149.2,93.25
Outpatient Medical Services,LAB,84478,TRIGLYCERIDES,300,170,6.35,Fee Schedule,127.5,75% of total billed charges,127.5,75% of total billed charges,40.8,24% of total billed charges,127.5,75% of total billed charges,127.5,75% of total billed charges,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,6.35,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,6.35,136,85
Outpatient Medical Services,LAB,84478,"TRIGLYCERIDES, PERITONEAL FLUID",300,45.5,6.35,Fee Schedule,34.13,75% of total billed charges,34.13,75% of total billed charges,10.92,24% of total billed charges,34.13,75% of total billed charges,34.13,75% of total billed charges,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,6.35,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,6.35,36.4,22.75
Outpatient Medical Services,LAB,84478,"TRIGLYCERIDES, PLEURAL FLUID",300,45.5,6.35,Fee Schedule,34.13,75% of total billed charges,34.13,75% of total billed charges,10.92,24% of total billed charges,34.13,75% of total billed charges,34.13,75% of total billed charges,36.4,80% of total billed charges,11.03,24.24% of total billed charges,22.93,50.4% of total billed charges,34.13,75% of total billed charges,11.14,24.48% of total billed charges,6.35,Fee Schedule,10.92,24% of total billed charges,14.2,31.2% of total billed charges,36.4,80% of total billed charges,10.92,24% of total billed charges,10.92,24% of total billed charges,6.35,36.4,22.75
Outpatient Medical Services,LAB,84478,TRIGLYCERIDES (SCP),300,12.5,6.35,Fee Schedule,9.38,75% of total billed charges,9.38,75% of total billed charges,3,24% of total billed charges,9.38,75% of total billed charges,9.38,75% of total billed charges,10,80% of total billed charges,3.03,24.24% of total billed charges,6.3,50.4% of total billed charges,9.38,75% of total billed charges,3.06,24.48% of total billed charges,6.35,Fee Schedule,3,24% of total billed charges,3.9,31.2% of total billed charges,10,80% of total billed charges,3,24% of total billed charges,3,24% of total billed charges,3,10,6.25
Outpatient Medical Services,LAB,84479,T3 UPTAKE,300,144,8.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,8.14,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,8.14,115.2,72
Outpatient Medical Services,LAB,84479,T3 UPTAKE (SCP),300,28,8.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.4,80% of total billed charges,6.79,24.24% of total billed charges,14.11,50.4% of total billed charges,21,75% of total billed charges,6.85,24.48% of total billed charges,8.14,Fee Schedule,6.72,24% of total billed charges,8.74,31.2% of total billed charges,22.4,80% of total billed charges,6.72,24% of total billed charges,6.72,24% of total billed charges,6.72,22.4,14
Outpatient Medical Services,LAB,84480,TOTAL T3,300,119.5,16.03,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,16.03,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,16.03,95.6,59.75
Outpatient Medical Services,LAB,84481,T3 FREE,300,108,21.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,21.3,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,21.3,86.4,54
Outpatient Medical Services,LAB,84482,T3 REVERSE,300,274,19.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,19.82,Fee Schedule,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,19.82,219.2,137
Outpatient Medical Services,LAB,84520,BUN,300,101,4.96,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.96,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.96,80.8,50.5
Outpatient Medical Services,LAB,84540,URINE UREA,300,83.5,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,5.98,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,5.98,66.8,41.75
Outpatient Medical Services,LAB,84545,URINE 24 HR UREA CLEARANCE,300,96,8.31,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,8.31,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,8.31,76.8,48
Outpatient Medical Services,LAB,84550,URIC ACID,300,101,5.68,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,5.68,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,5.68,80.8,50.5
Outpatient Medical Services,LAB,84560,URINE 24 HR URIC ACID,300,119.5,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,5.98,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,5.98,95.6,59.75
Outpatient Medical Services,LAB,84560,URINE URIC ACID,300,108,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,5.98,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,5.98,86.4,54
Outpatient Medical Services,LAB,84560,"URIC ACID, SYNOVIAL FLUID",300,50.5,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.4,80% of total billed charges,12.24,24.24% of total billed charges,25.45,50.4% of total billed charges,37.88,75% of total billed charges,12.36,24.48% of total billed charges,5.98,Fee Schedule,12.12,24% of total billed charges,15.76,31.2% of total billed charges,40.4,80% of total billed charges,12.12,24% of total billed charges,12.12,24% of total billed charges,5.98,40.4,25.25
Outpatient Medical Services,LAB,84585,URINE 24 HR VMA,300,213,19.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,19.49,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,19.49,170.4,106.5
Outpatient Medical Services,LAB,84590,VITAMIN A,300,119.5,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,14.58,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,14.58,95.6,59.75
Outpatient Medical Services,LAB,84597,VITAMIN K,300,312,17.24,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,249.6,80% of total billed charges,75.63,24.24% of total billed charges,157.25,50.4% of total billed charges,234,75% of total billed charges,76.38,24.48% of total billed charges,17.24,Fee Schedule,74.88,24% of total billed charges,97.34,31.2% of total billed charges,249.6,80% of total billed charges,74.88,24% of total billed charges,74.88,24% of total billed charges,17.24,249.6,156
Outpatient Medical Services,LAB,84630,ZINC,300,96,14.32,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,14.32,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,14.32,76.8,48
Outpatient Medical Services,LAB,84681,C PEPTIDE,300,320.5,19.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,256.4,80% of total billed charges,77.69,24.24% of total billed charges,161.53,50.4% of total billed charges,240.38,75% of total billed charges,78.46,24.48% of total billed charges,19.98,Fee Schedule,76.92,24% of total billed charges,100,31.2% of total billed charges,256.4,80% of total billed charges,76.92,24% of total billed charges,76.92,24% of total billed charges,19.98,256.4,160.25
Outpatient Medical Services,LAB,84702,"BETA HCG, QUANT",300,122.5,8.07,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,8.07,Fee Schedule,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,8.07,98,61.25
Outpatient Medical Services,LAB,84703,PREG TEST SERUM,300,114.5,8.07,Fee Schedule,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,8.07,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,8.07,91.6,57.25
Outpatient Medical Services,LAB,85002,BLEEDING TIME,300,83.5,5.66,Fee Schedule,62.63,75% of total billed charges,62.63,75% of total billed charges,20.04,24% of total billed charges,62.63,75% of total billed charges,62.63,75% of total billed charges,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,5.66,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,5.66,66.8,41.75
Outpatient Medical Services,LAB,85007,CBC W/MANUAL DIFF,300,83.5,4.33,Fee Schedule,62.63,75% of total billed charges,62.63,75% of total billed charges,20.04,24% of total billed charges,62.63,75% of total billed charges,62.63,75% of total billed charges,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,4.33,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,4.33,66.8,41.75
Outpatient Medical Services,LAB,85007,MANUAL DIFF PERFORMED,300,51.5,4.33,Fee Schedule,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,4.33,Fee Schedule,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,4.33,41.2,25.75
Outpatient Medical Services,LAB,85007,MANUAL DIFF & SMEAR REVIEW,300,83.5,4.33,Fee Schedule,62.63,75% of total billed charges,62.63,75% of total billed charges,20.04,24% of total billed charges,62.63,75% of total billed charges,62.63,75% of total billed charges,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,4.33,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,4.33,66.8,41.75
Outpatient Medical Services,LAB,85007,PATHOLOGIST SMEAR REVIEW,300,51.5,4.33,Fee Schedule,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,4.33,Fee Schedule,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,4.33,41.2,25.75
Outpatient Medical Services,LAB,85014,HEMATOCRIT,300,71,2.98,Fee Schedule,53.25,75% of total billed charges,53.25,75% of total billed charges,17.04,24% of total billed charges,53.25,75% of total billed charges,53.25,75% of total billed charges,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,2.98,Fee Schedule,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,2.98,56.8,35.5
Outpatient Medical Services,LAB,85018,HEMOGLOBIN (HGB),300,19,2.98,Fee Schedule,14.25,75% of total billed charges,14.25,75% of total billed charges,4.56,24% of total billed charges,14.25,75% of total billed charges,14.25,75% of total billed charges,15.2,80% of total billed charges,4.61,24.24% of total billed charges,9.58,50.4% of total billed charges,14.25,75% of total billed charges,4.65,24.48% of total billed charges,2.98,Fee Schedule,4.56,24% of total billed charges,5.93,31.2% of total billed charges,15.2,80% of total billed charges,4.56,24% of total billed charges,4.56,24% of total billed charges,2.98,15.2,9.5
Outpatient Medical Services,LAB,85018,HEMOGLOBIN,300,71,2.98,Fee Schedule,53.25,75% of total billed charges,53.25,75% of total billed charges,17.04,24% of total billed charges,53.25,75% of total billed charges,53.25,75% of total billed charges,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,2.98,Fee Schedule,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,2.98,56.8,35.5
Outpatient Medical Services,LAB,85025,CBC,300,39,9.77,Fee Schedule,29.25,75% of total billed charges,29.25,75% of total billed charges,9.36,24% of total billed charges,29.25,75% of total billed charges,29.25,75% of total billed charges,31.2,80% of total billed charges,9.45,24.24% of total billed charges,19.66,50.4% of total billed charges,29.25,75% of total billed charges,9.55,24.48% of total billed charges,9.77,Fee Schedule,9.36,24% of total billed charges,12.17,31.2% of total billed charges,31.2,80% of total billed charges,9.36,24% of total billed charges,9.36,24% of total billed charges,9.36,31.2,19.5
Outpatient Medical Services,LAB,85025,CBC W/DIFF,300,144,9.77,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,9.77,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,9.77,115.2,72
Outpatient Medical Services,LAB,85025,CBC W/DIFF - DxH 520,300,144,9.77,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,9.77,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,9.77,115.2,72
Outpatient Medical Services,LAB,85025,CBC,300,N/A,9.77,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,9.77,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,9.77,9.77,N/A
Outpatient Medical Services,LAB,85025,CBC W/DIFF & PLT (SCP),300,16.5,9.77,Fee Schedule,12.38,75% of total billed charges,12.38,75% of total billed charges,3.96,24% of total billed charges,12.38,75% of total billed charges,12.38,75% of total billed charges,13.2,80% of total billed charges,4,24.24% of total billed charges,8.32,50.4% of total billed charges,12.38,75% of total billed charges,4.04,24.48% of total billed charges,9.77,Fee Schedule,3.96,24% of total billed charges,5.15,31.2% of total billed charges,13.2,80% of total billed charges,3.96,24% of total billed charges,3.96,24% of total billed charges,3.96,13.2,8.25
Outpatient Medical Services,LAB,85027,CBC WITHOUT DIFF,300,130,8.14,Fee Schedule,97.5,75% of total billed charges,97.5,75% of total billed charges,31.2,24% of total billed charges,97.5,75% of total billed charges,97.5,75% of total billed charges,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,8.14,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,8.14,104,65
Outpatient Medical Services,LAB,85045,RETIC COUNT,300,71,5.03,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,5.03,Fee Schedule,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,5.03,56.8,35.5
Outpatient Medical Services,LAB,85048,WBC COUNT,300,72,3.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,3.2,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,3.2,57.6,36
Outpatient Medical Services,LAB,85049,PLATELET COUNT,300,59.5,5.63,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,5.63,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,5.63,47.6,29.75
Outpatient Medical Services,LAB,85220,FACTOR V ACTIVITY,300,652,22.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,156.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,521.6,80% of total billed charges,158.04,24.24% of total billed charges,328.61,50.4% of total billed charges,489,75% of total billed charges,159.61,24.48% of total billed charges,22.19,Fee Schedule,156.48,24% of total billed charges,203.42,31.2% of total billed charges,521.6,80% of total billed charges,156.48,24% of total billed charges,156.48,24% of total billed charges,22.19,521.6,326
Outpatient Medical Services,LAB,85240,FACTOR VIII ACTIVITY,300,427.5,22.52,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,102.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,342,80% of total billed charges,103.63,24.24% of total billed charges,215.46,50.4% of total billed charges,320.63,75% of total billed charges,104.65,24.48% of total billed charges,22.52,Fee Schedule,102.6,24% of total billed charges,133.38,31.2% of total billed charges,342,80% of total billed charges,102.6,24% of total billed charges,102.6,24% of total billed charges,22.52,342,213.75
Outpatient Medical Services,LAB,85245,VON WILL FACT ACT,300,465.5,28.85,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,372.4,80% of total billed charges,112.84,24.24% of total billed charges,234.61,50.4% of total billed charges,349.13,75% of total billed charges,113.95,24.48% of total billed charges,28.85,Fee Schedule,111.72,24% of total billed charges,145.24,31.2% of total billed charges,372.4,80% of total billed charges,111.72,24% of total billed charges,111.72,24% of total billed charges,28.85,372.4,232.75
Outpatient Medical Services,LAB,85246,VON WILL FACT AG,300,465.5,28.85,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,372.4,80% of total billed charges,112.84,24.24% of total billed charges,234.61,50.4% of total billed charges,349.13,75% of total billed charges,113.95,24.48% of total billed charges,28.85,Fee Schedule,111.72,24% of total billed charges,145.24,31.2% of total billed charges,372.4,80% of total billed charges,111.72,24% of total billed charges,111.72,24% of total billed charges,28.85,372.4,232.75
Outpatient Medical Services,LAB,85250,FACTOR IX ACTIVITY,300,225.5,23.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,180.4,80% of total billed charges,54.66,24.24% of total billed charges,113.65,50.4% of total billed charges,169.13,75% of total billed charges,55.2,24.48% of total billed charges,23.94,Fee Schedule,54.12,24% of total billed charges,70.36,31.2% of total billed charges,180.4,80% of total billed charges,54.12,24% of total billed charges,54.12,24% of total billed charges,23.94,180.4,112.75
Outpatient Medical Services,LAB,85300,ANTITHROMBIN III ACTIVITY,300,284.5,14.9,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,14.9,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,14.9,227.6,142.25
Outpatient Medical Services,LAB,85301,ANTITHROMBIN III AG,300,222.5,13.6,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,178,80% of total billed charges,53.93,24.24% of total billed charges,112.14,50.4% of total billed charges,166.88,75% of total billed charges,54.47,24.48% of total billed charges,13.6,Fee Schedule,53.4,24% of total billed charges,69.42,31.2% of total billed charges,178,80% of total billed charges,53.4,24% of total billed charges,53.4,24% of total billed charges,13.6,178,111.25
Outpatient Medical Services,LAB,85302,PROTEIN C AG TOTAL,300,96,15.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,15.12,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,15.12,76.8,48
Outpatient Medical Services,LAB,85303,PROTEIN C ACTIVITY,300,222.5,17.39,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,178,80% of total billed charges,53.93,24.24% of total billed charges,112.14,50.4% of total billed charges,166.88,75% of total billed charges,54.47,24.48% of total billed charges,17.39,Fee Schedule,53.4,24% of total billed charges,69.42,31.2% of total billed charges,178,80% of total billed charges,53.4,24% of total billed charges,53.4,24% of total billed charges,17.39,178,111.25
Outpatient Medical Services,LAB,85305,PROTEIN S AG TOTAL,300,100,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80,80% of total billed charges,24.24,24.24% of total billed charges,50.4,50.4% of total billed charges,75,75% of total billed charges,24.48,24.48% of total billed charges,14.58,Fee Schedule,24,24% of total billed charges,31.2,31.2% of total billed charges,80,80% of total billed charges,24,24% of total billed charges,24,24% of total billed charges,14.58,80,50
Outpatient Medical Services,LAB,85306,PROTEIN S ACTIVITY,300,222.5,19.27,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,178,80% of total billed charges,53.93,24.24% of total billed charges,112.14,50.4% of total billed charges,166.88,75% of total billed charges,54.47,24.48% of total billed charges,19.27,Fee Schedule,53.4,24% of total billed charges,69.42,31.2% of total billed charges,178,80% of total billed charges,53.4,24% of total billed charges,53.4,24% of total billed charges,19.27,178,111.25
Outpatient Medical Services,LAB,85307,ACTIVATED PROTEIN C RESISTANCE,300,254.5,19.27,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,203.6,80% of total billed charges,61.69,24.24% of total billed charges,128.27,50.4% of total billed charges,190.88,75% of total billed charges,62.3,24.48% of total billed charges,19.27,Fee Schedule,61.08,24% of total billed charges,79.4,31.2% of total billed charges,203.6,80% of total billed charges,61.08,24% of total billed charges,61.08,24% of total billed charges,19.27,203.6,127.25
Outpatient Medical Services,LAB,85362,FIBRINOGEN DEGRADATION PRODUCTS,300,144,8.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,8.66,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,8.66,115.2,72
Outpatient Medical Services,LAB,85379,D-DIMER,300,199,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,12.8,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,12.8,159.2,99.5
Outpatient Medical Services,LAB,85379,D-DIMER (SCP),300,22.5,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18,80% of total billed charges,5.45,24.24% of total billed charges,11.34,50.4% of total billed charges,16.88,75% of total billed charges,5.51,24.48% of total billed charges,12.8,Fee Schedule,5.4,24% of total billed charges,7.02,31.2% of total billed charges,18,80% of total billed charges,5.4,24% of total billed charges,5.4,24% of total billed charges,5.4,18,11.25
Outpatient Medical Services,LAB,85384,FIBRINOGEN,300,108,10.68,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,10.68,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,10.68,86.4,54
Outpatient Medical Services,LAB,85540,LEUKOCYTE ALK PHOS,300,178,7.6,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,7.6,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,7.6,142.4,89
Outpatient Medical Services,LAB,85549,LYSOZYME,300,119.5,23.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,23.59,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,23.59,95.6,59.75
Outpatient Medical Services,LAB,85597,PLATELET NEUTRALIZATION PROCEDURE,300,27,22.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,22.61,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,22.61,13.5
Outpatient Medical Services,LAB,85597,DRVVT CONFIRMATION,300,27,22.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,22.61,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,22.61,13.5
Outpatient Medical Services,LAB,85598,HEXAGONAL PHOSPHOLIPID NEUTRALIZATION,300,27,20.24,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,20.24,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85610,PROTIME,300,86.5,4.94,Fee Schedule,64.88,75% of total billed charges,64.88,75% of total billed charges,20.76,24% of total billed charges,64.88,75% of total billed charges,64.88,75% of total billed charges,69.2,80% of total billed charges,20.97,24.24% of total billed charges,43.6,50.4% of total billed charges,64.88,75% of total billed charges,21.18,24.48% of total billed charges,4.94,Fee Schedule,20.76,24% of total billed charges,26.99,31.2% of total billed charges,69.2,80% of total billed charges,20.76,24% of total billed charges,20.76,24% of total billed charges,4.94,69.2,43.25
Outpatient Medical Services,LAB,85610,PT & aPTT,300,N/A,4.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.94,4.94,N/A
Outpatient Medical Services,LAB,85610,PROTIME/INR (SCP),300,11.5,4.94,Fee Schedule,8.63,75% of total billed charges,8.63,75% of total billed charges,2.76,24% of total billed charges,8.63,75% of total billed charges,8.63,75% of total billed charges,9.2,80% of total billed charges,2.79,24.24% of total billed charges,5.8,50.4% of total billed charges,8.63,75% of total billed charges,2.82,24.48% of total billed charges,4.94,Fee Schedule,2.76,24% of total billed charges,3.59,31.2% of total billed charges,9.2,80% of total billed charges,2.76,24% of total billed charges,2.76,24% of total billed charges,2.76,9.2,5.75
Outpatient Medical Services,LAB,85613,DRVVT,300,27,12.03,Fee Schedule,20.25,75% of total billed charges,20.25,75% of total billed charges,6.48,24% of total billed charges,20.25,75% of total billed charges,20.25,75% of total billed charges,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,12.03,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85613,DILUTE RUSSELL VIPER,300,27,12.03,Fee Schedule,20.25,75% of total billed charges,20.25,75% of total billed charges,6.48,24% of total billed charges,20.25,75% of total billed charges,20.25,75% of total billed charges,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,12.03,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85635,REPTILASE TIME,300,27,12.38,Fee Schedule,20.25,75% of total billed charges,20.25,75% of total billed charges,6.48,24% of total billed charges,20.25,75% of total billed charges,20.25,75% of total billed charges,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,12.38,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85651,ESR,300,71,4.46,Fee Schedule,53.25,75% of total billed charges,53.25,75% of total billed charges,17.04,24% of total billed charges,53.25,75% of total billed charges,53.25,75% of total billed charges,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,4.46,Fee Schedule,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,4.46,56.8,35.5
Outpatient Medical Services,LAB,85660,SICKLE CELL SCREEN,300,83.5,6.94,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,6.94,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,6.94,66.8,41.75
Outpatient Medical Services,LAB,85670,THROMBIN TIME,300,76,7.26,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,60.8,80% of total billed charges,18.42,24.24% of total billed charges,38.3,50.4% of total billed charges,57,75% of total billed charges,18.6,24.48% of total billed charges,7.26,Fee Schedule,18.24,24% of total billed charges,23.71,31.2% of total billed charges,60.8,80% of total billed charges,18.24,24% of total billed charges,18.24,24% of total billed charges,7.26,60.8,38
Outpatient Medical Services,LAB,85730,APTT,300,101,7.54,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,7.54,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,7.54,80.8,50.5
Outpatient Medical Services,LAB,85730,PTT HEPARIN NEUTRALIZED,300,27,7.54,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,7.54,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85732,APTT 1:1 MIX,300,27,8.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,8.14,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,85999,URINE EO COUNT,300,71,19.07,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,19.07,26.86% of total billed charges,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,17.04,56.8,35.5
Outpatient Medical Services,LAB,86001,AUREOBASIDIUM PULLULANS IGG,300,110,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,6.57,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,6.57,88,55
Outpatient Medical Services,LAB,86001,PHOMA SPP IGG,300,110,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,6.57,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,6.57,88,55
Outpatient Medical Services,LAB,86001,TRICHODERMA VIRIDE IGG,300,110,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,6.57,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,6.57,88,55
Outpatient Medical Services,LAB,86001,MIXED FEATHERS IGG,300,110,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,6.57,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,6.57,88,55
Outpatient Medical Services,LAB,86001,PIGEON DROPPINGS IGG,300,110,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,6.57,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,6.57,88,55
Outpatient Medical Services,LAB,86003,LATEX IGE AB RAST,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,A FLAVIS ALLERGEN,300,35,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,8.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28,80% of total billed charges,8.48,24.24% of total billed charges,17.64,50.4% of total billed charges,26.25,75% of total billed charges,8.57,24.48% of total billed charges,6.57,Fee Schedule,8.4,24% of total billed charges,10.92,31.2% of total billed charges,28,80% of total billed charges,8.4,24% of total billed charges,8.4,24% of total billed charges,6.57,28,17.5
Outpatient Medical Services,LAB,86003,AMERICAN HOUSE DUST MITE IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,DOG DANDER IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,CAT DANDER IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,COMMON RAGWEED IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,BAHIA GRASS IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,ALTERNARIA ALTERNATA IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,WHITE OAK IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,CODFISH IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,SHRIMP IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,CRAB IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,TUNA IGE RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,LOBSTER IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,NETTLE IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,MUCOR RACEMOSUS IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,S ROSTRATA IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,SHEEP SORREL IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,EUROPEAN HOUSE DUST MITE IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,BERMUDA GRASS IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,TIMOTHY GRASS IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,COCKROACH IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,PENICILLIUM NOTATUM IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,CLADOSPORIUM HERBARUM IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,A FUMIGATUS IGE,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,MAPLE IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,SILVER BIRCH IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,CEDAR IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,WHITE ELM IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,PECAN/HICKORY TREE IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,COMMON PIGWEED IGE AB,300,21.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,6.57,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,86003,"ALLERGY EVALUATION 2, SOUTHEAST",300,212,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,50.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,169.6,80% of total billed charges,51.39,24.24% of total billed charges,106.85,50.4% of total billed charges,159,75% of total billed charges,51.9,24.48% of total billed charges,6.57,Fee Schedule,50.88,24% of total billed charges,66.14,31.2% of total billed charges,169.6,80% of total billed charges,50.88,24% of total billed charges,50.88,24% of total billed charges,6.57,169.6,106
Outpatient Medical Services,LAB,86003,PORK IGE RAST,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,MOUSE URINE PROTEIN IGE,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,STRAWBERRY RAST IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,RASPBERRY RAST IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,PEANUT RAST IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,GRAPE RAST IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,SCALLOP IGE,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,WHEAT IGE AB RAST,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,CORN IGE,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,SESAME SEED IGE,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,SOYBEAN IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,WALNUT IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,CLAM IGE AB,300,58.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,6.57,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,6.57,46.8,29.25
Outpatient Medical Services,LAB,86003,COW MILK IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,EGG WHITE IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,FOOD ALLERGY PANEL,300,438,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,105.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,350.4,80% of total billed charges,106.17,24.24% of total billed charges,220.75,50.4% of total billed charges,328.5,75% of total billed charges,107.22,24.48% of total billed charges,6.57,Fee Schedule,105.12,24% of total billed charges,136.66,31.2% of total billed charges,350.4,80% of total billed charges,105.12,24% of total billed charges,105.12,24% of total billed charges,6.57,350.4,219
Outpatient Medical Services,LAB,86003,PINEAPPLE RAST IGE,300,59.5,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.57,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.57,47.6,29.75
Outpatient Medical Services,LAB,86003,ALLERGY EVALUATION REG 3,300,212,6.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,50.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,169.6,80% of total billed charges,51.39,24.24% of total billed charges,106.85,50.4% of total billed charges,159,75% of total billed charges,51.9,24.48% of total billed charges,6.57,Fee Schedule,50.88,24% of total billed charges,66.14,31.2% of total billed charges,169.6,80% of total billed charges,50.88,24% of total billed charges,50.88,24% of total billed charges,6.57,169.6,106
Outpatient Medical Services,LAB,86015,ACTIN (SMOOTH MUSCLE AB) IGG,300,214,9.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,9.22,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,9.22,171.2,107
Outpatient Medical Services,LAB,86021,MPO ANTIBODY,300,166,18.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.93,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.93,132.8,83
Outpatient Medical Services,LAB,86021,PR3 ANTIBODY,300,166,18.93,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.93,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.93,132.8,83
Outpatient Medical Services,LAB,86022,HEPARIN INDUCED THROMBOCYTOPENIA AB,300,330.5,23.09,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,79.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,264.4,80% of total billed charges,80.11,24.24% of total billed charges,166.57,50.4% of total billed charges,247.88,75% of total billed charges,80.91,24.48% of total billed charges,23.09,Fee Schedule,79.32,24% of total billed charges,103.12,31.2% of total billed charges,264.4,80% of total billed charges,79.32,24% of total billed charges,79.32,24% of total billed charges,23.09,264.4,165.25
Outpatient Medical Services,LAB,86036,ANCA SCREEN,300,166,9.64,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,9.64,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,9.64,132.8,83
Outpatient Medical Services,LAB,86038,ANA,300,170,15.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,15.2,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,15.2,136,85
Outpatient Medical Services,LAB,86038,ANA MULTIPLEX w/ REFLEX TO 11 ABYS,300,170,15.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,15.2,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,15.2,136,85
Outpatient Medical Services,LAB,86039,ANA (TITER CHARGE ONLY),300,77.5,14.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62,80% of total billed charges,18.79,24.24% of total billed charges,39.06,50.4% of total billed charges,58.13,75% of total billed charges,18.97,24.48% of total billed charges,14.04,Fee Schedule,18.6,24% of total billed charges,24.18,31.2% of total billed charges,62,80% of total billed charges,18.6,24% of total billed charges,18.6,24% of total billed charges,14.04,62,38.75
Outpatient Medical Services,LAB,86060,ANTI-STREPTOLYSIN O ANTIBODY,300,119.5,8.79,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,8.79,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,8.79,95.6,59.75
Outpatient Medical Services,LAB,86078,TRANSFUSION REACTION WORKUP,300,913.5,45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,219.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,730.8,80% of total billed charges,221.43,24.24% of total billed charges,460.4,50.4% of total billed charges,685.13,75% of total billed charges,223.62,24.48% of total billed charges,45,Fee Schedule,219.24,24% of total billed charges,285.01,31.2% of total billed charges,730.8,80% of total billed charges,219.24,24% of total billed charges,219.24,24% of total billed charges,45,730.8,456.75
Outpatient Medical Services,LAB,86141,CRP (CARDIAC MARKER),300,114.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,16.28,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,16.28,91.6,57.25
Outpatient Medical Services,LAB,86141,HS CRP,300,119.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,16.28,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,16.28,95.6,59.75
Outpatient Medical Services,LAB,86141,CRP (INFLAMMATION),300,114.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,16.28,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,16.28,91.6,57.25
Outpatient Medical Services,LAB,86146,Beta 2 Glycoprotein I Antibody IgA,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86146,Beta 2 Glycoprotein I Antibody IgM,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86146,Beta 2 Glycoprotein I Antibody IgG,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86147,CARDIOLIPIN ANTIBODY IgA,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86147,CARDIOLIPIN Antibody IgG,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86147,CARDIOLIPIN ANTIBODY IgM,300,150.5,31.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,36.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.4,80% of total billed charges,36.48,24.24% of total billed charges,75.85,50.4% of total billed charges,112.88,75% of total billed charges,36.84,24.48% of total billed charges,31.99,Fee Schedule,36.12,24% of total billed charges,46.96,31.2% of total billed charges,120.4,80% of total billed charges,36.12,24% of total billed charges,36.12,24% of total billed charges,31.99,120.4,75.25
Outpatient Medical Services,LAB,86148,Antiphospholipid antibody IgA,300,95,20.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,20.2,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,20.2,76,47.5
Outpatient Medical Services,LAB,86148,Antiphospholipid antibody IgG,300,95,20.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,20.2,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,20.2,76,47.5
Outpatient Medical Services,LAB,86148,Antiphospholipid antibody IgM,300,95,20.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,20.2,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,20.2,76,47.5
Outpatient Medical Services,LAB,86157,COLD AGGLUTININ TITER,300,119.5,10.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,10.14,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,10.14,95.6,59.75
Outpatient Medical Services,LAB,86160,C1 ESTERASE INHIBITOR QUANT,300,226.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,181.2,80% of total billed charges,54.9,24.24% of total billed charges,114.16,50.4% of total billed charges,169.88,75% of total billed charges,55.45,24.48% of total billed charges,15.1,Fee Schedule,54.36,24% of total billed charges,70.67,31.2% of total billed charges,181.2,80% of total billed charges,54.36,24% of total billed charges,54.36,24% of total billed charges,15.1,181.2,113.25
Outpatient Medical Services,LAB,86160,COMPLEMENT C3,300,48.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.8,80% of total billed charges,11.76,24.24% of total billed charges,24.44,50.4% of total billed charges,36.38,75% of total billed charges,11.87,24.48% of total billed charges,15.1,Fee Schedule,11.64,24% of total billed charges,15.13,31.2% of total billed charges,38.8,80% of total billed charges,11.64,24% of total billed charges,11.64,24% of total billed charges,11.64,38.8,24.25
Outpatient Medical Services,LAB,86160,COMPLEMENT C4,300,48.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.8,80% of total billed charges,11.76,24.24% of total billed charges,24.44,50.4% of total billed charges,36.38,75% of total billed charges,11.87,24.48% of total billed charges,15.1,Fee Schedule,11.64,24% of total billed charges,15.13,31.2% of total billed charges,38.8,80% of total billed charges,11.64,24% of total billed charges,11.64,24% of total billed charges,11.64,38.8,24.25
Outpatient Medical Services,LAB,86160,COMPLEMENT C2,300,76,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,60.8,80% of total billed charges,18.42,24.24% of total billed charges,38.3,50.4% of total billed charges,57,75% of total billed charges,18.6,24.48% of total billed charges,15.1,Fee Schedule,18.24,24% of total billed charges,23.71,31.2% of total billed charges,60.8,80% of total billed charges,18.24,24% of total billed charges,18.24,24% of total billed charges,15.1,60.8,38
Outpatient Medical Services,LAB,86160,COMPLEMENT C1Q,300,159.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,127.6,80% of total billed charges,38.66,24.24% of total billed charges,80.39,50.4% of total billed charges,119.63,75% of total billed charges,39.05,24.48% of total billed charges,15.1,Fee Schedule,38.28,24% of total billed charges,49.76,31.2% of total billed charges,127.6,80% of total billed charges,38.28,24% of total billed charges,38.28,24% of total billed charges,15.1,127.6,79.75
Outpatient Medical Services,LAB,86160,C4a Level by RIA,300,159.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,127.6,80% of total billed charges,38.66,24.24% of total billed charges,80.39,50.4% of total billed charges,119.63,75% of total billed charges,39.05,24.48% of total billed charges,15.1,Fee Schedule,38.28,24% of total billed charges,49.76,31.2% of total billed charges,127.6,80% of total billed charges,38.28,24% of total billed charges,38.28,24% of total billed charges,15.1,127.6,79.75
Outpatient Medical Services,LAB,86160,COMPLEMENT C4,300,48.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.8,80% of total billed charges,11.76,24.24% of total billed charges,24.44,50.4% of total billed charges,36.38,75% of total billed charges,11.87,24.48% of total billed charges,15.1,Fee Schedule,11.64,24% of total billed charges,15.13,31.2% of total billed charges,38.8,80% of total billed charges,11.64,24% of total billed charges,11.64,24% of total billed charges,11.64,38.8,24.25
Outpatient Medical Services,LAB,86161,C1 INHIBITOR FUNCTIONAL,300,N/A,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.1,15.1,N/A
Outpatient Medical Services,LAB,86162,CH 50 TOTAL COMPLEMENT,300,188.5,25.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,25.55,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,25.55,150.8,94.25
Outpatient Medical Services,LAB,86200,CCP IGG,300,357.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,16.28,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,16.28,286,178.75
Outpatient Medical Services,LAB,86215,ANTI DNASE B AB,300,213,16.66,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,16.66,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,16.66,170.4,106.5
Outpatient Medical Services,LAB,86225,DS DNA  AB,300,166,17.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,17.28,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,17.28,132.8,83
Outpatient Medical Services,LAB,86235,Chromatin Nucleosomal Antibody,300,297.5,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,22.55,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,22.55,238,148.75
Outpatient Medical Services,LAB,86235,SJOGRENS SSA AB,300,225.5,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,180.4,80% of total billed charges,54.66,24.24% of total billed charges,113.65,50.4% of total billed charges,169.13,75% of total billed charges,55.2,24.48% of total billed charges,22.55,Fee Schedule,54.12,24% of total billed charges,70.36,31.2% of total billed charges,180.4,80% of total billed charges,54.12,24% of total billed charges,54.12,24% of total billed charges,22.55,180.4,112.75
Outpatient Medical Services,LAB,86235,JO 1 ANTIBODY,300,156,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,37.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,124.8,80% of total billed charges,37.81,24.24% of total billed charges,78.62,50.4% of total billed charges,117,75% of total billed charges,38.19,24.48% of total billed charges,22.55,Fee Schedule,37.44,24% of total billed charges,48.67,31.2% of total billed charges,124.8,80% of total billed charges,37.44,24% of total billed charges,37.44,24% of total billed charges,22.55,124.8,78
Outpatient Medical Services,LAB,86235,CENTROMERE ANTIBODY,300,213,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,22.55,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,22.55,170.4,106.5
Outpatient Medical Services,LAB,86235,SCLERODERMA  (SCL-70) AB,300,166,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,22.55,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,22.55,132.8,83
Outpatient Medical Services,LAB,86235,SJOGRENS SSB AB,300,96,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,22.55,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,22.55,76.8,48
Outpatient Medical Services,LAB,86235,SMITH ANTIBODY,300,119.5,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,22.55,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,22.55,95.6,59.75
Outpatient Medical Services,LAB,86235,RNP ANTIBODY,300,119.5,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,22.55,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,22.55,95.6,59.75
Outpatient Medical Services,LAB,86235,OJ AB,300,50,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,22.55,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,86235,SRP AB,300,50,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40,80% of total billed charges,12.12,24.24% of total billed charges,25.2,50.4% of total billed charges,37.5,75% of total billed charges,12.24,24.48% of total billed charges,22.55,Fee Schedule,12,24% of total billed charges,15.6,31.2% of total billed charges,40,80% of total billed charges,12,24% of total billed charges,12,24% of total billed charges,12,40,25
Outpatient Medical Services,LAB,86235,JO1 ANTIBODY,300,166,22.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,22.55,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,22.55,132.8,83
Outpatient Medical Services,LAB,86255,ANCA  ATYPICAL,300,104,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,15.16,Fee Schedule,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,15.16,83.2,52
Outpatient Medical Services,LAB,86255,PARIETAL CELL ANTIBODY W/ REFLEX,300,53.5,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.8,80% of total billed charges,12.97,24.24% of total billed charges,26.96,50.4% of total billed charges,40.13,75% of total billed charges,13.1,24.48% of total billed charges,15.16,Fee Schedule,12.84,24% of total billed charges,16.69,31.2% of total billed charges,42.8,80% of total billed charges,12.84,24% of total billed charges,12.84,24% of total billed charges,12.84,42.8,26.75
Outpatient Medical Services,LAB,86255,ADRENAL ANTIBODY SCREEN,300,236,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,188.8,80% of total billed charges,57.21,24.24% of total billed charges,118.94,50.4% of total billed charges,177,75% of total billed charges,57.77,24.48% of total billed charges,15.16,Fee Schedule,56.64,24% of total billed charges,73.63,31.2% of total billed charges,188.8,80% of total billed charges,56.64,24% of total billed charges,56.64,24% of total billed charges,15.16,188.8,118
Outpatient Medical Services,LAB,86256,EHRLICHIA ABS,300,213,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,15.16,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,15.16,170.4,106.5
Outpatient Medical Services,LAB,86256,ENDOMYSIAL IGA AB,300,199,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,15.16,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,15.16,159.2,99.5
Outpatient Medical Services,LAB,86256,RETICULIN IGG AB,300,213,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,15.16,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,15.16,170.4,106.5
Outpatient Medical Services,LAB,86256,PARIETAL CELL ANTIBODY TITER CHG,300,56.5,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.2,80% of total billed charges,13.7,24.24% of total billed charges,28.48,50.4% of total billed charges,42.38,75% of total billed charges,13.83,24.48% of total billed charges,15.16,Fee Schedule,13.56,24% of total billed charges,17.63,31.2% of total billed charges,45.2,80% of total billed charges,13.56,24% of total billed charges,13.56,24% of total billed charges,13.56,45.2,28.25
Outpatient Medical Services,LAB,86256,SMOOTH MUSCLE ANTIBODY TITER CHG,300,56.5,15.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.2,80% of total billed charges,13.7,24.24% of total billed charges,28.48,50.4% of total billed charges,42.38,75% of total billed charges,13.83,24.48% of total billed charges,15.16,Fee Schedule,13.56,24% of total billed charges,17.63,31.2% of total billed charges,45.2,80% of total billed charges,13.56,24% of total billed charges,13.56,24% of total billed charges,13.56,45.2,28.25
Outpatient Medical Services,LAB,86258,GLIADIN AB IGG,300,255.5,9.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,9.22,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,9.22,204.4,127.75
Outpatient Medical Services,LAB,86258,GLIADIN AB IGA,300,255.5,9.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,9.22,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,9.22,204.4,127.75
Outpatient Medical Services,LAB,86300,CA 15-3,300,188.5,26.16,Fee Schedule,141.38,75% of total billed charges,141.38,75% of total billed charges,45.24,24% of total billed charges,141.38,75% of total billed charges,141.38,75% of total billed charges,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,26.16,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,26.16,150.8,94.25
Outpatient Medical Services,LAB,86300,CA 27-29,300,188.5,26.16,Fee Schedule,141.38,75% of total billed charges,141.38,75% of total billed charges,45.24,24% of total billed charges,141.38,75% of total billed charges,141.38,75% of total billed charges,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,26.16,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,26.16,150.8,94.25
Outpatient Medical Services,LAB,86301,CA 19-9,300,297.5,26.16,Fee Schedule,223.13,75% of total billed charges,223.13,75% of total billed charges,71.4,24% of total billed charges,223.13,75% of total billed charges,223.13,75% of total billed charges,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,26.16,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,26.16,238,148.75
Outpatient Medical Services,LAB,86304,CA 125,300,357.5,26.16,Fee Schedule,268.13,75% of total billed charges,268.13,75% of total billed charges,85.8,24% of total billed charges,268.13,75% of total billed charges,268.13,75% of total billed charges,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,26.16,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,26.16,286,178.75
Outpatient Medical Services,LAB,86308,MONOSPOT,300,130,6.51,Fee Schedule,97.5,75% of total billed charges,97.5,75% of total billed charges,31.2,24% of total billed charges,97.5,75% of total billed charges,97.5,75% of total billed charges,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,6.51,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,6.51,104,65
Outpatient Medical Services,LAB,86308,HETEROPHIL ANTIBODY SCREEN,300,66,6.51,Fee Schedule,49.5,75% of total billed charges,49.5,75% of total billed charges,15.84,24% of total billed charges,49.5,75% of total billed charges,49.5,75% of total billed charges,52.8,80% of total billed charges,16,24.24% of total billed charges,33.26,50.4% of total billed charges,49.5,75% of total billed charges,16.16,24.48% of total billed charges,6.51,Fee Schedule,15.84,24% of total billed charges,20.59,31.2% of total billed charges,52.8,80% of total billed charges,15.84,24% of total billed charges,15.84,24% of total billed charges,6.51,52.8,33
Outpatient Medical Services,LAB,86316,CHROMOGRANIN A,300,119.5,26.16,Fee Schedule,89.63,75% of total billed charges,89.63,75% of total billed charges,28.68,24% of total billed charges,89.63,75% of total billed charges,89.63,75% of total billed charges,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,26.16,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,26.16,95.6,59.75
Outpatient Medical Services,LAB,86317,TETANUS ANTIBODY IGG,300,43.5,15.09,Fee Schedule,32.63,75% of total billed charges,32.63,75% of total billed charges,10.44,24% of total billed charges,32.63,75% of total billed charges,32.63,75% of total billed charges,34.8,80% of total billed charges,10.54,24.24% of total billed charges,21.92,50.4% of total billed charges,32.63,75% of total billed charges,10.65,24.48% of total billed charges,15.09,Fee Schedule,10.44,24% of total billed charges,13.57,31.2% of total billed charges,34.8,80% of total billed charges,10.44,24% of total billed charges,10.44,24% of total billed charges,10.44,34.8,21.75
Outpatient Medical Services,LAB,86317,STREP PNEUMONIAE IGG - 14 SEROTYPES,300,489.5,15.09,Fee Schedule,367.13,75% of total billed charges,367.13,75% of total billed charges,117.48,24% of total billed charges,367.13,75% of total billed charges,367.13,75% of total billed charges,391.6,80% of total billed charges,118.65,24.24% of total billed charges,246.71,50.4% of total billed charges,367.13,75% of total billed charges,119.83,24.48% of total billed charges,15.09,Fee Schedule,117.48,24% of total billed charges,152.72,31.2% of total billed charges,391.6,80% of total billed charges,117.48,24% of total billed charges,117.48,24% of total billed charges,15.09,391.6,244.75
Outpatient Medical Services,LAB,86334,"PROTEIN IMMUNOFIXATION, SERUM",300,134,28.09,Fee Schedule,100.5,75% of total billed charges,100.5,75% of total billed charges,32.16,24% of total billed charges,100.5,75% of total billed charges,100.5,75% of total billed charges,107.2,80% of total billed charges,32.48,24.24% of total billed charges,67.54,50.4% of total billed charges,100.5,75% of total billed charges,32.8,24.48% of total billed charges,28.09,Fee Schedule,32.16,24% of total billed charges,41.81,31.2% of total billed charges,107.2,80% of total billed charges,32.16,24% of total billed charges,32.16,24% of total billed charges,28.09,107.2,67
Outpatient Medical Services,LAB,86337,INSULIN AUTOANTIBODY,300,225.5,26.93,Fee Schedule,169.13,75% of total billed charges,169.13,75% of total billed charges,54.12,24% of total billed charges,169.13,75% of total billed charges,169.13,75% of total billed charges,180.4,80% of total billed charges,54.66,24.24% of total billed charges,113.65,50.4% of total billed charges,169.13,75% of total billed charges,55.2,24.48% of total billed charges,26.93,Fee Schedule,54.12,24% of total billed charges,70.36,31.2% of total billed charges,180.4,80% of total billed charges,54.12,24% of total billed charges,54.12,24% of total billed charges,26.93,180.4,112.75
Outpatient Medical Services,LAB,86340,INTRINSIC FACTOR BLOCK AB,300,166,18.95,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.95,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.95,132.8,83
Outpatient Medical Services,LAB,86341,GLUTAMIC ACID ABY,300,166,24.89,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,24.89,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,24.89,132.8,83
Outpatient Medical Services,LAB,86341,ISLET CELL AB IGG,300,166,24.89,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,24.89,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,24.89,132.8,83
Outpatient Medical Services,LAB,86355,"CD-19 B CELL, TOTAL",300,207,29.62,Fee Schedule,155.25,75% of total billed charges,155.25,75% of total billed charges,49.68,24% of total billed charges,155.25,75% of total billed charges,155.25,75% of total billed charges,165.6,80% of total billed charges,50.18,24.24% of total billed charges,104.33,50.4% of total billed charges,155.25,75% of total billed charges,50.67,24.48% of total billed charges,29.62,Fee Schedule,49.68,24% of total billed charges,64.58,31.2% of total billed charges,165.6,80% of total billed charges,49.68,24% of total billed charges,49.68,24% of total billed charges,29.62,165.6,103.5
Outpatient Medical Services,LAB,86357,"NATURAL KILLER CELL COUNT, TOTAL",300,207,29.62,Fee Schedule,155.25,75% of total billed charges,155.25,75% of total billed charges,49.68,24% of total billed charges,155.25,75% of total billed charges,155.25,75% of total billed charges,165.6,80% of total billed charges,50.18,24.24% of total billed charges,104.33,50.4% of total billed charges,155.25,75% of total billed charges,50.67,24.48% of total billed charges,29.62,Fee Schedule,49.68,24% of total billed charges,64.58,31.2% of total billed charges,165.6,80% of total billed charges,49.68,24% of total billed charges,49.68,24% of total billed charges,29.62,165.6,103.5
Outpatient Medical Services,LAB,86359,T CELL TOTAL COUNT,300,207,29.62,Fee Schedule,155.25,75% of total billed charges,155.25,75% of total billed charges,49.68,24% of total billed charges,155.25,75% of total billed charges,155.25,75% of total billed charges,165.6,80% of total billed charges,50.18,24.24% of total billed charges,104.33,50.4% of total billed charges,155.25,75% of total billed charges,50.67,24.48% of total billed charges,29.62,Fee Schedule,49.68,24% of total billed charges,64.58,31.2% of total billed charges,165.6,80% of total billed charges,49.68,24% of total billed charges,49.68,24% of total billed charges,29.62,165.6,103.5
Outpatient Medical Services,LAB,86360,CD4 CD8,300,783,59.09,Fee Schedule,587.25,75% of total billed charges,587.25,75% of total billed charges,187.92,24% of total billed charges,587.25,75% of total billed charges,587.25,75% of total billed charges,626.4,80% of total billed charges,189.8,24.24% of total billed charges,394.63,50.4% of total billed charges,587.25,75% of total billed charges,191.68,24.48% of total billed charges,59.09,Fee Schedule,187.92,24% of total billed charges,244.3,31.2% of total billed charges,626.4,80% of total billed charges,187.92,24% of total billed charges,187.92,24% of total billed charges,59.09,626.4,391.5
Outpatient Medical Services,LAB,86360,T CELL ABSOLUTE CT,300,313,59.09,Fee Schedule,234.75,75% of total billed charges,234.75,75% of total billed charges,75.12,24% of total billed charges,234.75,75% of total billed charges,234.75,75% of total billed charges,250.4,80% of total billed charges,75.87,24.24% of total billed charges,157.75,50.4% of total billed charges,234.75,75% of total billed charges,76.62,24.48% of total billed charges,59.09,Fee Schedule,75.12,24% of total billed charges,97.66,31.2% of total billed charges,250.4,80% of total billed charges,75.12,24% of total billed charges,75.12,24% of total billed charges,59.09,250.4,156.5
Outpatient Medical Services,LAB,86361,LYMPHOCYTE SUBSET PANEL 5,300,126.5,32.82,Fee Schedule,94.88,75% of total billed charges,94.88,75% of total billed charges,30.36,24% of total billed charges,94.88,75% of total billed charges,94.88,75% of total billed charges,101.2,80% of total billed charges,30.66,24.24% of total billed charges,63.76,50.4% of total billed charges,94.88,75% of total billed charges,30.97,24.48% of total billed charges,32.82,Fee Schedule,30.36,24% of total billed charges,39.47,31.2% of total billed charges,101.2,80% of total billed charges,30.36,24% of total billed charges,30.36,24% of total billed charges,30.36,101.2,63.25
Outpatient Medical Services,LAB,86376,LIVER/KIDNEY MICROSOMAL AB,300,284.5,18.3,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,18.3,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,18.3,227.6,142.25
Outpatient Medical Services,LAB,86376,THYROID PEROXIDASE AB,300,96,18.3,Fee Schedule,72,75% of total billed charges,72,75% of total billed charges,23.04,24% of total billed charges,72,75% of total billed charges,72,75% of total billed charges,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,18.3,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,18.3,76.8,48
Outpatient Medical Services,LAB,86403,CRYPTOCOCCAL ANTIGEN WREFLEX TITER,300,166,10,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,10,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,10,132.8,83
Outpatient Medical Services,LAB,86431,RHEUMATIOD FACTOR,300,130,7.14,Fee Schedule,97.5,75% of total billed charges,97.5,75% of total billed charges,31.2,24% of total billed charges,97.5,75% of total billed charges,97.5,75% of total billed charges,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,7.14,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,7.14,104,65
Outpatient Medical Services,LAB,86480,QUANTIFERON TB GOLD,300,284.5,77.93,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,77.93,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,68.28,227.6,142.25
Outpatient Medical Services,LAB,86592,RPR w/ REFLEX TO TITER & CONFIRM.,300,101,4.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.65,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.65,80.8,50.5
Outpatient Medical Services,LAB,86592,RPR (SCP),300,13.5,4.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.8,80% of total billed charges,3.27,24.24% of total billed charges,6.8,50.4% of total billed charges,10.13,75% of total billed charges,3.3,24.48% of total billed charges,4.65,Fee Schedule,3.24,24% of total billed charges,4.21,31.2% of total billed charges,10.8,80% of total billed charges,3.24,24% of total billed charges,3.24,24% of total billed charges,3.24,10.8,6.75
Outpatient Medical Services,LAB,86593,RPR TITER CHARGE,300,32,8.6,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,7.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.6,80% of total billed charges,7.76,24.24% of total billed charges,16.13,50.4% of total billed charges,24,75% of total billed charges,7.83,24.48% of total billed charges,8.6,26.86% of total billed charges,7.68,24% of total billed charges,9.98,31.2% of total billed charges,25.6,80% of total billed charges,7.68,24% of total billed charges,7.68,24% of total billed charges,7.68,25.6,16
Outpatient Medical Services,LAB,86609,SACCHAROPOLYSPORA RECTIVIRGULA,300,110,16.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,16.2,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,16.2,88,55
Outpatient Medical Services,LAB,86609,SACCHAROMONOSPORA VIRIDIS,300,110,16.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,16.2,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,16.2,88,55
Outpatient Medical Services,LAB,86609,THERMOACTINOMYCES CANDIDUS,300,110,16.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,16.2,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,16.2,88,55
Outpatient Medical Services,LAB,86609,THERMOACTINOMYCES SACCHARI,300,110,16.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,16.2,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,16.2,88,55
Outpatient Medical Services,LAB,86609,THERMOACTINOMYCES VULGARIS,300,110,16.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,16.2,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,16.2,88,55
Outpatient Medical Services,LAB,86611,BARTONELLA  HENSELAE IGG,300,284.5,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,12.8,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,12.8,227.6,142.25
Outpatient Medical Services,LAB,86611,BARTONELLA HENSELAE IGM,300,284.5,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,12.8,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,12.8,227.6,142.25
Outpatient Medical Services,LAB,86611,BARTONELLA  QUINTANA  IGG,300,284.5,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,12.8,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,12.8,227.6,142.25
Outpatient Medical Services,LAB,86611,BARTONELLA QUINTANA IGM,300,284.5,12.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,12.8,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,12.8,227.6,142.25
Outpatient Medical Services,LAB,86615,B PERTUSSIS IGG AB,300,139,16.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.2,80% of total billed charges,33.69,24.24% of total billed charges,70.06,50.4% of total billed charges,104.25,75% of total billed charges,34.03,24.48% of total billed charges,16.59,Fee Schedule,33.36,24% of total billed charges,43.37,31.2% of total billed charges,111.2,80% of total billed charges,33.36,24% of total billed charges,33.36,24% of total billed charges,16.59,111.2,69.5
Outpatient Medical Services,LAB,86615,B PERTUSSIS IGM AB,300,139,16.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.2,80% of total billed charges,33.69,24.24% of total billed charges,70.06,50.4% of total billed charges,104.25,75% of total billed charges,34.03,24.48% of total billed charges,16.59,Fee Schedule,33.36,24% of total billed charges,43.37,31.2% of total billed charges,111.2,80% of total billed charges,33.36,24% of total billed charges,33.36,24% of total billed charges,16.59,111.2,69.5
Outpatient Medical Services,LAB,86617,LYME CONF WB,300,166,19.48,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,19.48,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,19.48,132.8,83
Outpatient Medical Services,LAB,86618,LYME TITER,300,284.5,21.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,21.42,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,21.42,227.6,142.25
Outpatient Medical Services,LAB,86618,"LYME DISEASE AB (IGG, IGM) IMMUNOBLOT",300,274,21.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,21.42,Fee Schedule,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,21.42,219.2,137
Outpatient Medical Services,LAB,86618,"LYME DISEASE AB W/REFLEX BLOT(IGG,IGM)",300,274,21.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,21.42,Fee Schedule,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,21.42,219.2,137
Outpatient Medical Services,LAB,86628,"CANDIDA  ALBICANS IgG, IgA, IgM",300,535.5,15.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,128.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,428.4,80% of total billed charges,129.81,24.24% of total billed charges,269.89,50.4% of total billed charges,401.63,75% of total billed charges,131.09,24.48% of total billed charges,15.1,Fee Schedule,128.52,24% of total billed charges,167.08,31.2% of total billed charges,428.4,80% of total billed charges,128.52,24% of total billed charges,128.52,24% of total billed charges,15.1,428.4,267.75
Outpatient Medical Services,LAB,86631,CHLAMYDIA  ANTIBODY PANEL,300,166,14.87,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.87,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.87,132.8,83
Outpatient Medical Services,LAB,86644,CMV IGG AB,300,155.5,14.63,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,37.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,124.4,80% of total billed charges,37.69,24.24% of total billed charges,78.37,50.4% of total billed charges,116.63,75% of total billed charges,38.07,24.48% of total billed charges,14.63,Fee Schedule,37.32,24% of total billed charges,48.52,31.2% of total billed charges,124.4,80% of total billed charges,37.32,24% of total billed charges,37.32,24% of total billed charges,14.63,124.4,77.75
Outpatient Medical Services,LAB,86645,CMV IGM AB,300,143,21.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,21.19,Fee Schedule,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,21.19,114.4,71.5
Outpatient Medical Services,LAB,86654,WESTERN EQUINE ENCEPHALITIS VIRUS PANEL,300,772.5,16.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,185.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,618,80% of total billed charges,187.25,24.24% of total billed charges,389.34,50.4% of total billed charges,579.38,75% of total billed charges,189.11,24.48% of total billed charges,16.59,Fee Schedule,185.4,24% of total billed charges,241.02,31.2% of total billed charges,618,80% of total billed charges,185.4,24% of total billed charges,185.4,24% of total billed charges,16.59,618,386.25
Outpatient Medical Services,LAB,86663,EBV EARLY ANTIGEN IGG,300,219.5,16.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,52.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,175.6,80% of total billed charges,53.21,24.24% of total billed charges,110.63,50.4% of total billed charges,164.63,75% of total billed charges,53.73,24.48% of total billed charges,16.5,Fee Schedule,52.68,24% of total billed charges,68.48,31.2% of total billed charges,175.6,80% of total billed charges,52.68,24% of total billed charges,52.68,24% of total billed charges,16.5,175.6,109.75
Outpatient Medical Services,LAB,86664,EBV NUCLEAR AG IGG,300,356.5,19.24,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,19.24,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,19.24,285.2,178.25
Outpatient Medical Services,LAB,86665,EBV CAPSID IGG AB,300,219.5,22.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,52.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,175.6,80% of total billed charges,53.21,24.24% of total billed charges,110.63,50.4% of total billed charges,164.63,75% of total billed charges,53.73,24.48% of total billed charges,22.82,Fee Schedule,52.68,24% of total billed charges,68.48,31.2% of total billed charges,175.6,80% of total billed charges,52.68,24% of total billed charges,52.68,24% of total billed charges,22.82,175.6,109.75
Outpatient Medical Services,LAB,86665,EBV CAPSID IGM AB,300,219.5,22.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,52.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,175.6,80% of total billed charges,53.21,24.24% of total billed charges,110.63,50.4% of total billed charges,164.63,75% of total billed charges,53.73,24.48% of total billed charges,22.82,Fee Schedule,52.68,24% of total billed charges,68.48,31.2% of total billed charges,175.6,80% of total billed charges,52.68,24% of total billed charges,52.68,24% of total billed charges,22.82,175.6,109.75
Outpatient Medical Services,LAB,86671,SACCHAROMYCES IGA,300,104,15.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,15.42,Fee Schedule,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,15.42,83.2,52
Outpatient Medical Services,LAB,86671,SACCHAROMYCES IGG,300,504,15.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,403.2,80% of total billed charges,122.17,24.24% of total billed charges,254.02,50.4% of total billed charges,378,75% of total billed charges,123.38,24.48% of total billed charges,15.42,Fee Schedule,120.96,24% of total billed charges,157.25,31.2% of total billed charges,403.2,80% of total billed charges,120.96,24% of total billed charges,120.96,24% of total billed charges,15.42,403.2,252
Outpatient Medical Services,LAB,86677,H PYLORI AB,300,284.5,18.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,18.25,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,18.25,227.6,142.25
Outpatient Medical Services,LAB,86682,ECHINOCOCCUS IGG AB,300,188.5,16.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,16.35,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,16.35,150.8,94.25
Outpatient Medical Services,LAB,86687,HTLV I IGG AB,300,96,25.79,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,25.79,26.86% of total billed charges,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,23.04,76.8,48
Outpatient Medical Services,LAB,86695,HSV 1 IGG,300,284.5,16.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,16.59,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,16.59,227.6,142.25
Outpatient Medical Services,LAB,86695,HSV 1 IGM AB,300,256.5,16.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,205.2,80% of total billed charges,62.18,24.24% of total billed charges,129.28,50.4% of total billed charges,192.38,75% of total billed charges,62.79,24.48% of total billed charges,16.59,Fee Schedule,61.56,24% of total billed charges,80.03,31.2% of total billed charges,205.2,80% of total billed charges,61.56,24% of total billed charges,61.56,24% of total billed charges,16.59,205.2,128.25
Outpatient Medical Services,LAB,86696,HSV 2 IGM AB,300,256.5,24.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,205.2,80% of total billed charges,62.18,24.24% of total billed charges,129.28,50.4% of total billed charges,192.38,75% of total billed charges,62.79,24.48% of total billed charges,24.35,Fee Schedule,61.56,24% of total billed charges,80.03,31.2% of total billed charges,205.2,80% of total billed charges,61.56,24% of total billed charges,61.56,24% of total billed charges,24.35,205.2,128.25
Outpatient Medical Services,LAB,86696,HSV 2 IGG AB,300,256.5,24.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,205.2,80% of total billed charges,62.18,24.24% of total billed charges,129.28,50.4% of total billed charges,192.38,75% of total billed charges,62.79,24.48% of total billed charges,24.35,Fee Schedule,61.56,24% of total billed charges,80.03,31.2% of total billed charges,205.2,80% of total billed charges,61.56,24% of total billed charges,61.56,24% of total billed charges,24.35,205.2,128.25
Outpatient Medical Services,LAB,86698,HISTOPLASMA AB,300,119.5,15.71,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,15.71,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,15.71,95.6,59.75
Outpatient Medical Services,LAB,86701,HIV 1 ANTIBODY,300,161.5,9.7,Fee Schedule,121.13,75% of total billed charges,121.13,75% of total billed charges,38.76,24% of total billed charges,121.13,75% of total billed charges,121.13,75% of total billed charges,129.2,80% of total billed charges,39.15,24.24% of total billed charges,81.4,50.4% of total billed charges,121.13,75% of total billed charges,39.54,24.48% of total billed charges,9.7,Fee Schedule,38.76,24% of total billed charges,50.39,31.2% of total billed charges,129.2,80% of total billed charges,38.76,24% of total billed charges,38.76,24% of total billed charges,9.7,129.2,80.75
Outpatient Medical Services,LAB,86702,HIV 2,300,161.5,14.75,Fee Schedule,121.13,75% of total billed charges,121.13,75% of total billed charges,38.76,24% of total billed charges,121.13,75% of total billed charges,121.13,75% of total billed charges,129.2,80% of total billed charges,39.15,24.24% of total billed charges,81.4,50.4% of total billed charges,121.13,75% of total billed charges,39.54,24.48% of total billed charges,14.75,Fee Schedule,38.76,24% of total billed charges,50.39,31.2% of total billed charges,129.2,80% of total billed charges,38.76,24% of total billed charges,38.76,24% of total billed charges,14.75,129.2,80.75
Outpatient Medical Services,LAB,86703,HIV 1/2 SCREEN,300,199,14.96,Fee Schedule,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,14.96,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,14.96,159.2,99.5
Outpatient Medical Services,LAB,86704,HEP B CORE AB,300,357.5,15.16,Fee Schedule,268.13,75% of total billed charges,268.13,75% of total billed charges,85.8,24% of total billed charges,268.13,75% of total billed charges,268.13,75% of total billed charges,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,15.16,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,15.16,286,178.75
Outpatient Medical Services,LAB,86705,HEP B CORE IGM AB,300,297.5,14.8,Fee Schedule,223.13,75% of total billed charges,223.13,75% of total billed charges,71.4,24% of total billed charges,223.13,75% of total billed charges,223.13,75% of total billed charges,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,14.8,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,14.8,238,148.75
Outpatient Medical Services,LAB,86706,HEP B SURFACE AB QUALITATIVE,300,356.5,13.51,Fee Schedule,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,13.51,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,13.51,285.2,178.25
Outpatient Medical Services,LAB,86707,HEPATITIS BE ANTIBODY,300,146.5,14.54,Fee Schedule,109.88,75% of total billed charges,109.88,75% of total billed charges,35.16,24% of total billed charges,109.88,75% of total billed charges,109.88,75% of total billed charges,117.2,80% of total billed charges,35.51,24.24% of total billed charges,73.84,50.4% of total billed charges,109.88,75% of total billed charges,35.86,24.48% of total billed charges,14.54,Fee Schedule,35.16,24% of total billed charges,45.71,31.2% of total billed charges,117.2,80% of total billed charges,35.16,24% of total billed charges,35.16,24% of total billed charges,14.54,117.2,73.25
Outpatient Medical Services,LAB,86708,HEP A TOTAL AB,300,59.5,15.58,Fee Schedule,44.63,75% of total billed charges,44.63,75% of total billed charges,14.28,24% of total billed charges,44.63,75% of total billed charges,44.63,75% of total billed charges,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,15.58,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,14.28,47.6,29.75
Outpatient Medical Services,LAB,86708,HEPATITIS A  ABY W/ REFLEX TO IGM,300,59.5,15.58,Fee Schedule,44.63,75% of total billed charges,44.63,75% of total billed charges,14.28,24% of total billed charges,44.63,75% of total billed charges,44.63,75% of total billed charges,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,15.58,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,14.28,47.6,29.75
Outpatient Medical Services,LAB,86709,HEPATITIS A IGM ANTIBODY,300,166,14.16,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.16,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.16,132.8,83
Outpatient Medical Services,LAB,86713,LEGIONELLA PNEUMO AB IGG,300,380,19.25,Fee Schedule,285,75% of total billed charges,285,75% of total billed charges,91.2,24% of total billed charges,285,75% of total billed charges,285,75% of total billed charges,304,80% of total billed charges,92.11,24.24% of total billed charges,191.52,50.4% of total billed charges,285,75% of total billed charges,93.02,24.48% of total billed charges,19.25,Fee Schedule,91.2,24% of total billed charges,118.56,31.2% of total billed charges,304,80% of total billed charges,91.2,24% of total billed charges,91.2,24% of total billed charges,19.25,304,190
Outpatient Medical Services,LAB,86717,LEISHMANIA AB,300,284.5,15.41,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,15.41,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,15.41,227.6,142.25
Outpatient Medical Services,LAB,86720,LEPTOSPIRA TITER,300,108,16.59,Fee Schedule,81,75% of total billed charges,81,75% of total billed charges,25.92,24% of total billed charges,81,75% of total billed charges,81,75% of total billed charges,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,16.59,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,16.59,86.4,54
Outpatient Medical Services,LAB,86735,MUMPS VIRUS IGG,300,91.5,16.41,Fee Schedule,68.63,75% of total billed charges,68.63,75% of total billed charges,21.96,24% of total billed charges,68.63,75% of total billed charges,68.63,75% of total billed charges,73.2,80% of total billed charges,22.18,24.24% of total billed charges,46.12,50.4% of total billed charges,68.63,75% of total billed charges,22.4,24.48% of total billed charges,16.41,Fee Schedule,21.96,24% of total billed charges,28.55,31.2% of total billed charges,73.2,80% of total billed charges,21.96,24% of total billed charges,21.96,24% of total billed charges,16.41,73.2,45.75
Outpatient Medical Services,LAB,86735,MUMPS VIRUS IGM,300,91.5,16.41,Fee Schedule,68.63,75% of total billed charges,68.63,75% of total billed charges,21.96,24% of total billed charges,68.63,75% of total billed charges,68.63,75% of total billed charges,73.2,80% of total billed charges,22.18,24.24% of total billed charges,46.12,50.4% of total billed charges,68.63,75% of total billed charges,22.4,24.48% of total billed charges,16.41,Fee Schedule,21.96,24% of total billed charges,28.55,31.2% of total billed charges,73.2,80% of total billed charges,21.96,24% of total billed charges,21.96,24% of total billed charges,16.41,73.2,45.75
Outpatient Medical Services,LAB,86738,MYCOPLASMA PNEUMONIA IGM,300,178,16.66,Fee Schedule,133.5,75% of total billed charges,133.5,75% of total billed charges,42.72,24% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,16.66,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,16.66,142.4,89
Outpatient Medical Services,LAB,86738,MYCOPLASMA PNEUMONIA IGG,300,178,16.66,Fee Schedule,133.5,75% of total billed charges,133.5,75% of total billed charges,42.72,24% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,16.66,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,16.66,142.4,89
Outpatient Medical Services,LAB,86747,PARVOVIRUS B19 AB,300,439,18.9,Fee Schedule,329.25,75% of total billed charges,329.25,75% of total billed charges,105.36,24% of total billed charges,329.25,75% of total billed charges,329.25,75% of total billed charges,351.2,80% of total billed charges,106.41,24.24% of total billed charges,221.26,50.4% of total billed charges,329.25,75% of total billed charges,107.47,24.48% of total billed charges,18.9,Fee Schedule,105.36,24% of total billed charges,136.97,31.2% of total billed charges,351.2,80% of total billed charges,105.36,24% of total billed charges,105.36,24% of total billed charges,18.9,351.2,219.5
Outpatient Medical Services,LAB,86753,TRYPANOSOMA CRUZI ABY,300,483,15.59,Fee Schedule,362.25,75% of total billed charges,362.25,75% of total billed charges,115.92,24% of total billed charges,362.25,75% of total billed charges,362.25,75% of total billed charges,386.4,80% of total billed charges,117.08,24.24% of total billed charges,243.43,50.4% of total billed charges,362.25,75% of total billed charges,118.24,24.48% of total billed charges,15.59,Fee Schedule,115.92,24% of total billed charges,150.7,31.2% of total billed charges,386.4,80% of total billed charges,115.92,24% of total billed charges,115.92,24% of total billed charges,15.59,386.4,241.5
Outpatient Medical Services,LAB,86757,ROCK MT RICKETTSIA IGG,300,213,24.35,Fee Schedule,159.75,75% of total billed charges,159.75,75% of total billed charges,51.12,24% of total billed charges,159.75,75% of total billed charges,159.75,75% of total billed charges,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,24.35,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,24.35,170.4,106.5
Outpatient Medical Services,LAB,86757,ROCK MT RICKETTSIA IGM,300,213,24.35,Fee Schedule,159.75,75% of total billed charges,159.75,75% of total billed charges,51.12,24% of total billed charges,159.75,75% of total billed charges,159.75,75% of total billed charges,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,24.35,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,24.35,170.4,106.5
Outpatient Medical Services,LAB,86757,RICKETTSIA (RMSF) TITER,300,91.5,24.35,Fee Schedule,68.63,75% of total billed charges,68.63,75% of total billed charges,21.96,24% of total billed charges,68.63,75% of total billed charges,68.63,75% of total billed charges,73.2,80% of total billed charges,22.18,24.24% of total billed charges,46.12,50.4% of total billed charges,68.63,75% of total billed charges,22.4,24.48% of total billed charges,24.35,Fee Schedule,21.96,24% of total billed charges,28.55,31.2% of total billed charges,73.2,80% of total billed charges,21.96,24% of total billed charges,21.96,24% of total billed charges,21.96,73.2,45.75
Outpatient Medical Services,LAB,86762,RUBELLA IGG,300,108,14.63,Fee Schedule,81,75% of total billed charges,81,75% of total billed charges,25.92,24% of total billed charges,81,75% of total billed charges,81,75% of total billed charges,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,14.63,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,14.63,86.4,54
Outpatient Medical Services,LAB,86765,RUBEOLA (MEASLES) IgG ANTIBODY,300,119.5,16.2,Fee Schedule,89.63,75% of total billed charges,89.63,75% of total billed charges,28.68,24% of total billed charges,89.63,75% of total billed charges,89.63,75% of total billed charges,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,16.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,16.2,95.6,59.75
Outpatient Medical Services,LAB,86769,COVID 19 Antibody IgM & IgG,300,227.5,51.31,Fee Schedule,170.63,75% of total billed charges,170.63,75% of total billed charges,54.6,24% of total billed charges,170.63,75% of total billed charges,170.63,75% of total billed charges,182,80% of total billed charges,55.15,24.24% of total billed charges,114.66,50.4% of total billed charges,170.63,75% of total billed charges,55.69,24.48% of total billed charges,51.31,Fee Schedule,54.6,24% of total billed charges,70.98,31.2% of total billed charges,182,80% of total billed charges,54.6,24% of total billed charges,54.6,24% of total billed charges,51.31,182,113.75
Outpatient Medical Services,LAB,86777,TOXOPLASMA IGG AB,300,166,14.63,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.63,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.63,132.8,83
Outpatient Medical Services,LAB,86777,TOXOPLASMA IGG & IGM W/REFLEX,300,166,14.63,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.63,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.63,132.8,83
Outpatient Medical Services,LAB,86780,FTA  TREPONEMAL AB,300,127.5,34.25,26.86% of total billed charges,95.63,75% of total billed charges,95.63,75% of total billed charges,30.6,24% of total billed charges,95.63,75% of total billed charges,95.63,75% of total billed charges,102,80% of total billed charges,30.91,24.24% of total billed charges,64.26,50.4% of total billed charges,95.63,75% of total billed charges,31.21,24.48% of total billed charges,34.25,26.86% of total billed charges,30.6,24% of total billed charges,39.78,31.2% of total billed charges,102,80% of total billed charges,30.6,24% of total billed charges,30.6,24% of total billed charges,30.6,102,63.75
Outpatient Medical Services,LAB,86787,VARICELLA ZOSTER IGG,300,166,16.2,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.2,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.2,132.8,83
Outpatient Medical Services,LAB,86787,VARICELLA ZOSTER IGM,300,166,16.2,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.2,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.2,132.8,83
Outpatient Medical Services,LAB,86789,WEST NILE VIRUS,300,772.5,14.63,Fee Schedule,579.38,75% of total billed charges,579.38,75% of total billed charges,185.4,24% of total billed charges,579.38,75% of total billed charges,579.38,75% of total billed charges,618,80% of total billed charges,187.25,24.24% of total billed charges,389.34,50.4% of total billed charges,579.38,75% of total billed charges,189.11,24.48% of total billed charges,14.63,Fee Schedule,185.4,24% of total billed charges,241.02,31.2% of total billed charges,618,80% of total billed charges,185.4,24% of total billed charges,185.4,24% of total billed charges,14.63,618,386.25
Outpatient Medical Services,LAB,86790,RABIES AB TITER,300,356.5,16.2,Fee Schedule,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,16.2,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,16.2,285.2,178.25
Outpatient Medical Services,LAB,86790,HERPESVIRUS 6 ANTIBODIES (IGG & IGM),300,256.5,16.2,Fee Schedule,192.38,75% of total billed charges,192.38,75% of total billed charges,61.56,24% of total billed charges,192.38,75% of total billed charges,192.38,75% of total billed charges,205.2,80% of total billed charges,62.18,24.24% of total billed charges,129.28,50.4% of total billed charges,192.38,75% of total billed charges,62.79,24.48% of total billed charges,16.2,Fee Schedule,61.56,24% of total billed charges,80.03,31.2% of total billed charges,205.2,80% of total billed charges,61.56,24% of total billed charges,61.56,24% of total billed charges,16.2,205.2,128.25
Outpatient Medical Services,LAB,86800,THYROGLOBULIN AB,300,178,20,Fee Schedule,133.5,75% of total billed charges,133.5,75% of total billed charges,42.72,24% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,20,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,20,142.4,89
Outpatient Medical Services,LAB,86803,HCV ANTIBODY,300,255.5,10,Fee Schedule,191.63,75% of total billed charges,191.63,75% of total billed charges,61.32,24% of total billed charges,191.63,75% of total billed charges,191.63,75% of total billed charges,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,10,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,10,204.4,127.75
Outpatient Medical Services,LAB,86804,HEP C RIBAVIRIN,300,166,19.48,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,19.48,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,19.48,132.8,83
Outpatient Medical Services,LAB,86812,HLA B27,300,297.5,32.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,32.45,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,32.45,238,148.75
Outpatient Medical Services,LAB,86850,BB ANTIBODY SCREEN CCH,300,357.5,15.23,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,15.23,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,15.23,286,178.75
Outpatient Medical Services,LAB,86850,BB ANTIBODY SCREEN SHEPEARD,300,357.5,15.23,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,15.23,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,15.23,286,178.75
Outpatient Medical Services,LAB,86860,BB RBC ELUTION SHEP,300,213,6.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,6.12,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,6.12,170.4,106.5
Outpatient Medical Services,LAB,86870,BB ANTIBODY ID SHEPEARD,300,424.5,6.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,101.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,6.12,Fee Schedule,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,6.12,339.6,212.25
Outpatient Medical Services,LAB,86870,BB ANTIBODY ID CCH,300,213,6.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,6.12,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,6.12,170.4,106.5
Outpatient Medical Services,LAB,86880,BB DAT SHEPEARD,300,159.5,6.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,127.6,80% of total billed charges,38.66,24.24% of total billed charges,80.39,50.4% of total billed charges,119.63,75% of total billed charges,39.05,24.48% of total billed charges,6.75,Fee Schedule,38.28,24% of total billed charges,49.76,31.2% of total billed charges,127.6,80% of total billed charges,38.28,24% of total billed charges,38.28,24% of total billed charges,6.75,127.6,79.75
Outpatient Medical Services,LAB,86880,BB DIRECT COOMBS IGG CCH,300,83.5,6.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,6.75,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,6.75,66.8,41.75
Outpatient Medical Services,LAB,86885,BB SELECTED CELL SHEPEARD,300,143,7.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,7.19,Fee Schedule,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,7.19,114.4,71.5
Outpatient Medical Services,LAB,86900,BB ABO BLOOD TYPE,300,101,3.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,3.75,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,3.75,80.8,50.5
Outpatient Medical Services,LAB,86900,THERAPEUTIC PHLEBOTOMY,300,122.5,3.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,29.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,3.75,Fee Schedule,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,3.75,98,61.25
Outpatient Medical Services,LAB,86900,BB ABO BLOOD TYPE SHEPEARD,300,101,3.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,3.75,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,3.75,80.8,50.5
Outpatient Medical Services,LAB,86901,BB RH BLOOD TYPE,300,101,14.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,14.51,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,14.51,80.8,50.5
Outpatient Medical Services,LAB,86901,BB RH SHEPEARD,300,101,14.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,14.51,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,14.51,80.8,50.5
Outpatient Medical Services,LAB,86901,BB RH BLOOD TYPE SHEPEARD,300,101,14.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,14.51,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,14.51,80.8,50.5
Outpatient Medical Services,LAB,86902,BB ANTIGEN SCREEN SHEPEARD,300,272,4.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,4.3,Fee Schedule,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,4.3,217.6,136
Outpatient Medical Services,LAB,86902,BB UNIT AG SCRN CCH,300,178,4.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,4.3,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,4.3,142.4,89
Outpatient Medical Services,LAB,86905,BB AG TYPE NON RH SHEP,300,234,4.81,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,187.2,80% of total billed charges,56.72,24.24% of total billed charges,117.94,50.4% of total billed charges,175.5,75% of total billed charges,57.28,24.48% of total billed charges,4.81,Fee Schedule,56.16,24% of total billed charges,73.01,31.2% of total billed charges,187.2,80% of total billed charges,56.16,24% of total billed charges,56.16,24% of total billed charges,4.81,187.2,117
Outpatient Medical Services,LAB,86905,BB RBC AG OTHER THAN ABO OR D EACH,300,69,4.81,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,4.81,Fee Schedule,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,4.81,55.2,34.5
Outpatient Medical Services,LAB,86906,BB RH PHENOTYPING COMPLETE,300,64,9.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.2,80% of total billed charges,15.51,24.24% of total billed charges,32.26,50.4% of total billed charges,48,75% of total billed charges,15.67,24.48% of total billed charges,9.75,Fee Schedule,15.36,24% of total billed charges,19.97,31.2% of total billed charges,51.2,80% of total billed charges,15.36,24% of total billed charges,15.36,24% of total billed charges,9.75,51.2,32
Outpatient Medical Services,LAB,86920,HTLV 2 IGG AB,300,96,25.79,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,25.79,26.86% of total billed charges,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,23.04,76.8,48
Outpatient Medical Services,LAB,86920,BB CROSSMATCH IMMEDIATE SPIN,300,338,90.79,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,81.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,270.4,80% of total billed charges,81.93,24.24% of total billed charges,170.35,50.4% of total billed charges,253.5,75% of total billed charges,82.74,24.48% of total billed charges,90.79,26.86% of total billed charges,81.12,24% of total billed charges,105.46,31.2% of total billed charges,270.4,80% of total billed charges,81.12,24% of total billed charges,81.12,24% of total billed charges,81.12,270.4,169
Outpatient Medical Services,LAB,86922,BB AHG CROSSMATCH CCH,300,328.5,88.24,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,78.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,262.8,80% of total billed charges,79.63,24.24% of total billed charges,165.56,50.4% of total billed charges,246.38,75% of total billed charges,80.42,24.48% of total billed charges,88.24,26.86% of total billed charges,78.84,24% of total billed charges,102.49,31.2% of total billed charges,262.8,80% of total billed charges,78.84,24% of total billed charges,78.84,24% of total billed charges,78.84,262.8,164.25
Outpatient Medical Services,LAB,86922,BB AHG CROSSMATCH SHEPARD,300,328.5,88.24,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,78.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,262.8,80% of total billed charges,79.63,24.24% of total billed charges,165.56,50.4% of total billed charges,246.38,75% of total billed charges,80.42,24.48% of total billed charges,88.24,26.86% of total billed charges,78.84,24% of total billed charges,102.49,31.2% of total billed charges,262.8,80% of total billed charges,78.84,24% of total billed charges,78.84,24% of total billed charges,78.84,262.8,164.25
Outpatient Medical Services,LAB,86971,BB PRE TREATMENT WITH ENZYMES PER CELL,300,27,7.25,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,7.25,26.86% of total billed charges,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,6.48,21.6,13.5
Outpatient Medical Services,LAB,86978,DIFFERENTIAL / ADSORPTION OF SERUM,300,111,29.81,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88.8,80% of total billed charges,26.91,24.24% of total billed charges,55.94,50.4% of total billed charges,83.25,75% of total billed charges,27.17,24.48% of total billed charges,29.81,26.86% of total billed charges,26.64,24% of total billed charges,34.63,31.2% of total billed charges,88.8,80% of total billed charges,26.64,24% of total billed charges,26.64,24% of total billed charges,26.64,88.8,55.5
Outpatient Medical Services,LAB,87040,BLOOD CULTURE,300,199,12.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,12.98,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,12.98,159.2,99.5
Outpatient Medical Services,LAB,87040,.BLOOD CULTURE WORKUP,300,N/A,12.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.98,12.98,N/A
Outpatient Medical Services,LAB,87040,BLOOD CULTURE - QUEST,300,72,12.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,12.98,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,12.98,57.6,36
Outpatient Medical Services,LAB,87045,...STOOL CULTURE - do not use,300,114.5,30.75,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,LAB,87045,SALMONELLA & SHIGELLA CULTURE,300,44.5,11.95,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,35.6,80% of total billed charges,10.79,24.24% of total billed charges,22.43,50.4% of total billed charges,33.38,75% of total billed charges,10.89,24.48% of total billed charges,11.95,26.86% of total billed charges,10.68,24% of total billed charges,13.88,31.2% of total billed charges,35.6,80% of total billed charges,10.68,24% of total billed charges,10.68,24% of total billed charges,10.68,35.6,22.25
Outpatient Medical Services,LAB,87045,"GI PROFILE, STOOL, PCR, LABCORP",300,518,139.13,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,124.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,414.4,80% of total billed charges,125.56,24.24% of total billed charges,261.07,50.4% of total billed charges,388.5,75% of total billed charges,126.81,24.48% of total billed charges,139.13,26.86% of total billed charges,124.32,24% of total billed charges,161.62,31.2% of total billed charges,414.4,80% of total billed charges,124.32,24% of total billed charges,124.32,24% of total billed charges,124.32,414.4,259
Outpatient Medical Services,LAB,87046,CAMPYLOBACTER CULTURE,300,44.5,2.97,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,35.6,80% of total billed charges,10.79,24.24% of total billed charges,22.43,50.4% of total billed charges,33.38,75% of total billed charges,10.89,24.48% of total billed charges,2.97,Fee Schedule,10.68,24% of total billed charges,13.88,31.2% of total billed charges,35.6,80% of total billed charges,10.68,24% of total billed charges,10.68,24% of total billed charges,2.97,35.6,22.25
Outpatient Medical Services,LAB,87070,ROUTINE CULTURE,300,199,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,10.83,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,10.83,159.2,99.5
Outpatient Medical Services,LAB,87070,THROAT OR NP CULTURE,300,119.5,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,10.83,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,10.83,95.6,59.75
Outpatient Medical Services,LAB,87070,EAR CULTURE,300,167,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,133.6,80% of total billed charges,40.48,24.24% of total billed charges,84.17,50.4% of total billed charges,125.25,75% of total billed charges,40.88,24.48% of total billed charges,10.83,Fee Schedule,40.08,24% of total billed charges,52.1,31.2% of total billed charges,133.6,80% of total billed charges,40.08,24% of total billed charges,40.08,24% of total billed charges,10.83,133.6,83.5
Outpatient Medical Services,LAB,87070,EYE CULTURE,300,167,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,133.6,80% of total billed charges,40.48,24.24% of total billed charges,84.17,50.4% of total billed charges,125.25,75% of total billed charges,40.88,24.48% of total billed charges,10.83,Fee Schedule,40.08,24% of total billed charges,52.1,31.2% of total billed charges,133.6,80% of total billed charges,40.08,24% of total billed charges,40.08,24% of total billed charges,10.83,133.6,83.5
Outpatient Medical Services,LAB,87070,"MRSA SCREEN, NASAL",300,167,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,133.6,80% of total billed charges,40.48,24.24% of total billed charges,84.17,50.4% of total billed charges,125.25,75% of total billed charges,40.88,24.48% of total billed charges,10.83,Fee Schedule,40.08,24% of total billed charges,52.1,31.2% of total billed charges,133.6,80% of total billed charges,40.08,24% of total billed charges,40.08,24% of total billed charges,10.83,133.6,83.5
Outpatient Medical Services,LAB,87070,SPUTUM CULTURE,300,167,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,133.6,80% of total billed charges,40.48,24.24% of total billed charges,84.17,50.4% of total billed charges,125.25,75% of total billed charges,40.88,24.48% of total billed charges,10.83,Fee Schedule,40.08,24% of total billed charges,52.1,31.2% of total billed charges,133.6,80% of total billed charges,40.08,24% of total billed charges,40.08,24% of total billed charges,10.83,133.6,83.5
Outpatient Medical Services,LAB,87070,CULTURE WOUND  AEROBIC,300,199,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,10.83,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,10.83,159.2,99.5
Outpatient Medical Services,LAB,87070,.EYE CULTURE WORKUP,300,N/A,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,10.83,N/A
Outpatient Medical Services,LAB,87070,.EAR CULTURE WORKUP,300,N/A,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,10.83,N/A
Outpatient Medical Services,LAB,87070,.SPUTUM CULTURE WORKUP,300,N/A,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,10.83,N/A
Outpatient Medical Services,LAB,87070,.THROAT CULTURE WORKUP,300,N/A,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,10.83,N/A
Outpatient Medical Services,LAB,87070,".WOUND CULTURE WORKUP, AEROBIC",300,N/A,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.83,10.83,N/A
Outpatient Medical Services,LAB,87070,AEROBIC CULTURE - QUEST,300,134,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,32.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,107.2,80% of total billed charges,32.48,24.24% of total billed charges,67.54,50.4% of total billed charges,100.5,75% of total billed charges,32.8,24.48% of total billed charges,10.83,Fee Schedule,32.16,24% of total billed charges,41.81,31.2% of total billed charges,107.2,80% of total billed charges,32.16,24% of total billed charges,32.16,24% of total billed charges,10.83,107.2,67
Outpatient Medical Services,LAB,87070,AEROBIC & ANAEROBIC CULTURE - QUEST,300,134,10.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,32.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,107.2,80% of total billed charges,32.48,24.24% of total billed charges,67.54,50.4% of total billed charges,100.5,75% of total billed charges,32.8,24.48% of total billed charges,10.83,Fee Schedule,32.16,24% of total billed charges,41.81,31.2% of total billed charges,107.2,80% of total billed charges,32.16,24% of total billed charges,32.16,24% of total billed charges,10.83,107.2,67
Outpatient Medical Services,LAB,87075,ANAEROBIC CULTURE w/ GRAM STAIN,300,166,11.9,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,11.9,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,11.9,132.8,83
Outpatient Medical Services,LAB,87077,AERO ID & SUSCEPTIBILITY - QUEST,300,107,10.16,Fee Schedule,80.25,75% of total billed charges,80.25,75% of total billed charges,25.68,24% of total billed charges,80.25,75% of total billed charges,80.25,75% of total billed charges,85.6,80% of total billed charges,25.94,24.24% of total billed charges,53.93,50.4% of total billed charges,80.25,75% of total billed charges,26.19,24.48% of total billed charges,10.16,Fee Schedule,25.68,24% of total billed charges,33.38,31.2% of total billed charges,85.6,80% of total billed charges,25.68,24% of total billed charges,25.68,24% of total billed charges,10.16,85.6,53.5
Outpatient Medical Services,LAB,87077,BACTERIAL IDENTIFICATION CHARGE ONLY,300,107,10.16,Fee Schedule,80.25,75% of total billed charges,80.25,75% of total billed charges,25.68,24% of total billed charges,80.25,75% of total billed charges,80.25,75% of total billed charges,85.6,80% of total billed charges,25.94,24.24% of total billed charges,53.93,50.4% of total billed charges,80.25,75% of total billed charges,26.19,24.48% of total billed charges,10.16,Fee Schedule,25.68,24% of total billed charges,33.38,31.2% of total billed charges,85.6,80% of total billed charges,25.68,24% of total billed charges,25.68,24% of total billed charges,10.16,85.6,53.5
Outpatient Medical Services,LAB,87077,CLO TEST,300,101,10.16,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,10.16,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,10.16,80.8,50.5
Outpatient Medical Services,LAB,87081,H PYLORI CULTURE & SENSITIVITY,300,175,8.33,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,140,80% of total billed charges,42.42,24.24% of total billed charges,88.2,50.4% of total billed charges,131.25,75% of total billed charges,42.84,24.48% of total billed charges,8.33,Fee Schedule,42,24% of total billed charges,54.6,31.2% of total billed charges,140,80% of total billed charges,42,24% of total billed charges,42,24% of total billed charges,8.33,140,87.5
Outpatient Medical Services,LAB,87086,COLONY COUNT URINE,300,85.5,10.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.4,80% of total billed charges,20.73,24.24% of total billed charges,43.09,50.4% of total billed charges,64.13,75% of total billed charges,20.93,24.48% of total billed charges,10.15,Fee Schedule,20.52,24% of total billed charges,26.68,31.2% of total billed charges,68.4,80% of total billed charges,20.52,24% of total billed charges,20.52,24% of total billed charges,10.15,68.4,42.75
Outpatient Medical Services,LAB,87088,URINE CULTURE,300,114.5,10.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,10.18,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,10.18,91.6,57.25
Outpatient Medical Services,LAB,87088,.URINE CULTURE WORKUP,300,N/A,10.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.18,10.18,N/A
Outpatient Medical Services,LAB,87101,FUNGAL CULTURE,300,166,9.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,9.69,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,9.69,132.8,83
Outpatient Medical Services,LAB,87102,"FUNGAL CX W/ SMEAR-NOT HAIR,SKIN,BLD",300,46.5,10.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,37.2,80% of total billed charges,11.27,24.24% of total billed charges,23.44,50.4% of total billed charges,34.88,75% of total billed charges,11.38,24.48% of total billed charges,10.57,Fee Schedule,11.16,24% of total billed charges,14.51,31.2% of total billed charges,37.2,80% of total billed charges,11.16,24% of total billed charges,11.16,24% of total billed charges,10.57,37.2,23.25
Outpatient Medical Services,LAB,87107,FUNGAL ISOLATE IDENTIFICATION,300,48.5,12.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.8,80% of total billed charges,11.76,24.24% of total billed charges,24.44,50.4% of total billed charges,36.38,75% of total billed charges,11.87,24.48% of total billed charges,12.98,Fee Schedule,11.64,24% of total billed charges,15.13,31.2% of total billed charges,38.8,80% of total billed charges,11.64,24% of total billed charges,11.64,24% of total billed charges,11.64,38.8,24.25
Outpatient Medical Services,LAB,87116,AFB CULTURE,300,166,44.59,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,44.59,26.86% of total billed charges,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,39.84,132.8,83
Outpatient Medical Services,LAB,87172,PINWORM PREP,300,59.5,5.36,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,5.36,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,5.36,47.6,29.75
Outpatient Medical Services,LAB,87177,OVA & PARASITE SMEAR,300,42,11.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,10.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.6,80% of total billed charges,10.18,24.24% of total billed charges,21.17,50.4% of total billed charges,31.5,75% of total billed charges,10.28,24.48% of total billed charges,11.19,Fee Schedule,10.08,24% of total billed charges,13.1,31.2% of total billed charges,33.6,80% of total billed charges,10.08,24% of total billed charges,10.08,24% of total billed charges,10.08,33.6,21
Outpatient Medical Services,LAB,87186,SUSCEPTIBILITY PANEL MIC,300,119.5,10.87,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,10.87,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,10.87,95.6,59.75
Outpatient Medical Services,LAB,87205,GRAM STAIN,300,83.5,2.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,2.95,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,2.95,66.8,41.75
Outpatient Medical Services,LAB,87205,"GRAM STAIN, QUEST",300,83.5,2.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,2.95,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,2.95,66.8,41.75
Outpatient Medical Services,LAB,87206,AFB SMEAR,300,96,6.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,6.75,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,6.75,76.8,48
Outpatient Medical Services,LAB,87207,MALARIA SMEAR,300,96,7.53,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,7.53,Fee Schedule,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,7.53,76.8,48
Outpatient Medical Services,LAB,87209,OVA & PARASITE STAIN,300,84.5,22.6,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,67.6,80% of total billed charges,20.48,24.24% of total billed charges,42.59,50.4% of total billed charges,63.38,75% of total billed charges,20.69,24.48% of total billed charges,22.6,Fee Schedule,20.28,24% of total billed charges,26.36,31.2% of total billed charges,67.6,80% of total billed charges,20.28,24% of total billed charges,20.28,24% of total billed charges,20.28,67.6,42.25
Outpatient Medical Services,LAB,87210,INDIA INK PREP,300,59.5,5.36,Fee Schedule,44.63,75% of total billed charges,44.63,75% of total billed charges,14.28,24% of total billed charges,44.63,75% of total billed charges,44.63,75% of total billed charges,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,5.36,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,5.36,47.6,29.75
Outpatient Medical Services,LAB,87210,WET PREP,300,71,5.36,Fee Schedule,53.25,75% of total billed charges,53.25,75% of total billed charges,17.04,24% of total billed charges,53.25,75% of total billed charges,53.25,75% of total billed charges,56.8,80% of total billed charges,17.21,24.24% of total billed charges,35.78,50.4% of total billed charges,53.25,75% of total billed charges,17.38,24.48% of total billed charges,5.36,Fee Schedule,17.04,24% of total billed charges,22.15,31.2% of total billed charges,56.8,80% of total billed charges,17.04,24% of total billed charges,17.04,24% of total billed charges,5.36,56.8,35.5
Outpatient Medical Services,LAB,87210,KOH PREP,300,86.5,5.36,Fee Schedule,64.88,75% of total billed charges,64.88,75% of total billed charges,20.76,24% of total billed charges,64.88,75% of total billed charges,64.88,75% of total billed charges,69.2,80% of total billed charges,20.97,24.24% of total billed charges,43.6,50.4% of total billed charges,64.88,75% of total billed charges,21.18,24.48% of total billed charges,5.36,Fee Schedule,20.76,24% of total billed charges,26.99,31.2% of total billed charges,69.2,80% of total billed charges,20.76,24% of total billed charges,20.76,24% of total billed charges,5.36,69.2,43.25
Outpatient Medical Services,LAB,87220,PARASITES ID IN TISSUE,300,27,5.36,Fee Schedule,20.25,75% of total billed charges,20.25,75% of total billed charges,6.48,24% of total billed charges,20.25,75% of total billed charges,20.25,75% of total billed charges,21.6,80% of total billed charges,6.54,24.24% of total billed charges,13.61,50.4% of total billed charges,20.25,75% of total billed charges,6.61,24.48% of total billed charges,5.36,Fee Schedule,6.48,24% of total billed charges,8.42,31.2% of total billed charges,21.6,80% of total billed charges,6.48,24% of total billed charges,6.48,24% of total billed charges,5.36,21.6,13.5
Outpatient Medical Services,LAB,87252,VIRAL CULTURE,300,213,27.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,27.8,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,27.8,170.4,106.5
Outpatient Medical Services,LAB,87255,HERPES CULTURE,300,145,38.04,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,116,80% of total billed charges,35.15,24.24% of total billed charges,73.08,50.4% of total billed charges,108.75,75% of total billed charges,35.5,24.48% of total billed charges,38.04,Fee Schedule,34.8,24% of total billed charges,45.24,31.2% of total billed charges,116,80% of total billed charges,34.8,24% of total billed charges,34.8,24% of total billed charges,34.8,116,72.5
Outpatient Medical Services,LAB,87273,HERPES SIMPLEX C/S AND TYPING,300,560.5,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,134.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,448.4,80% of total billed charges,135.87,24.24% of total billed charges,282.49,50.4% of total billed charges,420.38,75% of total billed charges,137.21,24.48% of total billed charges,15.08,Fee Schedule,134.52,24% of total billed charges,174.88,31.2% of total billed charges,448.4,80% of total billed charges,134.52,24% of total billed charges,134.52,24% of total billed charges,15.08,448.4,280.25
Outpatient Medical Services,LAB,87273,HSV 2 CULTURE,300,73,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,15.08,Fee Schedule,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,15.08,58.4,36.5
Outpatient Medical Services,LAB,87274,HSV 1 CULTURE,300,73,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,15.08,Fee Schedule,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,15.08,58.4,36.5
Outpatient Medical Services,LAB,87324,C DIFF,300,214,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,15.08,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,15.08,171.2,107
Outpatient Medical Services,LAB,87324,C DIFF CONFIRMATION TEST,300,265.5,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,63.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,212.4,80% of total billed charges,64.36,24.24% of total billed charges,133.81,50.4% of total billed charges,199.13,75% of total billed charges,64.99,24.48% of total billed charges,15.08,Fee Schedule,63.72,24% of total billed charges,82.84,31.2% of total billed charges,212.4,80% of total billed charges,63.72,24% of total billed charges,63.72,24% of total billed charges,15.08,212.4,132.75
Outpatient Medical Services,LAB,87328,CRYPTOSPORIDIUM AG STOOL,300,108,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,15.08,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,15.08,86.4,54
Outpatient Medical Services,LAB,87328,"CRYPTOSPORIDIUM ANTIGEN, EIA",300,166,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,15.08,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,15.08,132.8,83
Outpatient Medical Services,LAB,87328,.CRYPTOSPORIDIUM AG EIA,300,101,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,15.08,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,15.08,80.8,50.5
Outpatient Medical Services,LAB,87329,.GIARDIA AG STOOL,300,199,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,15.08,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,15.08,159.2,99.5
Outpatient Medical Services,LAB,87329,"GIARDIA LAMBLIA IGG, IGM, IGA PANEL",300,173,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,41.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,138.4,80% of total billed charges,41.94,24.24% of total billed charges,87.19,50.4% of total billed charges,129.75,75% of total billed charges,42.35,24.48% of total billed charges,15.08,Fee Schedule,41.52,24% of total billed charges,53.98,31.2% of total billed charges,138.4,80% of total billed charges,41.52,24% of total billed charges,41.52,24% of total billed charges,15.08,138.4,86.5
Outpatient Medical Services,LAB,87329,"GIARDIA ANTIGEN, STOOL",300,56.5,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.2,80% of total billed charges,13.7,24.24% of total billed charges,28.48,50.4% of total billed charges,42.38,75% of total billed charges,13.83,24.48% of total billed charges,15.08,Fee Schedule,13.56,24% of total billed charges,17.63,31.2% of total billed charges,45.2,80% of total billed charges,13.56,24% of total billed charges,13.56,24% of total billed charges,13.56,45.2,28.25
Outpatient Medical Services,LAB,87336,ENTAMOEBA  DISPAR,300,67,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.6,80% of total billed charges,16.24,24.24% of total billed charges,33.77,50.4% of total billed charges,50.25,75% of total billed charges,16.4,24.48% of total billed charges,15.08,Fee Schedule,16.08,24% of total billed charges,20.9,31.2% of total billed charges,53.6,80% of total billed charges,16.08,24% of total billed charges,16.08,24% of total billed charges,15.08,53.6,33.5
Outpatient Medical Services,LAB,87337,"ENTAMOEBA HISTOLYTICA, AG",300,56.5,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.2,80% of total billed charges,13.7,24.24% of total billed charges,28.48,50.4% of total billed charges,42.38,75% of total billed charges,13.83,24.48% of total billed charges,15.08,Fee Schedule,13.56,24% of total billed charges,17.63,31.2% of total billed charges,45.2,80% of total billed charges,13.56,24% of total billed charges,13.56,24% of total billed charges,13.56,45.2,28.25
Outpatient Medical Services,LAB,87338,H PYLORI AG STOOL,300,133,18.09,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,31.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,18.09,Fee Schedule,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,18.09,106.4,66.5
Outpatient Medical Services,LAB,87340,HBV SURFACE AG W/ REFLEX,300,166,12.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,12.99,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,12.99,132.8,83
Outpatient Medical Services,LAB,87341,HEPATITIS B SURF AG CONFIRMATION,300,48.5,12.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.8,80% of total billed charges,11.76,24.24% of total billed charges,24.44,50.4% of total billed charges,36.38,75% of total billed charges,11.87,24.48% of total billed charges,12.99,Fee Schedule,11.64,24% of total billed charges,15.13,31.2% of total billed charges,38.8,80% of total billed charges,11.64,24% of total billed charges,11.64,24% of total billed charges,11.64,38.8,24.25
Outpatient Medical Services,LAB,87350,HEP BE AG,300,199,14.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,14.49,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,14.49,159.2,99.5
Outpatient Medical Services,LAB,87389,HIV ANTIGEN & ANTIBODY WITH REFLEX,300,166,27.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,27.3,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,27.3,132.8,83
Outpatient Medical Services,LAB,87400,FLU A  AG QUICK SCRN,300,95,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,15.08,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,15.08,76,47.5
Outpatient Medical Services,LAB,87400,FLU B AG QUICK SCRN,300,95,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,15.08,Fee Schedule,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,15.08,76,47.5
Outpatient Medical Services,LAB,87400,FLU  A and B SCRN,300,202,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,161.6,80% of total billed charges,48.96,24.24% of total billed charges,101.81,50.4% of total billed charges,151.5,75% of total billed charges,49.45,24.48% of total billed charges,15.08,Fee Schedule,48.48,24% of total billed charges,63.02,31.2% of total billed charges,161.6,80% of total billed charges,48.48,24% of total billed charges,48.48,24% of total billed charges,15.08,161.6,101
Outpatient Medical Services,LAB,87420,RSV - ANTIGEN,300,214,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,15.08,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,15.08,171.2,107
Outpatient Medical Services,LAB,87425,ROTAVIRUS,300,166,15.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,15.08,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,15.08,132.8,83
Outpatient Medical Services,LAB,87426,COVID ANTIGEN - CCH,300,244,36.18,Fee Schedule,183,75% of total billed charges,183,75% of total billed charges,58.56,24% of total billed charges,183,75% of total billed charges,183,75% of total billed charges,195.2,80% of total billed charges,59.15,24.24% of total billed charges,122.98,50.4% of total billed charges,183,75% of total billed charges,59.73,24.48% of total billed charges,36.18,Fee Schedule,58.56,24% of total billed charges,76.13,31.2% of total billed charges,195.2,80% of total billed charges,58.56,24% of total billed charges,58.56,24% of total billed charges,36.18,195.2,122
Outpatient Medical Services,LAB,87427,E COLI SHIGA TOXIN,300,125.5,15.08,Fee Schedule,94.13,75% of total billed charges,94.13,75% of total billed charges,30.12,24% of total billed charges,94.13,75% of total billed charges,94.13,75% of total billed charges,100.4,80% of total billed charges,30.42,24.24% of total billed charges,63.25,50.4% of total billed charges,94.13,75% of total billed charges,30.72,24.48% of total billed charges,15.08,Fee Schedule,30.12,24% of total billed charges,39.16,31.2% of total billed charges,100.4,80% of total billed charges,30.12,24% of total billed charges,30.12,24% of total billed charges,15.08,100.4,62.75
Outpatient Medical Services,LAB,87427,E COLI SHIGA TOXIN 2,300,125.5,15.08,Fee Schedule,94.13,75% of total billed charges,94.13,75% of total billed charges,30.12,24% of total billed charges,94.13,75% of total billed charges,94.13,75% of total billed charges,100.4,80% of total billed charges,30.42,24.24% of total billed charges,63.25,50.4% of total billed charges,94.13,75% of total billed charges,30.72,24.48% of total billed charges,15.08,Fee Schedule,30.12,24% of total billed charges,39.16,31.2% of total billed charges,100.4,80% of total billed charges,30.12,24% of total billed charges,30.12,24% of total billed charges,15.08,100.4,62.75
Outpatient Medical Services,LAB,87430,QUICK STREP,300,101,15.08,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,15.08,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,15.08,80.8,50.5
Outpatient Medical Services,LAB,87449,CAMPYLOBACTER AG,300,63,15.08,Fee Schedule,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,15.08,Fee Schedule,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.08,50.4,31.5
Outpatient Medical Services,LAB,87449,LEGIONELLA PNEUMO AG URINE,300,212,15.08,Fee Schedule,159,75% of total billed charges,159,75% of total billed charges,50.88,24% of total billed charges,159,75% of total billed charges,159,75% of total billed charges,169.6,80% of total billed charges,51.39,24.24% of total billed charges,106.85,50.4% of total billed charges,159,75% of total billed charges,51.9,24.48% of total billed charges,15.08,Fee Schedule,50.88,24% of total billed charges,66.14,31.2% of total billed charges,169.6,80% of total billed charges,50.88,24% of total billed charges,50.88,24% of total billed charges,15.08,169.6,106
Outpatient Medical Services,LAB,87480,VP CANDIDA SP DNA,300,108,24.8,Fee Schedule,81,75% of total billed charges,81,75% of total billed charges,25.92,24% of total billed charges,81,75% of total billed charges,81,75% of total billed charges,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,24.8,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,24.8,86.4,54
Outpatient Medical Services,LAB,87491,CHLAMYDIA  AMPLIFIED,300,166,24.67,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,24.67,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,24.67,132.8,83
Outpatient Medical Services,LAB,87497,CMV Quantification DNA/PCR,300,306,53.87,Fee Schedule,229.5,75% of total billed charges,229.5,75% of total billed charges,73.44,24% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,244.8,80% of total billed charges,74.17,24.24% of total billed charges,154.22,50.4% of total billed charges,229.5,75% of total billed charges,74.91,24.48% of total billed charges,53.87,Fee Schedule,73.44,24% of total billed charges,95.47,31.2% of total billed charges,244.8,80% of total billed charges,73.44,24% of total billed charges,73.44,24% of total billed charges,53.87,244.8,153
Outpatient Medical Services,LAB,87502,FLU  A & B MOLECULAR,300,133,58.43,Fee Schedule,99.75,75% of total billed charges,99.75,75% of total billed charges,31.92,24% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,58.43,Fee Schedule,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,31.92,106.4,66.5
Outpatient Medical Services,LAB,87517,HBV DNA QUANT PCR,300,168,53.87,Fee Schedule,126,75% of total billed charges,126,75% of total billed charges,40.32,24% of total billed charges,126,75% of total billed charges,126,75% of total billed charges,134.4,80% of total billed charges,40.72,24.24% of total billed charges,84.67,50.4% of total billed charges,126,75% of total billed charges,41.13,24.48% of total billed charges,53.87,Fee Schedule,40.32,24% of total billed charges,52.42,31.2% of total billed charges,134.4,80% of total billed charges,40.32,24% of total billed charges,40.32,24% of total billed charges,40.32,134.4,84
Outpatient Medical Services,LAB,87521,HCV RNA QUALITATIVE,300,138,24.67,Fee Schedule,103.5,75% of total billed charges,103.5,75% of total billed charges,33.12,24% of total billed charges,103.5,75% of total billed charges,103.5,75% of total billed charges,110.4,80% of total billed charges,33.45,24.24% of total billed charges,69.55,50.4% of total billed charges,103.5,75% of total billed charges,33.78,24.48% of total billed charges,24.67,Fee Schedule,33.12,24% of total billed charges,43.06,31.2% of total billed charges,110.4,80% of total billed charges,33.12,24% of total billed charges,33.12,24% of total billed charges,24.67,110.4,69
Outpatient Medical Services,LAB,87522,HCV RNA QUANT PCR,300,497.5,53.87,Fee Schedule,373.13,75% of total billed charges,373.13,75% of total billed charges,119.4,24% of total billed charges,373.13,75% of total billed charges,373.13,75% of total billed charges,398,80% of total billed charges,120.59,24.24% of total billed charges,250.74,50.4% of total billed charges,373.13,75% of total billed charges,121.79,24.48% of total billed charges,53.87,Fee Schedule,119.4,24% of total billed charges,155.22,31.2% of total billed charges,398,80% of total billed charges,119.4,24% of total billed charges,119.4,24% of total billed charges,53.87,398,248.75
Outpatient Medical Services,LAB,87522,DELETED....,300,202,53.87,Fee Schedule,151.5,75% of total billed charges,151.5,75% of total billed charges,48.48,24% of total billed charges,151.5,75% of total billed charges,151.5,75% of total billed charges,161.6,80% of total billed charges,48.96,24.24% of total billed charges,101.81,50.4% of total billed charges,151.5,75% of total billed charges,49.45,24.48% of total billed charges,53.87,Fee Schedule,48.48,24% of total billed charges,63.02,31.2% of total billed charges,161.6,80% of total billed charges,48.48,24% of total billed charges,48.48,24% of total billed charges,48.48,161.6,101
Outpatient Medical Services,LAB,87522,HCV RNA QUANT PCR WITH REFLEX TO GENO,300,497.5,53.87,Fee Schedule,373.13,75% of total billed charges,373.13,75% of total billed charges,119.4,24% of total billed charges,373.13,75% of total billed charges,373.13,75% of total billed charges,398,80% of total billed charges,120.59,24.24% of total billed charges,250.74,50.4% of total billed charges,373.13,75% of total billed charges,121.79,24.48% of total billed charges,53.87,Fee Schedule,119.4,24% of total billed charges,155.22,31.2% of total billed charges,398,80% of total billed charges,119.4,24% of total billed charges,119.4,24% of total billed charges,53.87,398,248.75
Outpatient Medical Services,LAB,87522,HCV RNA QUANT CHG ONLY,300,497.5,53.87,Fee Schedule,373.13,75% of total billed charges,373.13,75% of total billed charges,119.4,24% of total billed charges,373.13,75% of total billed charges,373.13,75% of total billed charges,398,80% of total billed charges,120.59,24.24% of total billed charges,250.74,50.4% of total billed charges,373.13,75% of total billed charges,121.79,24.48% of total billed charges,53.87,Fee Schedule,119.4,24% of total billed charges,155.22,31.2% of total billed charges,398,80% of total billed charges,119.4,24% of total billed charges,119.4,24% of total billed charges,53.87,398,248.75
Outpatient Medical Services,LAB,87522,HEP C RNA PCR (SCP),300,63,53.87,Fee Schedule,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,53.87,Fee Schedule,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,53.87,31.5
Outpatient Medical Services,LAB,87529,HSV 1 DNA QUAL BY PCR,300,138,24.67,Fee Schedule,103.5,75% of total billed charges,103.5,75% of total billed charges,33.12,24% of total billed charges,103.5,75% of total billed charges,103.5,75% of total billed charges,110.4,80% of total billed charges,33.45,24.24% of total billed charges,69.55,50.4% of total billed charges,103.5,75% of total billed charges,33.78,24.48% of total billed charges,24.67,Fee Schedule,33.12,24% of total billed charges,43.06,31.2% of total billed charges,110.4,80% of total billed charges,33.12,24% of total billed charges,33.12,24% of total billed charges,24.67,110.4,69
Outpatient Medical Services,LAB,87529,HSV 2 DNA QUAL BY PCR,300,138,24.67,Fee Schedule,103.5,75% of total billed charges,103.5,75% of total billed charges,33.12,24% of total billed charges,103.5,75% of total billed charges,103.5,75% of total billed charges,110.4,80% of total billed charges,33.45,24.24% of total billed charges,69.55,50.4% of total billed charges,103.5,75% of total billed charges,33.78,24.48% of total billed charges,24.67,Fee Schedule,33.12,24% of total billed charges,43.06,31.2% of total billed charges,110.4,80% of total billed charges,33.12,24% of total billed charges,33.12,24% of total billed charges,24.67,110.4,69
Outpatient Medical Services,LAB,87536,HIV 1 RNA VIRAL LOAD,300,427.5,56.5,Fee Schedule,320.63,75% of total billed charges,320.63,75% of total billed charges,102.6,24% of total billed charges,320.63,75% of total billed charges,320.63,75% of total billed charges,342,80% of total billed charges,103.63,24.24% of total billed charges,215.46,50.4% of total billed charges,320.63,75% of total billed charges,104.65,24.48% of total billed charges,56.5,Fee Schedule,102.6,24% of total billed charges,133.38,31.2% of total billed charges,342,80% of total billed charges,102.6,24% of total billed charges,102.6,24% of total billed charges,56.5,342,213.75
Outpatient Medical Services,LAB,87550,VP GARDERELLA VAG DNA,300,107,28.74,26.86% of total billed charges,80.25,75% of total billed charges,80.25,75% of total billed charges,25.68,24% of total billed charges,80.25,75% of total billed charges,80.25,75% of total billed charges,85.6,80% of total billed charges,25.94,24.24% of total billed charges,53.93,50.4% of total billed charges,80.25,75% of total billed charges,26.19,24.48% of total billed charges,28.74,26.86% of total billed charges,25.68,24% of total billed charges,33.38,31.2% of total billed charges,85.6,80% of total billed charges,25.68,24% of total billed charges,25.68,24% of total billed charges,25.68,85.6,53.5
Outpatient Medical Services,LAB,87591,GC  AMPLIFIED,300,262.5,21.42,Fee Schedule,196.88,75% of total billed charges,196.88,75% of total billed charges,63,24% of total billed charges,196.88,75% of total billed charges,196.88,75% of total billed charges,210,80% of total billed charges,63.63,24.24% of total billed charges,132.3,50.4% of total billed charges,196.88,75% of total billed charges,64.26,24.48% of total billed charges,21.42,Fee Schedule,63,24% of total billed charges,81.9,31.2% of total billed charges,210,80% of total billed charges,63,24% of total billed charges,63,24% of total billed charges,21.42,210,131.25
Outpatient Medical Services,LAB,87634,RSV - MOLECULAR,300,133,69.33,Fee Schedule,99.75,75% of total billed charges,99.75,75% of total billed charges,31.92,24% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,69.33,Fee Schedule,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,31.92,106.4,66.5
Outpatient Medical Services,LAB,87635,COVID-19 PCR TEST - QUEST,300,424.5,51.31,Fee Schedule,318.38,75% of total billed charges,318.38,75% of total billed charges,101.88,24% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,51.31,Fee Schedule,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,51.31,339.6,212.25
Outpatient Medical Services,LAB,87635,COVID-19 PCR TEST - HORIZON LAB,300,424.5,51.31,Fee Schedule,318.38,75% of total billed charges,318.38,75% of total billed charges,101.88,24% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,51.31,Fee Schedule,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,51.31,339.6,212.25
Outpatient Medical Services,LAB,87635,SARS COV2 MOLECULAR- CCH,300,333.5,51.31,Fee Schedule,250.13,75% of total billed charges,250.13,75% of total billed charges,80.04,24% of total billed charges,250.13,75% of total billed charges,250.13,75% of total billed charges,266.8,80% of total billed charges,80.84,24.24% of total billed charges,168.08,50.4% of total billed charges,250.13,75% of total billed charges,81.64,24.48% of total billed charges,51.31,Fee Schedule,80.04,24% of total billed charges,104.05,31.2% of total billed charges,266.8,80% of total billed charges,80.04,24% of total billed charges,80.04,24% of total billed charges,51.31,266.8,166.75
Outpatient Medical Services,LAB,87635,SARS COV2 MOLECULAR W/ REFLEX TO PCR,300,333.5,51.31,Fee Schedule,250.13,75% of total billed charges,250.13,75% of total billed charges,80.04,24% of total billed charges,250.13,75% of total billed charges,250.13,75% of total billed charges,266.8,80% of total billed charges,80.84,24.24% of total billed charges,168.08,50.4% of total billed charges,250.13,75% of total billed charges,81.64,24.48% of total billed charges,51.31,Fee Schedule,80.04,24% of total billed charges,104.05,31.2% of total billed charges,266.8,80% of total billed charges,80.04,24% of total billed charges,80.04,24% of total billed charges,51.31,266.8,166.75
Outpatient Medical Services,LAB,87651,STREP A - MOLECULAR,300,85.5,24.67,Fee Schedule,64.13,75% of total billed charges,64.13,75% of total billed charges,20.52,24% of total billed charges,64.13,75% of total billed charges,64.13,75% of total billed charges,68.4,80% of total billed charges,20.73,24.24% of total billed charges,43.09,50.4% of total billed charges,64.13,75% of total billed charges,20.93,24.48% of total billed charges,24.67,Fee Schedule,20.52,24% of total billed charges,26.68,31.2% of total billed charges,68.4,80% of total billed charges,20.52,24% of total billed charges,20.52,24% of total billed charges,20.52,68.4,42.75
Outpatient Medical Services,LAB,87660,VP TRICHOMONAS VAG DNA,300,108,24.8,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,24.8,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,24.8,86.4,54
Outpatient Medical Services,LAB,87661,"TRICHOMONAS VAGINALIS, RNA, MALES",300,166,21.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.42,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.42,132.8,83
Outpatient Medical Services,LAB,87661,"TRICHOMONAS VAGINALIS, RNA, QUAL, TMA",300,166,21.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.42,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.42,132.8,83
Outpatient Medical Services,LAB,87798,H1N1 FLU PCR,300,309,24.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,247.2,80% of total billed charges,74.9,24.24% of total billed charges,155.74,50.4% of total billed charges,231.75,75% of total billed charges,75.64,24.48% of total billed charges,24.67,Fee Schedule,74.16,24% of total billed charges,96.41,31.2% of total billed charges,247.2,80% of total billed charges,74.16,24% of total billed charges,74.16,24% of total billed charges,24.67,247.2,154.5
Outpatient Medical Services,LAB,87798,"EBV BY PCR, QUAL",300,309,24.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,247.2,80% of total billed charges,74.9,24.24% of total billed charges,155.74,50.4% of total billed charges,231.75,75% of total billed charges,75.64,24.48% of total billed charges,24.67,Fee Schedule,74.16,24% of total billed charges,96.41,31.2% of total billed charges,247.2,80% of total billed charges,74.16,24% of total billed charges,74.16,24% of total billed charges,24.67,247.2,154.5
Outpatient Medical Services,LAB,87799,BK VIRUS DNA QUANT,300,889,238.79,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,213.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,711.2,80% of total billed charges,215.49,24.24% of total billed charges,448.06,50.4% of total billed charges,666.75,75% of total billed charges,217.63,24.48% of total billed charges,238.79,26.86% of total billed charges,213.36,24% of total billed charges,277.37,31.2% of total billed charges,711.2,80% of total billed charges,213.36,24% of total billed charges,213.36,24% of total billed charges,213.36,711.2,444.5
Outpatient Medical Services,LAB,87799,BK VIRUS QUANT PCR URINE,300,889,238.79,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,213.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,711.2,80% of total billed charges,215.49,24.24% of total billed charges,448.06,50.4% of total billed charges,666.75,75% of total billed charges,217.63,24.48% of total billed charges,238.79,26.86% of total billed charges,213.36,24% of total billed charges,277.37,31.2% of total billed charges,711.2,80% of total billed charges,213.36,24% of total billed charges,213.36,24% of total billed charges,213.36,711.2,444.5
Outpatient Medical Services,LAB,87899,"STREP PNEU AG, URINE",300,281,15.08,Fee Schedule,210.75,75% of total billed charges,210.75,75% of total billed charges,67.44,24% of total billed charges,210.75,75% of total billed charges,210.75,75% of total billed charges,224.8,80% of total billed charges,68.11,24.24% of total billed charges,141.62,50.4% of total billed charges,210.75,75% of total billed charges,68.79,24.48% of total billed charges,15.08,Fee Schedule,67.44,24% of total billed charges,87.67,31.2% of total billed charges,224.8,80% of total billed charges,67.44,24% of total billed charges,67.44,24% of total billed charges,15.08,224.8,140.5
Outpatient Medical Services,LAB,87902,HEP C VIRAL RNA GENOTYPE 1 NS5A DRUG RES,300,1210.5,109.67,Fee Schedule,907.88,75% of total billed charges,907.88,75% of total billed charges,290.52,24% of total billed charges,907.88,75% of total billed charges,907.88,75% of total billed charges,968.4,80% of total billed charges,293.43,24.24% of total billed charges,610.09,50.4% of total billed charges,907.88,75% of total billed charges,296.33,24.48% of total billed charges,109.67,Fee Schedule,290.52,24% of total billed charges,377.68,31.2% of total billed charges,968.4,80% of total billed charges,290.52,24% of total billed charges,290.52,24% of total billed charges,109.67,968.4,605.25
Outpatient Medical Services,LAB,87902,"HCV RNA GENOTYPE, LIPA",300,1011.5,109.67,Fee Schedule,758.63,75% of total billed charges,758.63,75% of total billed charges,242.76,24% of total billed charges,758.63,75% of total billed charges,758.63,75% of total billed charges,809.2,80% of total billed charges,245.19,24.24% of total billed charges,509.8,50.4% of total billed charges,758.63,75% of total billed charges,247.62,24.48% of total billed charges,109.67,Fee Schedule,242.76,24% of total billed charges,315.59,31.2% of total billed charges,809.2,80% of total billed charges,242.76,24% of total billed charges,242.76,24% of total billed charges,109.67,809.2,505.75
Outpatient Medical Services,LAB,87912,HEP B GENOTYPE,300,948.5,95.9,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.64,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,758.8,80% of total billed charges,229.92,24.24% of total billed charges,478.04,50.4% of total billed charges,711.38,75% of total billed charges,232.19,24.48% of total billed charges,95.9,Fee Schedule,227.64,24% of total billed charges,295.93,31.2% of total billed charges,758.8,80% of total billed charges,227.64,24% of total billed charges,227.64,24% of total billed charges,95.9,758.8,474.25
Outpatient Medical Services,LAB,89051,"CELL COUNT, BODY FLUID, OTHER",300,72,2.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.21,57.6,36
Outpatient Medical Services,LAB,89051,"CELL COUNT, PLEURAL FLUID",300,72,2.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.21,57.6,36
Outpatient Medical Services,LAB,89051,"CELL COUNT & DIFF, SYNOVIAL FLUID",300,72,2.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.21,57.6,36
Outpatient Medical Services,LAB,89051,"CELL COUNT & DIFF, PERITONEAL FLUID",300,72,2.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.21,57.6,36
Outpatient Medical Services,LAB,89060,"CRYSTALS, SYNOVIAL FLUID",300,83.5,8.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,8.99,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,8.99,66.8,41.75
Outpatient Medical Services,LAB,89190,NASAL EO COUNT,300,59.5,5.98,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,5.98,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,5.98,47.6,29.75
Outpatient Medical Services,LAB,99001,BB SPECIMEN HANDLING,300,51.5,13.83,26.86% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,13.83,26.86% of total billed charges,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,41.2,25.75
Outpatient Medical Services,LAB,G0103,PSA SCREEN (CCH),300,214,25.7,Fee Schedule,160.5,75% of total billed charges,160.5,75% of total billed charges,51.36,24% of total billed charges,160.5,75% of total billed charges,160.5,75% of total billed charges,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,25.7,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,25.7,171.2,107
Outpatient Medical Services,LAB,G0480,SALIVA DRUG CONFIRMATION TESTING,300,N/A,94.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,94.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,94.12,94.12,N/A
Outpatient Medical Services,LAB,G0480,URINE DRUG CONFIRMATION TEST,300,N/A,94.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,94.12,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,94.12,94.12,N/A
Outpatient Medical Services,LAB,G0480,DRUG TEST CONFIRMATION 1-7 CLASSES,300,375,94.12,Fee Schedule,281.25,75% of total billed charges,281.25,75% of total billed charges,90,24% of total billed charges,281.25,75% of total billed charges,281.25,75% of total billed charges,300,80% of total billed charges,90.9,24.24% of total billed charges,189,50.4% of total billed charges,281.25,75% of total billed charges,91.8,24.48% of total billed charges,94.12,Fee Schedule,90,24% of total billed charges,117,31.2% of total billed charges,300,80% of total billed charges,90,24% of total billed charges,90,24% of total billed charges,90,300,187.5
Outpatient Medical Services,LAB,G0481,DRUG TEST CONFIRMATION 8-14 CLASSES,300,512,128.79,Fee Schedule,384,75% of total billed charges,384,75% of total billed charges,122.88,24% of total billed charges,384,75% of total billed charges,384,75% of total billed charges,409.6,80% of total billed charges,124.11,24.24% of total billed charges,258.05,50.4% of total billed charges,384,75% of total billed charges,125.34,24.48% of total billed charges,128.79,Fee Schedule,122.88,24% of total billed charges,159.74,31.2% of total billed charges,409.6,80% of total billed charges,122.88,24% of total billed charges,122.88,24% of total billed charges,122.88,409.6,256
Outpatient Medical Services,LAB,G0482,DRUG TEST CONFIRMATION 15-21 CLASSES,300,650,163.47,Fee Schedule,487.5,75% of total billed charges,487.5,75% of total billed charges,156,24% of total billed charges,487.5,75% of total billed charges,487.5,75% of total billed charges,520,80% of total billed charges,157.56,24.24% of total billed charges,327.6,50.4% of total billed charges,487.5,75% of total billed charges,159.12,24.48% of total billed charges,163.47,Fee Schedule,156,24% of total billed charges,202.8,31.2% of total billed charges,520,80% of total billed charges,156,24% of total billed charges,156,24% of total billed charges,156,520,325
Outpatient Medical Services,LAB,G0483,DRUG TEST CONFIRMATION 22+ CLASSES,300,807.5,203.1,Fee Schedule,605.63,75% of total billed charges,605.63,75% of total billed charges,193.8,24% of total billed charges,605.63,75% of total billed charges,605.63,75% of total billed charges,646,80% of total billed charges,195.74,24.24% of total billed charges,406.98,50.4% of total billed charges,605.63,75% of total billed charges,197.68,24.48% of total billed charges,203.1,Fee Schedule,193.8,24% of total billed charges,251.94,31.2% of total billed charges,646,80% of total billed charges,193.8,24% of total billed charges,193.8,24% of total billed charges,193.8,646,403.75
Outpatient Medical Services,LAB,80047,ISTAT BMP,301,237,27.46,Fee Schedule,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,27.46,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,27.46,189.6,118.5
Outpatient Medical Services,LAB,80048,BASIC METABOLIC PANEL,301,284.5,10.65,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,10.65,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,10.65,227.6,142.25
Outpatient Medical Services,LAB,80051,ELECTROLYTES,301,166,8.82,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,8.82,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,8.82,132.8,83
Outpatient Medical Services,LAB,80051,ELECTROLYTES - EPOC,301,166,8.82,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,8.82,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,8.82,132.8,83
Outpatient Medical Services,LAB,80051,ELECTROLYTES (SCP),301,8,8.82,Fee Schedule,6,75% of total billed charges,6,75% of total billed charges,1.92,24% of total billed charges,6,75% of total billed charges,6,75% of total billed charges,6.4,80% of total billed charges,1.94,24.24% of total billed charges,4.03,50.4% of total billed charges,6,75% of total billed charges,1.96,24.48% of total billed charges,8.82,Fee Schedule,1.92,24% of total billed charges,2.5,31.2% of total billed charges,6.4,80% of total billed charges,1.92,24% of total billed charges,1.92,24% of total billed charges,1.92,8.82,4
Outpatient Medical Services,LAB,80053,COMPREHENSIVE METABOLIC PANEL,301,427.5,13.29,Fee Schedule,320.63,75% of total billed charges,320.63,75% of total billed charges,102.6,24% of total billed charges,320.63,75% of total billed charges,320.63,75% of total billed charges,342,80% of total billed charges,103.63,24.24% of total billed charges,215.46,50.4% of total billed charges,320.63,75% of total billed charges,104.65,24.48% of total billed charges,13.29,Fee Schedule,102.6,24% of total billed charges,133.38,31.2% of total billed charges,342,80% of total billed charges,102.6,24% of total billed charges,102.6,24% of total billed charges,13.29,342,213.75
Outpatient Medical Services,LAB,80053,....C METABOLIC  PANEL (SCP),301,22.5,13.29,Fee Schedule,16.88,75% of total billed charges,16.88,75% of total billed charges,5.4,24% of total billed charges,16.88,75% of total billed charges,16.88,75% of total billed charges,18,80% of total billed charges,5.45,24.24% of total billed charges,11.34,50.4% of total billed charges,16.88,75% of total billed charges,5.51,24.48% of total billed charges,13.29,Fee Schedule,5.4,24% of total billed charges,7.02,31.2% of total billed charges,18,80% of total billed charges,5.4,24% of total billed charges,5.4,24% of total billed charges,5.4,18,11.25
Outpatient Medical Services,LAB,80069,RENAL PANEL,301,284.5,10.92,Fee Schedule,213.38,75% of total billed charges,213.38,75% of total billed charges,68.28,24% of total billed charges,213.38,75% of total billed charges,213.38,75% of total billed charges,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,10.92,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,10.92,227.6,142.25
Outpatient Medical Services,LAB,80074,ACUTE HEPATITIS PANEL,301,568.5,59.89,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,454.8,80% of total billed charges,137.8,24.24% of total billed charges,286.52,50.4% of total billed charges,426.38,75% of total billed charges,139.17,24.48% of total billed charges,59.89,Fee Schedule,136.44,24% of total billed charges,177.37,31.2% of total billed charges,454.8,80% of total billed charges,136.44,24% of total billed charges,136.44,24% of total billed charges,59.89,454.8,284.25
Outpatient Medical Services,LAB,80076,HEPATIC FUNCTION PROFILE,301,249.5,10.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,59.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,199.6,80% of total billed charges,60.48,24.24% of total billed charges,125.75,50.4% of total billed charges,187.13,75% of total billed charges,61.08,24.48% of total billed charges,10.28,Fee Schedule,59.88,24% of total billed charges,77.84,31.2% of total billed charges,199.6,80% of total billed charges,59.88,24% of total billed charges,59.88,24% of total billed charges,10.28,199.6,124.75
Outpatient Medical Services,LAB,80076,HEPATIC FUNCTION (SCP),301,17.5,10.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14,80% of total billed charges,4.24,24.24% of total billed charges,8.82,50.4% of total billed charges,13.13,75% of total billed charges,4.28,24.48% of total billed charges,10.28,Fee Schedule,4.2,24% of total billed charges,5.46,31.2% of total billed charges,14,80% of total billed charges,4.2,24% of total billed charges,4.2,24% of total billed charges,4.2,14,8.75
Outpatient Medical Services,LAB,80143,ACETAMINOPHEN (TYLENOL) ASSAY,301,243,14.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,14.91,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,14.91,194.4,121.5
Outpatient Medical Services,LAB,80143,ACETAMENOPHEN,301,N/A,14.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.91,14.91,N/A
Outpatient Medical Services,LAB,80151,AMIODARONE,301,297.5,14.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,14.91,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,14.91,238,148.75
Outpatient Medical Services,LAB,80156,"CARBAMAZEPINE, TOTAL",301,243,18.31,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,18.31,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,18.31,194.4,121.5
Outpatient Medical Services,LAB,80157,"CARBAMAZEPINE, FREE",301,47.5,12.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38,80% of total billed charges,11.51,24.24% of total billed charges,23.94,50.4% of total billed charges,35.63,75% of total billed charges,11.63,24.48% of total billed charges,12.5,Fee Schedule,11.4,24% of total billed charges,14.82,31.2% of total billed charges,38,80% of total billed charges,11.4,24% of total billed charges,11.4,24% of total billed charges,11.4,38,23.75
Outpatient Medical Services,LAB,80158,"CYCLOSPORINE, TROUGH",301,203,7.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,162.4,80% of total billed charges,49.21,24.24% of total billed charges,102.31,50.4% of total billed charges,152.25,75% of total billed charges,49.69,24.48% of total billed charges,7.5,Fee Schedule,48.72,24% of total billed charges,63.34,31.2% of total billed charges,162.4,80% of total billed charges,48.72,24% of total billed charges,48.72,24% of total billed charges,7.5,162.4,101.5
Outpatient Medical Services,LAB,80159,CLOZAPINE,301,87.5,20.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,21,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,70,80% of total billed charges,21.21,24.24% of total billed charges,44.1,50.4% of total billed charges,65.63,75% of total billed charges,21.42,24.48% of total billed charges,20.18,Fee Schedule,21,24% of total billed charges,27.3,31.2% of total billed charges,70,80% of total billed charges,21,24% of total billed charges,21,24% of total billed charges,20.18,70,43.75
Outpatient Medical Services,LAB,80162,DIGOXIN,301,199,16.7,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,16.7,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,16.7,159.2,99.5
Outpatient Medical Services,LAB,80164,VALPROIC ACID,301,199,14.27,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,14.27,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,14.27,159.2,99.5
Outpatient Medical Services,LAB,80170,GENTAMICIN PEAK,301,166,20.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,20.61,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,20.61,132.8,83
Outpatient Medical Services,LAB,80170,GENTAMICIN TROUGH,301,166,20.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,20.61,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,20.61,132.8,83
Outpatient Medical Services,LAB,80173,HALOPERIDOL,301,297.5,18.31,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,18.31,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,18.31,238,148.75
Outpatient Medical Services,LAB,80175,LAMOTRIGINE,301,166,14.47,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.47,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.47,132.8,83
Outpatient Medical Services,LAB,80176,LIDOCAINE,301,178,18.47,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,18.47,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,18.47,142.4,89
Outpatient Medical Services,LAB,80177,LEVETIRACETAM,301,274,14.47,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,65.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,14.47,Fee Schedule,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,14.47,219.2,137
Outpatient Medical Services,LAB,80178,LITHIUM,301,166,8.32,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,8.32,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,8.32,132.8,83
Outpatient Medical Services,LAB,80179,SALICYLATE,301,199,14.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,14.91,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,14.91,159.2,99.5
Outpatient Medical Services,LAB,80180,MYCOPHENOLIC ACID,301,645,6.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,154.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,516,80% of total billed charges,156.35,24.24% of total billed charges,325.08,50.4% of total billed charges,483.75,75% of total billed charges,157.9,24.48% of total billed charges,6.5,Fee Schedule,154.8,24% of total billed charges,201.24,31.2% of total billed charges,516,80% of total billed charges,154.8,24% of total billed charges,154.8,24% of total billed charges,6.5,516,322.5
Outpatient Medical Services,LAB,80183,TRILEPTAL LEVEL,301,213,14.47,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,14.47,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,14.47,170.4,106.5
Outpatient Medical Services,LAB,80184,PHENOBARBITAL,301,10.5,14.41,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,2.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,8.4,80% of total billed charges,2.55,24.24% of total billed charges,5.29,50.4% of total billed charges,7.88,75% of total billed charges,2.57,24.48% of total billed charges,14.41,Fee Schedule,2.52,24% of total billed charges,3.28,31.2% of total billed charges,8.4,80% of total billed charges,2.52,24% of total billed charges,2.52,24% of total billed charges,2.52,14.41,5.25
Outpatient Medical Services,LAB,80185,PHENYTOIN TOTAL,301,166,16.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.67,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.67,132.8,83
Outpatient Medical Services,LAB,80186,PHENYTOIN FREE,301,166,17.31,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,17.31,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,17.31,132.8,83
Outpatient Medical Services,LAB,80188,PRIMIDONE,301,277,20.86,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,20.86,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,20.86,221.6,138.5
Outpatient Medical Services,LAB,80194,CARDIQUIN,301,166,18.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.35,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.35,132.8,83
Outpatient Medical Services,LAB,80195,SIROLIMUS,301,237,17.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,17.25,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,17.25,189.6,118.5
Outpatient Medical Services,LAB,80197,TACROLIMUS,301,384,17.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,92.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,307.2,80% of total billed charges,93.08,24.24% of total billed charges,193.54,50.4% of total billed charges,288,75% of total billed charges,94,24.48% of total billed charges,17.25,Fee Schedule,92.16,24% of total billed charges,119.81,31.2% of total billed charges,307.2,80% of total billed charges,92.16,24% of total billed charges,92.16,24% of total billed charges,17.25,307.2,192
Outpatient Medical Services,LAB,80198,"THEOPHYLLINE, TROUGH",301,166,17.79,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,17.79,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,17.79,132.8,83
Outpatient Medical Services,LAB,80200,TOBRAMYCIN,301,166,18.84,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.84,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.84,132.8,83
Outpatient Medical Services,LAB,80201,TOPIRAMATE,301,166,14.99,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.99,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.99,132.8,83
Outpatient Medical Services,LAB,80202,VANCOMYCIN TROUGH,301,199,14.27,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,14.27,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,14.27,159.2,99.5
Outpatient Medical Services,LAB,80202,VANCOMYCIN PEAK,301,166,14.27,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,14.27,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,14.27,132.8,83
Outpatient Medical Services,LAB,80299,CLINDAMYCIN,301,297.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,15.14,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,15.14,238,148.75
Outpatient Medical Services,LAB,80299,NEURONTIN,301,166,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,15.14,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,15.14,132.8,83
Outpatient Medical Services,LAB,80299,QUETIAPINE,301,356.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,15.14,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,15.14,285.2,178.25
Outpatient Medical Services,LAB,80299,6 MERCAPTOPURINE,301,254.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,203.6,80% of total billed charges,61.69,24.24% of total billed charges,128.27,50.4% of total billed charges,190.88,75% of total billed charges,62.3,24.48% of total billed charges,15.14,Fee Schedule,61.08,24% of total billed charges,79.4,31.2% of total billed charges,203.6,80% of total billed charges,61.08,24% of total billed charges,61.08,24% of total billed charges,15.14,203.6,127.25
Outpatient Medical Services,LAB,80299,6 THIOGUANINE,301,254.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,203.6,80% of total billed charges,61.69,24.24% of total billed charges,128.27,50.4% of total billed charges,190.88,75% of total billed charges,62.3,24.48% of total billed charges,15.14,Fee Schedule,61.08,24% of total billed charges,79.4,31.2% of total billed charges,203.6,80% of total billed charges,61.08,24% of total billed charges,61.08,24% of total billed charges,15.14,203.6,127.25
Outpatient Medical Services,LAB,80299,ADALIMUMAB LEVEL FOR IBD,301,79.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,19.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,63.6,80% of total billed charges,19.27,24.24% of total billed charges,40.07,50.4% of total billed charges,59.63,75% of total billed charges,19.46,24.48% of total billed charges,15.14,Fee Schedule,19.08,24% of total billed charges,24.8,31.2% of total billed charges,63.6,80% of total billed charges,19.08,24% of total billed charges,19.08,24% of total billed charges,15.14,63.6,39.75
Outpatient Medical Services,LAB,80299,ESLICARBAZEPINE,301,356.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,15.14,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,15.14,285.2,178.25
Outpatient Medical Services,LAB,80299,DEXAMETHASONE,301,297.5,15.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,15.14,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,15.14,238,148.75
Outpatient Medical Services,LAB,80307,UDS CCH,301,243,61.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,61.16,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,58.32,194.4,121.5
Outpatient Medical Services,LAB,80307,"MEDICAL DRUG SCREEN & CONFIRM., URINE",301,243,61.16,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,61.16,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,58.32,194.4,121.5
Outpatient Medical Services,LAB,80320,METHANOL,301,76,13.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,60.8,80% of total billed charges,18.42,24.24% of total billed charges,38.3,50.4% of total billed charges,57,75% of total billed charges,18.6,24.48% of total billed charges,13.59,Fee Schedule,18.24,24% of total billed charges,23.71,31.2% of total billed charges,60.8,80% of total billed charges,18.24,24% of total billed charges,18.24,24% of total billed charges,13.59,60.8,38
Outpatient Medical Services,LAB,80321,ETHYL GLUCURONIDE UA,301,438,13.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,105.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,350.4,80% of total billed charges,106.17,24.24% of total billed charges,220.75,50.4% of total billed charges,328.5,75% of total billed charges,107.22,24.48% of total billed charges,13.59,Fee Schedule,105.12,24% of total billed charges,136.66,31.2% of total billed charges,350.4,80% of total billed charges,105.12,24% of total billed charges,105.12,24% of total billed charges,13.59,350.4,219
Outpatient Medical Services,LAB,80335,AMITRIPTYLINE,301,166,22.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,22.51,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,22.51,132.8,83
Outpatient Medical Services,LAB,80346,CLONAZEPAM,301,119.5,23.26,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,23.26,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,23.26,95.6,59.75
Outpatient Medical Services,LAB,81479,CYP2B6 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,CACNA1C GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,UGT2B15 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,COMT GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,OPRM1 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ABCG2 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,LPA GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,NOS3 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,12Q15 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ANKKI/DRD2 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ADRA2A GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,SLC6A4 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,FKBP5 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,BDNF GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ANK3 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,5HT2A GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,DRD2 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,GRIK4 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,HTR2A GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,HTR2C GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ANKK1 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ADH1B GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ALDH2 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,C11orF65 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,CYP2C8 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,DBH GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,CPY2B86 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,GRIK1 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,GRIN2B GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,SCN1A GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,SLC47A2 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ALC6A4 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,TPMT GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,81479,ITGB3 GENE,301,277,890.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,221.6,80% of total billed charges,67.14,24.24% of total billed charges,139.61,50.4% of total billed charges,207.75,75% of total billed charges,67.81,24.48% of total billed charges,890.08,Fee Schedule,66.48,24% of total billed charges,86.42,31.2% of total billed charges,221.6,80% of total billed charges,66.48,24% of total billed charges,66.48,24% of total billed charges,66.48,890.08,138.5
Outpatient Medical Services,LAB,82009,SERUM ACETONE,301,101,4.13,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.13,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.13,80.8,50.5
Outpatient Medical Services,LAB,82024,CORTICOTROPIN,301,415,48.57,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,99.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,332,80% of total billed charges,100.6,24.24% of total billed charges,209.16,50.4% of total billed charges,311.25,75% of total billed charges,101.59,24.48% of total billed charges,48.57,Fee Schedule,99.6,24% of total billed charges,129.48,31.2% of total billed charges,332,80% of total billed charges,99.6,24% of total billed charges,99.6,24% of total billed charges,48.57,332,207.5
Outpatient Medical Services,LAB,82040,ALBUMIN,301,101,3.62,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,3.62,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,3.62,80.8,50.5
Outpatient Medical Services,LAB,82043,MICRO/CREAT RATIO 24 HR,301,166,7.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,7.28,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,7.28,132.8,83
Outpatient Medical Services,LAB,82043,MICRO/CREAT RATIO,301,114.5,7.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,7.28,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,7.28,91.6,57.25
Outpatient Medical Services,LAB,82043,"MICROALBUMIN w/o CREATININE, 24 HR URINE",301,20.5,7.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.4,80% of total billed charges,4.97,24.24% of total billed charges,10.33,50.4% of total billed charges,15.38,75% of total billed charges,5.02,24.48% of total billed charges,7.28,Fee Schedule,4.92,24% of total billed charges,6.4,31.2% of total billed charges,16.4,80% of total billed charges,4.92,24% of total billed charges,4.92,24% of total billed charges,4.92,16.4,10.25
Outpatient Medical Services,LAB,82043,"MICROALBUMIN, URINE QUANT",301,114.5,7.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,7.28,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,7.28,91.6,57.25
Outpatient Medical Services,LAB,82077,BLOOD ALCOHOL,301,101,13.82,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,13.82,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,13.82,80.8,50.5
Outpatient Medical Services,LAB,82085,..ZZ TEST TSH QUEST,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST CMP QUEST,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST SALMONELLA SHIGELLA,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST CULTURE BLOOD,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST HSV QUEST,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST PTH INTACT QUEST,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST VITAMIN D QUEST,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,..ZZ TEST CULTURE AEROBIC GS,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82085,ALDOLASE,301,119.5,12.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,12.2,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,12.2,95.6,59.75
Outpatient Medical Services,LAB,82088,ALDOSTERONE,301,356.5,51.25,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,51.25,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,51.25,285.2,178.25
Outpatient Medical Services,LAB,82103,"ALPHA 1 ANTITRYPSIN, QUANT",301,166,16.89,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,16.89,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,16.89,132.8,83
Outpatient Medical Services,LAB,82104,A1A WITH PHENO,301,166,18.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.18,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.18,132.8,83
Outpatient Medical Services,LAB,82105,ALPHA FETOPROTEIN,301,342,21.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,273.6,80% of total billed charges,82.9,24.24% of total billed charges,172.37,50.4% of total billed charges,256.5,75% of total billed charges,83.72,24.48% of total billed charges,21.1,Fee Schedule,82.08,24% of total billed charges,106.7,31.2% of total billed charges,273.6,80% of total billed charges,82.08,24% of total billed charges,82.08,24% of total billed charges,21.1,273.6,171
Outpatient Medical Services,LAB,82108,ALUMINUM,301,166,21.2,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.2,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.2,132.8,83
Outpatient Medical Services,LAB,82131,URINE 24 HR CYSTINE,301,119.5,21.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,21.21,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,21.21,95.6,59.75
Outpatient Medical Services,LAB,82131,URINE CYSTINE,301,119.5,21.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,21.21,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,21.21,95.6,59.75
Outpatient Medical Services,LAB,82140,AMMONIA,301,170,12.44,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,12.44,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,12.44,136,85
Outpatient Medical Services,LAB,82140,AMMONIA (SCP),301,21.5,12.44,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,5.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,12.44,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,5.16,17.2,10.75
Outpatient Medical Services,LAB,82150,URINE AMYLASE,301,141,8.15,Fee Schedule,105.75,75% of total billed charges,105.75,75% of total billed charges,33.84,24% of total billed charges,105.75,75% of total billed charges,105.75,75% of total billed charges,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,8.15,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,8.15,112.8,70.5
Outpatient Medical Services,LAB,82150,AMYLASE,301,130,8.15,Fee Schedule,97.5,75% of total billed charges,97.5,75% of total billed charges,31.2,24% of total billed charges,97.5,75% of total billed charges,97.5,75% of total billed charges,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,8.15,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,8.15,104,65
Outpatient Medical Services,LAB,82150,AMYLASE ISO,301,166,8.15,Fee Schedule,124.5,75% of total billed charges,124.5,75% of total billed charges,39.84,24% of total billed charges,124.5,75% of total billed charges,124.5,75% of total billed charges,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,8.15,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,8.15,132.8,83
Outpatient Medical Services,LAB,82150,AMYLASE (SCP),301,14.5,8.15,Fee Schedule,10.88,75% of total billed charges,10.88,75% of total billed charges,3.48,24% of total billed charges,10.88,75% of total billed charges,10.88,75% of total billed charges,11.6,80% of total billed charges,3.51,24.24% of total billed charges,7.31,50.4% of total billed charges,10.88,75% of total billed charges,3.55,24.48% of total billed charges,8.15,Fee Schedule,3.48,24% of total billed charges,4.52,31.2% of total billed charges,11.6,80% of total billed charges,3.48,24% of total billed charges,3.48,24% of total billed charges,3.48,11.6,7.25
Outpatient Medical Services,LAB,82164,ACE,301,166,18.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,18.35,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,18.35,132.8,83
Outpatient Medical Services,LAB,82172,APOLIPROTEIN B,301,203,19.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,162.4,80% of total billed charges,49.21,24.24% of total billed charges,102.31,50.4% of total billed charges,152.25,75% of total billed charges,49.69,24.48% of total billed charges,19.49,Fee Schedule,48.72,24% of total billed charges,63.34,31.2% of total billed charges,162.4,80% of total billed charges,48.72,24% of total billed charges,48.72,24% of total billed charges,19.49,162.4,101.5
Outpatient Medical Services,LAB,82172,APOLIPROTEIN A,301,203,19.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,162.4,80% of total billed charges,49.21,24.24% of total billed charges,102.31,50.4% of total billed charges,152.25,75% of total billed charges,49.69,24.48% of total billed charges,19.49,Fee Schedule,48.72,24% of total billed charges,63.34,31.2% of total billed charges,162.4,80% of total billed charges,48.72,24% of total billed charges,48.72,24% of total billed charges,19.49,162.4,101.5
Outpatient Medical Services,LAB,82175,ARSENIC,301,226.5,23.86,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,181.2,80% of total billed charges,54.9,24.24% of total billed charges,114.16,50.4% of total billed charges,169.88,75% of total billed charges,55.45,24.48% of total billed charges,23.86,Fee Schedule,54.36,24% of total billed charges,70.67,31.2% of total billed charges,181.2,80% of total billed charges,54.36,24% of total billed charges,54.36,24% of total billed charges,23.86,181.2,113.25
Outpatient Medical Services,LAB,82232,BETA 2 MICROGLOBULIN,301,203,20.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,162.4,80% of total billed charges,49.21,24.24% of total billed charges,102.31,50.4% of total billed charges,152.25,75% of total billed charges,49.69,24.48% of total billed charges,20.35,Fee Schedule,48.72,24% of total billed charges,63.34,31.2% of total billed charges,162.4,80% of total billed charges,48.72,24% of total billed charges,48.72,24% of total billed charges,20.35,162.4,101.5
Outpatient Medical Services,LAB,82247,TOTAL BILIRUBIN,301,144,6.32,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,6.32,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,6.32,115.2,72
Outpatient Medical Services,LAB,82247,BILIRUBIN TOTAL (SCP),301,11.5,6.32,Fee Schedule,8.63,75% of total billed charges,8.63,75% of total billed charges,2.76,24% of total billed charges,8.63,75% of total billed charges,8.63,75% of total billed charges,9.2,80% of total billed charges,2.79,24.24% of total billed charges,5.8,50.4% of total billed charges,8.63,75% of total billed charges,2.82,24.48% of total billed charges,6.32,Fee Schedule,2.76,24% of total billed charges,3.59,31.2% of total billed charges,9.2,80% of total billed charges,2.76,24% of total billed charges,2.76,24% of total billed charges,2.76,9.2,5.75
Outpatient Medical Services,LAB,82248,DIRECT BILIRUBIN,301,144,6.32,Fee Schedule,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,6.32,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,6.32,115.2,72
Outpatient Medical Services,LAB,82248,DIRECT BILIRUBIN (SCP),301,11.5,6.32,Fee Schedule,8.63,75% of total billed charges,8.63,75% of total billed charges,2.76,24% of total billed charges,8.63,75% of total billed charges,8.63,75% of total billed charges,9.2,80% of total billed charges,2.79,24.24% of total billed charges,5.8,50.4% of total billed charges,8.63,75% of total billed charges,2.82,24.48% of total billed charges,6.32,Fee Schedule,2.76,24% of total billed charges,3.59,31.2% of total billed charges,9.2,80% of total billed charges,2.76,24% of total billed charges,2.76,24% of total billed charges,2.76,9.2,5.75
Outpatient Medical Services,LAB,82270,OCCULT BLOOD,301,101,4.04,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.04,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.04,80.8,50.5
Outpatient Medical Services,LAB,82271,GASTROCCULT,301,101,4.04,Fee Schedule,75.75,75% of total billed charges,75.75,75% of total billed charges,24.24,24% of total billed charges,75.75,75% of total billed charges,75.75,75% of total billed charges,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,4.04,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,4.04,80.8,50.5
Outpatient Medical Services,LAB,82300,CADMIUM,301,188.5,29.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,29.1,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,29.1,150.8,94.25
Outpatient Medical Services,LAB,82306,VITAMIN D 25 OH,301,357.5,37.22,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,286,80% of total billed charges,86.66,24.24% of total billed charges,180.18,50.4% of total billed charges,268.13,75% of total billed charges,87.52,24.48% of total billed charges,37.22,Fee Schedule,85.8,24% of total billed charges,111.54,31.2% of total billed charges,286,80% of total billed charges,85.8,24% of total billed charges,85.8,24% of total billed charges,37.22,286,178.75
Outpatient Medical Services,LAB,82308,CALCITONIN,301,284.5,33.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,33.67,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,33.67,227.6,142.25
Outpatient Medical Services,LAB,82310,CALCIUM,301,101,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,6.35,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,6.35,80.8,50.5
Outpatient Medical Services,LAB,82330,IONIZED CALCIUM,301,170,17.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,40.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,136,80% of total billed charges,41.21,24.24% of total billed charges,85.68,50.4% of total billed charges,127.5,75% of total billed charges,41.62,24.48% of total billed charges,17.18,Fee Schedule,40.8,24% of total billed charges,53.04,31.2% of total billed charges,136,80% of total billed charges,40.8,24% of total billed charges,40.8,24% of total billed charges,17.18,136,85
Outpatient Medical Services,LAB,82340,"URINE CALCIUM, RANDOM",301,108,7.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,7.59,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,7.59,86.4,54
Outpatient Medical Services,LAB,82340,"URINE CALCIUM, 24 hour",301,108,7.59,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,7.59,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,7.59,86.4,54
Outpatient Medical Services,LAB,82365,RENAL STONE ANALYSIS,301,108,16.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,16.21,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,16.21,86.4,54
Outpatient Medical Services,LAB,82374,BICARBONATE [MOLES/VOLUME] IN ARTERIAL B,301,83.5,6.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,6.15,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,6.15,66.8,41.75
Outpatient Medical Services,LAB,82374,CO2,301,59.5,6.15,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,6.15,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,6.15,47.6,29.75
Outpatient Medical Services,LAB,82375,CARBOXYHEMOGLOBIN,301,141,3.62,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,33.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112.8,80% of total billed charges,34.18,24.24% of total billed charges,71.06,50.4% of total billed charges,105.75,75% of total billed charges,34.52,24.48% of total billed charges,3.62,Fee Schedule,33.84,24% of total billed charges,43.99,31.2% of total billed charges,112.8,80% of total billed charges,33.84,24% of total billed charges,33.84,24% of total billed charges,3.62,112.8,70.5
Outpatient Medical Services,LAB,82378,CEA,301,214,23.86,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,23.86,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,23.86,171.2,107
Outpatient Medical Services,LAB,82378,"CEA, PERITONEAL FLUID",301,214,23.86,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,23.86,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,23.86,171.2,107
Outpatient Medical Services,LAB,82378,"CEA, PANCREATIC CYST FLUID",301,214,23.86,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,171.2,80% of total billed charges,51.87,24.24% of total billed charges,107.86,50.4% of total billed charges,160.5,75% of total billed charges,52.39,24.48% of total billed charges,23.86,Fee Schedule,51.36,24% of total billed charges,66.77,31.2% of total billed charges,171.2,80% of total billed charges,51.36,24% of total billed charges,51.36,24% of total billed charges,23.86,171.2,107
Outpatient Medical Services,LAB,82379,CARNITINE,301,237,21.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,21.21,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,21.21,189.6,118.5
Outpatient Medical Services,LAB,82380,CAROTENE,301,166,11.6,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,11.6,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,11.6,132.8,83
Outpatient Medical Services,LAB,82384,NOREPINEPHRINE,301,356.5,31.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,85.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,31.75,Fee Schedule,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,31.75,285.2,178.25
Outpatient Medical Services,LAB,82384,"CATECHOLAMINES, FRAC, PLASMA",301,99,31.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,79.2,80% of total billed charges,24,24.24% of total billed charges,49.9,50.4% of total billed charges,74.25,75% of total billed charges,24.24,24.48% of total billed charges,31.75,Fee Schedule,23.76,24% of total billed charges,30.89,31.2% of total billed charges,79.2,80% of total billed charges,23.76,24% of total billed charges,23.76,24% of total billed charges,23.76,79.2,49.5
Outpatient Medical Services,LAB,82384,"CATECHOLAMINES, FRAC, 24 HR URINE",301,99,31.75,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,23.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,79.2,80% of total billed charges,24,24.24% of total billed charges,49.9,50.4% of total billed charges,74.25,75% of total billed charges,24.24,24.48% of total billed charges,31.75,Fee Schedule,23.76,24% of total billed charges,30.89,31.2% of total billed charges,79.2,80% of total billed charges,23.76,24% of total billed charges,23.76,24% of total billed charges,23.76,79.2,49.5
Outpatient Medical Services,LAB,82390,CERULOPLASMIN,301,108,13.51,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,13.51,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,13.51,86.4,54
Outpatient Medical Services,LAB,82397,ANTI-MULLERIAN HORMONE,301,173,17.77,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,41.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,138.4,80% of total billed charges,41.94,24.24% of total billed charges,87.19,50.4% of total billed charges,129.75,75% of total billed charges,42.35,24.48% of total billed charges,17.77,Fee Schedule,41.52,24% of total billed charges,53.98,31.2% of total billed charges,138.4,80% of total billed charges,41.52,24% of total billed charges,41.52,24% of total billed charges,17.77,138.4,86.5
Outpatient Medical Services,LAB,82435,CHLORIDE,301,83.5,5.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,20.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66.8,80% of total billed charges,20.24,24.24% of total billed charges,42.08,50.4% of total billed charges,62.63,75% of total billed charges,20.44,24.48% of total billed charges,5.78,Fee Schedule,20.04,24% of total billed charges,26.05,31.2% of total billed charges,66.8,80% of total billed charges,20.04,24% of total billed charges,20.04,24% of total billed charges,5.78,66.8,41.75
Outpatient Medical Services,LAB,82436,URINE CHLORIDE,301,101,6.32,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,6.32,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,6.32,80.8,50.5
Outpatient Medical Services,LAB,82436,URINE 24 HR CHLORIDE,301,119.5,6.32,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,6.32,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,6.32,95.6,59.75
Outpatient Medical Services,LAB,82465,CHOLESTEROL,301,130,5.47,Fee Schedule,97.5,75% of total billed charges,97.5,75% of total billed charges,31.2,24% of total billed charges,97.5,75% of total billed charges,97.5,75% of total billed charges,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,5.47,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,5.47,104,65
Outpatient Medical Services,LAB,82465,CHOLESTEROL (SCP),301,12.5,5.47,Fee Schedule,9.38,75% of total billed charges,9.38,75% of total billed charges,3,24% of total billed charges,9.38,75% of total billed charges,9.38,75% of total billed charges,10,80% of total billed charges,3.03,24.24% of total billed charges,6.3,50.4% of total billed charges,9.38,75% of total billed charges,3.06,24.48% of total billed charges,5.47,Fee Schedule,3,24% of total billed charges,3.9,31.2% of total billed charges,10,80% of total billed charges,3,24% of total billed charges,3,24% of total billed charges,3,10,6.25
Outpatient Medical Services,LAB,82507,CITRATE,301,380,34.97,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,91.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,304,80% of total billed charges,92.11,24.24% of total billed charges,191.52,50.4% of total billed charges,285,75% of total billed charges,93.02,24.48% of total billed charges,34.97,Fee Schedule,91.2,24% of total billed charges,118.56,31.2% of total billed charges,304,80% of total billed charges,91.2,24% of total billed charges,91.2,24% of total billed charges,34.97,304,190
Outpatient Medical Services,LAB,82507,"URINE CITRIC ACID, 24 HR",301,73,34.97,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,34.97,Fee Schedule,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,LAB,82525,COPPER,301,166,15.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,15.61,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,15.61,132.8,83
Outpatient Medical Services,LAB,82530,URINE CORTISOL FREE,301,166,21.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.02,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.02,132.8,83
Outpatient Medical Services,LAB,82530,"CORTISOL, SALIVA",301,419,21.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,100.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,335.2,80% of total billed charges,101.57,24.24% of total billed charges,211.18,50.4% of total billed charges,314.25,75% of total billed charges,102.57,24.48% of total billed charges,21.02,Fee Schedule,100.56,24% of total billed charges,130.73,31.2% of total billed charges,335.2,80% of total billed charges,100.56,24% of total billed charges,100.56,24% of total billed charges,21.02,335.2,209.5
Outpatient Medical Services,LAB,82530,CORTISOL FREE (SERUM),301,166,21.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.02,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.02,132.8,83
Outpatient Medical Services,LAB,82530,CORTISOL FREE 24 HR URINE,301,166,21.02,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,21.02,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,21.02,132.8,83
Outpatient Medical Services,LAB,82533,CORTISOL,301,144,20.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,20.5,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,20.5,115.2,72
Outpatient Medical Services,LAB,82533,"CORTISOL, A.M.",301,144,20.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,34.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,20.5,Fee Schedule,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,20.5,115.2,72
Outpatient Medical Services,LAB,82540,CREATINE SERUM,301,213,5.83,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,5.83,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,5.83,170.4,106.5
Outpatient Medical Services,LAB,82550,CPK,301,114.5,6.35,Fee Schedule,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,6.35,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,6.35,91.6,57.25
Outpatient Medical Services,LAB,82550,CPK (SCP),301,14.5,6.35,Fee Schedule,10.88,75% of total billed charges,10.88,75% of total billed charges,3.48,24% of total billed charges,10.88,75% of total billed charges,10.88,75% of total billed charges,11.6,80% of total billed charges,3.51,24.24% of total billed charges,7.31,50.4% of total billed charges,10.88,75% of total billed charges,3.55,24.48% of total billed charges,6.35,Fee Schedule,3.48,24% of total billed charges,4.52,31.2% of total billed charges,11.6,80% of total billed charges,3.48,24% of total billed charges,3.48,24% of total billed charges,3.48,11.6,7.25
Outpatient Medical Services,LAB,82552,CPK ISOENZYMES,301,213,16.84,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,51.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,170.4,80% of total billed charges,51.63,24.24% of total billed charges,107.35,50.4% of total billed charges,159.75,75% of total billed charges,52.14,24.48% of total billed charges,16.84,Fee Schedule,51.12,24% of total billed charges,66.46,31.2% of total billed charges,170.4,80% of total billed charges,51.12,24% of total billed charges,51.12,24% of total billed charges,16.84,170.4,106.5
Outpatient Medical Services,LAB,82553,CKMB,301,226.5,14.52,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,54.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,181.2,80% of total billed charges,54.9,24.24% of total billed charges,114.16,50.4% of total billed charges,169.88,75% of total billed charges,55.45,24.48% of total billed charges,14.52,Fee Schedule,54.36,24% of total billed charges,70.67,31.2% of total billed charges,181.2,80% of total billed charges,54.36,24% of total billed charges,54.36,24% of total billed charges,14.52,181.2,113.25
Outpatient Medical Services,LAB,82565,CREATININE,301,101,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,24.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,80.8,80% of total billed charges,24.48,24.24% of total billed charges,50.9,50.4% of total billed charges,75.75,75% of total billed charges,24.72,24.48% of total billed charges,6.35,Fee Schedule,24.24,24% of total billed charges,31.51,31.2% of total billed charges,80.8,80% of total billed charges,24.24,24% of total billed charges,24.24,24% of total billed charges,6.35,80.8,50.5
Outpatient Medical Services,LAB,82565,GLOMERULAR FILTRATION RATE/1 73 SQ M PRE,301,N/A,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,6.35,6.35,N/A
Outpatient Medical Services,LAB,82565,CREATININE - EPOC,301,18.5,6.35,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.8,80% of total billed charges,4.48,24.24% of total billed charges,9.32,50.4% of total billed charges,13.88,75% of total billed charges,4.53,24.48% of total billed charges,6.35,Fee Schedule,4.44,24% of total billed charges,5.77,31.2% of total billed charges,14.8,80% of total billed charges,4.44,24% of total billed charges,4.44,24% of total billed charges,4.44,14.8,9.25
Outpatient Medical Services,LAB,82570,URINE CREATININE,301,114.5,6.51,Fee Schedule,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,6.51,Fee Schedule,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,6.51,91.6,57.25
Outpatient Medical Services,LAB,82570,URINE 24 HR CREAT,301,119.5,6.51,Fee Schedule,89.63,75% of total billed charges,89.63,75% of total billed charges,28.68,24% of total billed charges,89.63,75% of total billed charges,89.63,75% of total billed charges,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,6.51,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,6.51,95.6,59.75
Outpatient Medical Services,LAB,82575,CREATININE CLEARANCE,301,166,11.88,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,11.88,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,11.88,132.8,83
Outpatient Medical Services,LAB,82595,CRYOGLOBULIN,301,108,8.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,8.14,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,8.14,86.4,54
Outpatient Medical Services,LAB,82607,VITAMIN B12,301,255.5,18.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,61.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,204.4,80% of total billed charges,61.93,24.24% of total billed charges,128.77,50.4% of total billed charges,191.63,75% of total billed charges,62.55,24.48% of total billed charges,18.95,Fee Schedule,61.32,24% of total billed charges,79.72,31.2% of total billed charges,204.4,80% of total billed charges,61.32,24% of total billed charges,61.32,24% of total billed charges,18.95,204.4,127.75
Outpatient Medical Services,LAB,82607,VITAMIN B12 (SCP),301,33,18.95,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,7.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,80% of total billed charges,8,24.24% of total billed charges,16.63,50.4% of total billed charges,24.75,75% of total billed charges,8.08,24.48% of total billed charges,18.95,Fee Schedule,7.92,24% of total billed charges,10.3,31.2% of total billed charges,26.4,80% of total billed charges,7.92,24% of total billed charges,7.92,24% of total billed charges,7.92,26.4,16.5
Outpatient Medical Services,LAB,82626,"DHEA, UNCONJUGATED",301,345,31.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,276,80% of total billed charges,83.63,24.24% of total billed charges,173.88,50.4% of total billed charges,258.75,75% of total billed charges,84.46,24.48% of total billed charges,31.78,Fee Schedule,82.8,24% of total billed charges,107.64,31.2% of total billed charges,276,80% of total billed charges,82.8,24% of total billed charges,82.8,24% of total billed charges,31.78,276,172.5
Outpatient Medical Services,LAB,82627,DHEA S,301,345,27.96,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,276,80% of total billed charges,83.63,24.24% of total billed charges,173.88,50.4% of total billed charges,258.75,75% of total billed charges,84.46,24.48% of total billed charges,27.96,Fee Schedule,82.8,24% of total billed charges,107.64,31.2% of total billed charges,276,80% of total billed charges,82.8,24% of total billed charges,82.8,24% of total billed charges,27.96,276,172.5
Outpatient Medical Services,LAB,82652,"VITAMIN D 1,25",301,243,48.4,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,58.32,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,194.4,80% of total billed charges,58.9,24.24% of total billed charges,122.47,50.4% of total billed charges,182.25,75% of total billed charges,59.49,24.48% of total billed charges,48.4,Fee Schedule,58.32,24% of total billed charges,75.82,31.2% of total billed charges,194.4,80% of total billed charges,58.32,24% of total billed charges,58.32,24% of total billed charges,48.4,194.4,121.5
Outpatient Medical Services,LAB,82668,ERYTHROPOIETIN,301,237,23.63,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,56.88,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,23.63,Fee Schedule,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,23.63,189.6,118.5
Outpatient Medical Services,LAB,82670,"ESTRADIOL, TOTAL",301,188.5,35.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,35.14,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,35.14,150.8,94.25
Outpatient Medical Services,LAB,82670,"ESTRADIOL, FREE",301,188.5,35.14,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,35.14,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,35.14,150.8,94.25
Outpatient Medical Services,LAB,82677,ESTRIOL,301,119.5,30.41,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,30.41,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,28.68,95.6,59.75
Outpatient Medical Services,LAB,82679,ESTRONE SULFATE,301,119.5,31.39,Fee Schedule,89.63,75% of total billed charges,89.63,75% of total billed charges,28.68,24% of total billed charges,89.63,75% of total billed charges,89.63,75% of total billed charges,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,31.39,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,28.68,95.6,59.75
Outpatient Medical Services,LAB,82693,ETHYLENE GLYCOL,301,297.5,18.74,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,71.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,238,80% of total billed charges,72.11,24.24% of total billed charges,149.94,50.4% of total billed charges,223.13,75% of total billed charges,72.83,24.48% of total billed charges,18.74,Fee Schedule,71.4,24% of total billed charges,92.82,31.2% of total billed charges,238,80% of total billed charges,71.4,24% of total billed charges,71.4,24% of total billed charges,18.74,238,148.75
Outpatient Medical Services,LAB,82705,FECAL FAT,301,284.5,6.4,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,68.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,227.6,80% of total billed charges,68.96,24.24% of total billed charges,143.39,50.4% of total billed charges,213.38,75% of total billed charges,69.65,24.48% of total billed charges,6.4,Fee Schedule,68.28,24% of total billed charges,88.76,31.2% of total billed charges,227.6,80% of total billed charges,68.28,24% of total billed charges,68.28,24% of total billed charges,6.4,227.6,142.25
Outpatient Medical Services,LAB,82726,PHYTANIC ACID,301,119.5,7.55,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,28.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.6,80% of total billed charges,28.97,24.24% of total billed charges,60.23,50.4% of total billed charges,89.63,75% of total billed charges,29.25,24.48% of total billed charges,7.55,Fee Schedule,28.68,24% of total billed charges,37.28,31.2% of total billed charges,95.6,80% of total billed charges,28.68,24% of total billed charges,28.68,24% of total billed charges,7.55,95.6,59.75
Outpatient Medical Services,LAB,82728,FERRITIN,301,199,17.13,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,17.13,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,17.13,159.2,99.5
Outpatient Medical Services,LAB,82746,FOLATE,301,199,18.49,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,18.49,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,18.49,159.2,99.5
Outpatient Medical Services,LAB,82747,RBC FOLATE,301,188.5,21.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.24,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,150.8,80% of total billed charges,45.69,24.24% of total billed charges,95,50.4% of total billed charges,141.38,75% of total billed charges,46.14,24.48% of total billed charges,21.78,Fee Schedule,45.24,24% of total billed charges,58.81,31.2% of total billed charges,150.8,80% of total billed charges,45.24,24% of total billed charges,45.24,24% of total billed charges,21.78,150.8,94.25
Outpatient Medical Services,LAB,82784,IGD,301,166,11.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,11.69,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,11.69,132.8,83
Outpatient Medical Services,LAB,82784,IGA,301,199,11.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,11.69,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,11.69,159.2,99.5
Outpatient Medical Services,LAB,82784,IGG,301,199,11.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,11.69,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,11.69,159.2,99.5
Outpatient Medical Services,LAB,82784,IGM,301,199,11.69,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.76,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,11.69,Fee Schedule,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,11.69,159.2,99.5
Outpatient Medical Services,LAB,82785,IGE,301,166,20.71,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,39.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,132.8,80% of total billed charges,40.24,24.24% of total billed charges,83.66,50.4% of total billed charges,124.5,75% of total billed charges,40.64,24.48% of total billed charges,20.71,Fee Schedule,39.84,24% of total billed charges,51.79,31.2% of total billed charges,132.8,80% of total billed charges,39.84,24% of total billed charges,39.84,24% of total billed charges,20.71,132.8,83
Outpatient Medical Services,LAB,82787,IGG SUBCLASS 1,301,59.5,10.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,10.08,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,10.08,47.6,29.75
Outpatient Medical Services,LAB,82787,IGG SUBCLASS 3,301,59.5,10.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,10.08,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,10.08,47.6,29.75
Outpatient Medical Services,LAB,82787,IGG SUBCLASS 4,301,59.5,10.08,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.6,80% of total billed charges,14.42,24.24% of total billed charges,29.99,50.4% of total billed charges,44.63,75% of total billed charges,14.57,24.48% of total billed charges,10.08,Fee Schedule,14.28,24% of total billed charges,18.56,31.2% of total billed charges,47.6,80% of total billed charges,14.28,24% of total billed charges,14.28,24% of total billed charges,10.08,47.6,29.75
Outpatient Medical Services,LAB,82803,ARTERIAL BLOOD GAS,301,483,24.34,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,115.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,386.4,80% of total billed charges,117.08,24.24% of total billed charges,243.43,50.4% of total billed charges,362.25,75% of total billed charges,118.24,24.48% of total billed charges,24.34,Fee Schedule,115.92,24% of total billed charges,150.7,31.2% of total billed charges,386.4,80% of total billed charges,115.92,24% of total billed charges,115.92,24% of total billed charges,24.34,386.4,241.5
Outpatient Medical Services,LAB,82948,GLUCOMETER STRIP,301,21.5,3.99,Fee Schedule,16.13,75% of total billed charges,16.13,75% of total billed charges,5.16,24% of total billed charges,16.13,75% of total billed charges,16.13,75% of total billed charges,17.2,80% of total billed charges,5.21,24.24% of total billed charges,10.84,50.4% of total billed charges,16.13,75% of total billed charges,5.26,24.48% of total billed charges,3.99,Fee Schedule,5.16,24% of total billed charges,6.71,31.2% of total billed charges,17.2,80% of total billed charges,5.16,24% of total billed charges,5.16,24% of total billed charges,3.99,17.2,10.75
Outpatient Medical Services,LAB,83018,THALLIUM,301,77.5,27.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,18.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,62,80% of total billed charges,18.79,24.24% of total billed charges,39.06,50.4% of total billed charges,58.13,75% of total billed charges,18.97,24.48% of total billed charges,27.61,Fee Schedule,18.6,24% of total billed charges,24.18,31.2% of total billed charges,62,80% of total billed charges,18.6,24% of total billed charges,18.6,24% of total billed charges,18.6,62,38.75
Outpatient Medical Services,LAB,83520,ADALIMUMAB DRUG ANTIBODY,301,981.5,16.28,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,235.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,785.2,80% of total billed charges,237.92,24.24% of total billed charges,494.68,50.4% of total billed charges,736.13,75% of total billed charges,240.27,24.48% of total billed charges,16.28,Fee Schedule,235.56,24% of total billed charges,306.23,31.2% of total billed charges,785.2,80% of total billed charges,235.56,24% of total billed charges,235.56,24% of total billed charges,16.28,785.2,490.75
Outpatient Medical Services,LAB,83835,"METANEPHRINES, URINE, 24HR",301,72,21.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,21.3,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,17.28,57.6,36
Outpatient Medical Services,LAB,83930,OSMOLALITY SERUM,301,108,8.32,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,25.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,86.4,80% of total billed charges,26.18,24.24% of total billed charges,54.43,50.4% of total billed charges,81,75% of total billed charges,26.44,24.48% of total billed charges,8.32,Fee Schedule,25.92,24% of total billed charges,33.7,31.2% of total billed charges,86.4,80% of total billed charges,25.92,24% of total billed charges,25.92,24% of total billed charges,8.32,86.4,54
Outpatient Medical Services,LAB,83986,PH OF BLOOD,301,72,4.5,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,17.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,4.5,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,4.5,57.6,36
Outpatient Medical Services,LAB,83993,"CALPROTECTIN, STOOL",301,69,24.68,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,24.68,Fee Schedule,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,16.56,55.2,34.5
Outpatient Medical Services,LAB,84156,URINE TOTAL PROTEIN,301,130,4.61,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,31.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,104,80% of total billed charges,31.51,24.24% of total billed charges,65.52,50.4% of total billed charges,97.5,75% of total billed charges,31.82,24.48% of total billed charges,4.61,Fee Schedule,31.2,24% of total billed charges,40.56,31.2% of total billed charges,104,80% of total billed charges,31.2,24% of total billed charges,31.2,24% of total billed charges,4.61,104,65
Outpatient Medical Services,LAB,84252,"VITAMIN B2, RIBOFLAVIN",301,129,25.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,30.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,103.2,80% of total billed charges,31.27,24.24% of total billed charges,65.02,50.4% of total billed charges,96.75,75% of total billed charges,31.58,24.48% of total billed charges,25.45,Fee Schedule,30.96,24% of total billed charges,40.25,31.2% of total billed charges,103.2,80% of total billed charges,30.96,24% of total billed charges,30.96,24% of total billed charges,25.45,103.2,64.5
Outpatient Medical Services,LAB,84255,SELENIUM,301,110,32.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,88,80% of total billed charges,26.66,24.24% of total billed charges,55.44,50.4% of total billed charges,82.5,75% of total billed charges,26.93,24.48% of total billed charges,32.1,Fee Schedule,26.4,24% of total billed charges,34.32,31.2% of total billed charges,88,80% of total billed charges,26.4,24% of total billed charges,26.4,24% of total billed charges,26.4,88,55
Outpatient Medical Services,LAB,84484,..TROPONIN I,301,342,12.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,273.6,80% of total billed charges,82.9,24.24% of total billed charges,172.37,50.4% of total billed charges,256.5,75% of total billed charges,83.72,24.48% of total billed charges,12.38,Fee Schedule,82.08,24% of total billed charges,106.7,31.2% of total billed charges,273.6,80% of total billed charges,82.08,24% of total billed charges,82.08,24% of total billed charges,12.38,273.6,171
Outpatient Medical Services,LAB,84484,Troponin I - HS,301,342,12.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,82.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,273.6,80% of total billed charges,82.9,24.24% of total billed charges,172.37,50.4% of total billed charges,256.5,75% of total billed charges,83.72,24.48% of total billed charges,12.38,Fee Schedule,82.08,24% of total billed charges,106.7,31.2% of total billed charges,273.6,80% of total billed charges,82.08,24% of total billed charges,82.08,24% of total billed charges,12.38,273.6,171
Outpatient Medical Services,LAB,84591,VITAMIN E GAMMA,301,178,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,14.58,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,14.58,142.4,89
Outpatient Medical Services,LAB,84591,VITAMIN B7 (BIOTIN),301,178,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,14.58,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,14.58,142.4,89
Outpatient Medical Services,LAB,84591,VITAMIN B3,301,178,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,14.58,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,14.58,142.4,89
Outpatient Medical Services,LAB,84591,VITAMIN B5 (PANTOTHENIC ACID),301,178,14.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.72,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,14.58,Fee Schedule,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,14.58,142.4,89
Outpatient Medical Services,LAB,86226,ssDNA ANTIBODY (IGG),301,56.5,15.23,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,13.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,45.2,80% of total billed charges,13.7,24.24% of total billed charges,28.48,50.4% of total billed charges,42.38,75% of total billed charges,13.83,24.48% of total billed charges,15.23,Fee Schedule,13.56,24% of total billed charges,17.63,31.2% of total billed charges,45.2,80% of total billed charges,13.56,24% of total billed charges,13.56,24% of total billed charges,13.56,45.2,28.25
Outpatient Medical Services,LAB,86317,"HEPATITIS B SURFACE ABY IMMUNITY, QUANT",301,52.5,15.09,Fee Schedule,39.38,75% of total billed charges,39.38,75% of total billed charges,12.6,24% of total billed charges,39.38,75% of total billed charges,39.38,75% of total billed charges,42,80% of total billed charges,12.73,24.24% of total billed charges,26.46,50.4% of total billed charges,39.38,75% of total billed charges,12.85,24.48% of total billed charges,15.09,Fee Schedule,12.6,24% of total billed charges,16.38,31.2% of total billed charges,42,80% of total billed charges,12.6,24% of total billed charges,12.6,24% of total billed charges,12.6,42,26.25
Outpatient Medical Services,LAB,86769,SARS CoV-2 IgG (QUEST),301,133,51.31,Fee Schedule,99.75,75% of total billed charges,99.75,75% of total billed charges,31.92,24% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,51.31,Fee Schedule,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,31.92,106.4,66.5
Outpatient Medical Services,LAB,86769,SARS CoV-2 IgG (CCH),301,196.5,51.31,Fee Schedule,147.38,75% of total billed charges,147.38,75% of total billed charges,47.16,24% of total billed charges,147.38,75% of total billed charges,147.38,75% of total billed charges,157.2,80% of total billed charges,47.63,24.24% of total billed charges,99.04,50.4% of total billed charges,147.38,75% of total billed charges,48.1,24.48% of total billed charges,51.31,Fee Schedule,47.16,24% of total billed charges,61.31,31.2% of total billed charges,157.2,80% of total billed charges,47.16,24% of total billed charges,47.16,24% of total billed charges,47.16,157.2,98.25
Outpatient Medical Services,LAB,87426,SARS CoV2 ANTIGEN - DODGE COUNTY,301,227.5,36.18,Fee Schedule,170.63,75% of total billed charges,170.63,75% of total billed charges,54.6,24% of total billed charges,170.63,75% of total billed charges,170.63,75% of total billed charges,182,80% of total billed charges,55.15,24.24% of total billed charges,114.66,50.4% of total billed charges,170.63,75% of total billed charges,55.69,24.48% of total billed charges,36.18,Fee Schedule,54.6,24% of total billed charges,70.98,31.2% of total billed charges,182,80% of total billed charges,54.6,24% of total billed charges,54.6,24% of total billed charges,36.18,182,113.75
Outpatient Medical Services,LAB,86580,PPD TEST (TUBERCULIN) 0.1ML,302,63,8.13,Fee Schedule,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,8.13,Fee Schedule,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,8.13,50.4,31.5
Outpatient Medical Services,LAB,86671,"SACCHAROMYCES CEREVISIAE ABS, IGG/IGA",302,N/A,15.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.42,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,15.42,15.42,N/A
Outpatient Medical Services,LAB,86794,ZIKA VIRUS ANTIBODY IGM,302,318.5,16.64,Fee Schedule,238.88,75% of total billed charges,238.88,75% of total billed charges,76.44,24% of total billed charges,238.88,75% of total billed charges,238.88,75% of total billed charges,254.8,80% of total billed charges,77.2,24.24% of total billed charges,160.52,50.4% of total billed charges,238.88,75% of total billed charges,77.97,24.48% of total billed charges,16.64,Fee Schedule,76.44,24% of total billed charges,99.37,31.2% of total billed charges,254.8,80% of total billed charges,76.44,24% of total billed charges,76.44,24% of total billed charges,16.64,254.8,159.25
Outpatient Medical Services,LAB,87496,CMV PCR QUAL,306,306,24.67,Fee Schedule,229.5,75% of total billed charges,229.5,75% of total billed charges,73.44,24% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,244.8,80% of total billed charges,74.17,24.24% of total billed charges,154.22,50.4% of total billed charges,229.5,75% of total billed charges,74.91,24.48% of total billed charges,24.67,Fee Schedule,73.44,24% of total billed charges,95.47,31.2% of total billed charges,244.8,80% of total billed charges,73.44,24% of total billed charges,73.44,24% of total billed charges,24.67,244.8,153
Outpatient Medical Services,LAB,81001,URINALYSIS BY DIPSTICK OR TABLET REAGENT,307,31,3.99,Fee Schedule,23.25,75% of total billed charges,23.25,75% of total billed charges,7.44,24% of total billed charges,23.25,75% of total billed charges,23.25,75% of total billed charges,24.8,80% of total billed charges,7.51,24.24% of total billed charges,15.62,50.4% of total billed charges,23.25,75% of total billed charges,7.59,24.48% of total billed charges,3.99,Fee Schedule,7.44,24% of total billed charges,9.67,31.2% of total billed charges,24.8,80% of total billed charges,7.44,24% of total billed charges,7.44,24% of total billed charges,3.99,24.8,15.5
Outpatient Medical Services,LAB,81001,URINE MICROSCOPIC REFLEX,307,86.5,3.99,Fee Schedule,64.88,75% of total billed charges,64.88,75% of total billed charges,20.76,24% of total billed charges,64.88,75% of total billed charges,64.88,75% of total billed charges,69.2,80% of total billed charges,20.97,24.24% of total billed charges,43.6,50.4% of total billed charges,64.88,75% of total billed charges,21.18,24.48% of total billed charges,3.99,Fee Schedule,20.76,24% of total billed charges,26.99,31.2% of total billed charges,69.2,80% of total billed charges,20.76,24% of total billed charges,20.76,24% of total billed charges,3.99,69.2,43.25
Outpatient Medical Services,LAB,81002,URINE ACETONE,307,72,3.21,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,3.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,3.21,57.6,36
Outpatient Medical Services,LAB,81002,URINE BILE,307,72,3.21,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,3.21,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,3.21,57.6,36
Outpatient Medical Services,LAB,81002,URINE DIPSTICK TEST,307,N/A,3.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3.21,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,3.21,3.21,N/A
Outpatient Medical Services,LAB,81003,URINE SG,307,72,2.83,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.83,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.83,57.6,36
Outpatient Medical Services,LAB,81003,URINE DIPSTICK ANALYSIS CHG,307,72,2.83,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.83,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.83,57.6,36
Outpatient Medical Services,LAB,81003,URINE GLUCOSE,307,72,2.83,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.83,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.83,57.6,36
Outpatient Medical Services,LAB,81003,URINE BLOOD,307,72,2.83,Fee Schedule,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,2.83,Fee Schedule,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,2.83,57.6,36
Outpatient Medical Services,LAB,81225,CYP2C19 GENE,310,778.5,244,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,186.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,622.8,80% of total billed charges,188.71,24.24% of total billed charges,392.36,50.4% of total billed charges,583.88,75% of total billed charges,190.58,24.48% of total billed charges,244,Fee Schedule,186.84,24% of total billed charges,242.89,31.2% of total billed charges,622.8,80% of total billed charges,186.84,24% of total billed charges,186.84,24% of total billed charges,186.84,622.8,389.25
Outpatient Medical Services,LAB,81226,CYP2D6 GENE,310,1204,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,288.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,963.2,80% of total billed charges,291.85,24.24% of total billed charges,606.82,50.4% of total billed charges,903,75% of total billed charges,294.74,24.48% of total billed charges,40,Fee Schedule,288.96,24% of total billed charges,375.65,31.2% of total billed charges,963.2,80% of total billed charges,288.96,24% of total billed charges,288.96,24% of total billed charges,40,963.2,602
Outpatient Medical Services,LAB,81227,CYP2C9 GENE,310,466.5,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,111.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,373.2,80% of total billed charges,113.08,24.24% of total billed charges,235.12,50.4% of total billed charges,349.88,75% of total billed charges,114.2,24.48% of total billed charges,40,Fee Schedule,111.96,24% of total billed charges,145.55,31.2% of total billed charges,373.2,80% of total billed charges,111.96,24% of total billed charges,111.96,24% of total billed charges,40,373.2,233.25
Outpatient Medical Services,LAB,81230,CYP3A4 GENE,310,727,139.85,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,174.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,581.6,80% of total billed charges,176.22,24.24% of total billed charges,366.41,50.4% of total billed charges,545.25,75% of total billed charges,177.97,24.48% of total billed charges,139.85,Fee Schedule,174.48,24% of total billed charges,226.82,31.2% of total billed charges,581.6,80% of total billed charges,174.48,24% of total billed charges,174.48,24% of total billed charges,139.85,581.6,363.5
Outpatient Medical Services,LAB,81231,CYP3A5 GENE,310,727,139.85,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,174.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,581.6,80% of total billed charges,176.22,24.24% of total billed charges,366.41,50.4% of total billed charges,545.25,75% of total billed charges,177.97,24.48% of total billed charges,139.85,Fee Schedule,174.48,24% of total billed charges,226.82,31.2% of total billed charges,581.6,80% of total billed charges,174.48,24% of total billed charges,174.48,24% of total billed charges,139.85,581.6,363.5
Outpatient Medical Services,LAB,81291,MTHFR GENE,310,158.5,40,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,126.8,80% of total billed charges,38.42,24.24% of total billed charges,79.88,50.4% of total billed charges,118.88,75% of total billed charges,38.8,24.48% of total billed charges,40,Fee Schedule,38.04,24% of total billed charges,49.45,31.2% of total billed charges,126.8,80% of total billed charges,38.04,24% of total billed charges,38.04,24% of total billed charges,38.04,126.8,79.25
Outpatient Medical Services,LAB,81328,SLCO1B1 GENE,310,339,139.85,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,81.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,271.2,80% of total billed charges,82.17,24.24% of total billed charges,170.86,50.4% of total billed charges,254.25,75% of total billed charges,82.99,24.48% of total billed charges,139.85,Fee Schedule,81.36,24% of total billed charges,105.77,31.2% of total billed charges,271.2,80% of total billed charges,81.36,24% of total billed charges,81.36,24% of total billed charges,81.36,271.2,169.5
Outpatient Medical Services,LAB,81355,VKORC1 GENE,310,467.5,72,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,112.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,374,80% of total billed charges,113.32,24.24% of total billed charges,235.62,50.4% of total billed charges,350.63,75% of total billed charges,114.44,24.48% of total billed charges,72,Fee Schedule,112.2,24% of total billed charges,145.86,31.2% of total billed charges,374,80% of total billed charges,112.2,24% of total billed charges,112.2,24% of total billed charges,72,374,233.75
Outpatient Medical Services,LAB,81401,APOE GENE,310,727,112,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,174.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,581.6,80% of total billed charges,176.22,24.24% of total billed charges,366.41,50.4% of total billed charges,545.25,75% of total billed charges,177.97,24.48% of total billed charges,112,Fee Schedule,174.48,24% of total billed charges,226.82,31.2% of total billed charges,581.6,80% of total billed charges,174.48,24% of total billed charges,174.48,24% of total billed charges,112,581.6,363.5
Outpatient Medical Services,LAB,81402,CYP1A2 GENE,310,797,164,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,191.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,637.6,80% of total billed charges,193.19,24.24% of total billed charges,401.69,50.4% of total billed charges,597.75,75% of total billed charges,195.11,24.48% of total billed charges,164,Fee Schedule,191.28,24% of total billed charges,248.66,31.2% of total billed charges,637.6,80% of total billed charges,191.28,24% of total billed charges,191.28,24% of total billed charges,164,637.6,398.5
Outpatient Medical Services,LAB,88108,CYTO CONC SMEARS INTER,310,51.5,45.74,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,45.74,Fee Schedule,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,45.74,25.75
Outpatient Medical Services,LAB,88108,CYTO FLUIDS OTHER WASHINGS WITH CENTRIFU,310,159.5,45.74,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,38.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,127.6,80% of total billed charges,38.66,24.24% of total billed charges,80.39,50.4% of total billed charges,119.63,75% of total billed charges,39.05,24.48% of total billed charges,45.74,Fee Schedule,38.28,24% of total billed charges,49.76,31.2% of total billed charges,127.6,80% of total billed charges,38.28,24% of total billed charges,38.28,24% of total billed charges,38.28,127.6,79.75
Outpatient Medical Services,LAB,88300,PATH LEVEL 1 SURG 88300,310,204,14.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,48.96,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,163.2,80% of total billed charges,49.45,24.24% of total billed charges,102.82,50.4% of total billed charges,153,75% of total billed charges,49.94,24.48% of total billed charges,14.3,Fee Schedule,48.96,24% of total billed charges,63.65,31.2% of total billed charges,163.2,80% of total billed charges,48.96,24% of total billed charges,48.96,24% of total billed charges,14.3,163.2,102
Outpatient Medical Services,LAB,88302,PATH LEVEL II SURG  - 88302,310,409,35.06,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,98.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,327.2,80% of total billed charges,99.14,24.24% of total billed charges,206.14,50.4% of total billed charges,306.75,75% of total billed charges,100.12,24.48% of total billed charges,35.06,Fee Schedule,98.16,24% of total billed charges,127.61,31.2% of total billed charges,327.2,80% of total billed charges,98.16,24% of total billed charges,98.16,24% of total billed charges,35.06,327.2,204.5
Outpatient Medical Services,LAB,88302,PATH LEVEL II SURG  - 88302-TC,310,135.5,35.06,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,32.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,108.4,80% of total billed charges,32.85,24.24% of total billed charges,68.29,50.4% of total billed charges,101.63,75% of total billed charges,33.17,24.48% of total billed charges,35.06,Fee Schedule,32.52,24% of total billed charges,42.28,31.2% of total billed charges,108.4,80% of total billed charges,32.52,24% of total billed charges,32.52,24% of total billed charges,32.52,108.4,67.75
Outpatient Medical Services,LAB,88304,PATH LEVEL III SURG - 88304,310,419,30.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,100.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,335.2,80% of total billed charges,101.57,24.24% of total billed charges,211.18,50.4% of total billed charges,314.25,75% of total billed charges,102.57,24.48% of total billed charges,30.18,Fee Schedule,100.56,24% of total billed charges,130.73,31.2% of total billed charges,335.2,80% of total billed charges,100.56,24% of total billed charges,100.56,24% of total billed charges,30.18,335.2,209.5
Outpatient Medical Services,LAB,88304,PATH LEVEL III - 88304-TC,310,318.5,30.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,76.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,254.8,80% of total billed charges,77.2,24.24% of total billed charges,160.52,50.4% of total billed charges,238.88,75% of total billed charges,77.97,24.48% of total billed charges,30.18,Fee Schedule,76.44,24% of total billed charges,99.37,31.2% of total billed charges,254.8,80% of total billed charges,76.44,24% of total billed charges,76.44,24% of total billed charges,30.18,254.8,159.25
Outpatient Medical Services,LAB,88304,PATH LEVEL III SURG - 88304 TC,310,221.5,30.18,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,53.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,177.2,80% of total billed charges,53.69,24.24% of total billed charges,111.64,50.4% of total billed charges,166.13,75% of total billed charges,54.22,24.48% of total billed charges,30.18,Fee Schedule,53.16,24% of total billed charges,69.11,31.2% of total billed charges,177.2,80% of total billed charges,53.16,24% of total billed charges,53.16,24% of total billed charges,30.18,177.2,110.75
Outpatient Medical Services,LAB,88305,PATH LEVEL IV SURG  - 88305,310,503.5,65.88,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,120.84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,402.8,80% of total billed charges,122.05,24.24% of total billed charges,253.76,50.4% of total billed charges,377.63,75% of total billed charges,123.26,24.48% of total billed charges,65.88,Fee Schedule,120.84,24% of total billed charges,157.09,31.2% of total billed charges,402.8,80% of total billed charges,120.84,24% of total billed charges,120.84,24% of total billed charges,65.88,402.8,251.75
Outpatient Medical Services,LAB,88305,PATH LEVEL IV TECH CHG  - 88305-TC,310,350,65.88,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,280,80% of total billed charges,84.84,24.24% of total billed charges,176.4,50.4% of total billed charges,262.5,75% of total billed charges,85.68,24.48% of total billed charges,65.88,Fee Schedule,84,24% of total billed charges,109.2,31.2% of total billed charges,280,80% of total billed charges,84,24% of total billed charges,84,24% of total billed charges,65.88,280,175
Outpatient Medical Services,LAB,88307,PATH LEVEL V SURG  - 88307,310,721,133.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,173.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,576.8,80% of total billed charges,174.77,24.24% of total billed charges,363.38,50.4% of total billed charges,540.75,75% of total billed charges,176.5,24.48% of total billed charges,133.3,Fee Schedule,173.04,24% of total billed charges,224.95,31.2% of total billed charges,576.8,80% of total billed charges,173.04,24% of total billed charges,173.04,24% of total billed charges,133.3,576.8,360.5
Outpatient Medical Services,LAB,88307,PATH LEVEL V TECH CHG  - 88307-TC,310,350,133.3,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,84,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,280,80% of total billed charges,84.84,24.24% of total billed charges,176.4,50.4% of total billed charges,262.5,75% of total billed charges,85.68,24.48% of total billed charges,133.3,Fee Schedule,84,24% of total billed charges,109.2,31.2% of total billed charges,280,80% of total billed charges,84,24% of total billed charges,84,24% of total billed charges,84,280,175
Outpatient Medical Services,LAB,88309,PATH LEVEL VI SURG  - 88309,310,1564.5,187.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,375.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,1251.6,80% of total billed charges,379.23,24.24% of total billed charges,788.51,50.4% of total billed charges,1173.38,75% of total billed charges,382.99,24.48% of total billed charges,187.78,Fee Schedule,375.48,24% of total billed charges,488.12,31.2% of total billed charges,1251.6,80% of total billed charges,375.48,24% of total billed charges,375.48,24% of total billed charges,187.78,1251.6,782.25
Outpatient Medical Services,LAB,88309,PATH LEVEL VI SURG  - 88309-TC,310,262.5,187.78,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,63,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,210,80% of total billed charges,63.63,24.24% of total billed charges,132.3,50.4% of total billed charges,196.88,75% of total billed charges,64.26,24.48% of total billed charges,187.78,Fee Schedule,63,24% of total billed charges,81.9,31.2% of total billed charges,210,80% of total billed charges,63,24% of total billed charges,63,24% of total billed charges,63,210,131.25
Outpatient Medical Services,LAB,88104,CYTO FLUIDS WASHINGS-88104,311,51.5,42.68,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,12.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,42.68,Fee Schedule,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,42.68,25.75
Outpatient Medical Services,LAB,88104,URINE CYTOLOGY EXAM,311,147.5,42.68,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,35.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,118,80% of total billed charges,35.75,24.24% of total billed charges,74.34,50.4% of total billed charges,110.63,75% of total billed charges,36.11,24.48% of total billed charges,42.68,Fee Schedule,35.4,24% of total billed charges,46.02,31.2% of total billed charges,118,80% of total billed charges,35.4,24% of total billed charges,35.4,24% of total billed charges,35.4,118,73.75
Outpatient Medical Services,LAB,88112,BF CYTOLOGY,311,419,106.19,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,100.56,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,335.2,80% of total billed charges,101.57,24.24% of total billed charges,211.18,50.4% of total billed charges,314.25,75% of total billed charges,102.57,24.48% of total billed charges,106.19,Fee Schedule,100.56,24% of total billed charges,130.73,31.2% of total billed charges,335.2,80% of total billed charges,100.56,24% of total billed charges,100.56,24% of total billed charges,100.56,335.2,209.5
Outpatient Medical Services,LAB,88161,CYTOLOGY NON GYN SMEAR NIPPLE DISCHARGE,311,58.5,34.89,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,14.04,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,46.8,80% of total billed charges,14.18,24.24% of total billed charges,29.48,50.4% of total billed charges,43.88,75% of total billed charges,14.32,24.48% of total billed charges,34.89,Fee Schedule,14.04,24% of total billed charges,18.25,31.2% of total billed charges,46.8,80% of total billed charges,14.04,24% of total billed charges,14.04,24% of total billed charges,14.04,46.8,29.25
Outpatient Medical Services,LAB,88173,FNA INTERPRETATION AND REPORT,311,112.5,91.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,90,80% of total billed charges,27.27,24.24% of total billed charges,56.7,50.4% of total billed charges,84.38,75% of total billed charges,27.54,24.48% of total billed charges,91.58,Fee Schedule,27,24% of total billed charges,35.1,31.2% of total billed charges,90,80% of total billed charges,27,24% of total billed charges,27,24% of total billed charges,27,91.58,56.25
Outpatient Medical Services,LAB,88173,CYTOLOGY FNA NON GYN,311,515,91.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,123.6,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,412,80% of total billed charges,124.84,24.24% of total billed charges,259.56,50.4% of total billed charges,386.25,75% of total billed charges,126.07,24.48% of total billed charges,91.58,Fee Schedule,123.6,24% of total billed charges,160.68,31.2% of total billed charges,412,80% of total billed charges,123.6,24% of total billed charges,123.6,24% of total billed charges,91.58,412,257.5
Outpatient Medical Services,LAB,88182,DNA CELL CYCLE ANALYSIS,311,196.5,66.96,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,47.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,157.2,80% of total billed charges,47.63,24.24% of total billed charges,99.04,50.4% of total billed charges,147.38,75% of total billed charges,48.1,24.48% of total billed charges,66.96,Fee Schedule,47.16,24% of total billed charges,61.31,31.2% of total billed charges,157.2,80% of total billed charges,47.16,24% of total billed charges,47.16,24% of total billed charges,47.16,157.2,98.25
Outpatient Medical Services,LAB,88184,LEUK & LYMPH MARKERS - 88184,312,82.5,46.1,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,19.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,46.1,Fee Schedule,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,LAB,88185,LEUK & LYMPH MARKERS - 88185,312,46.5,22.67,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,11.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,37.2,80% of total billed charges,11.27,24.24% of total billed charges,23.44,50.4% of total billed charges,34.88,75% of total billed charges,11.38,24.48% of total billed charges,22.67,Fee Schedule,11.16,24% of total billed charges,14.51,31.2% of total billed charges,37.2,80% of total billed charges,11.16,24% of total billed charges,11.16,24% of total billed charges,11.16,37.2,23.25
Outpatient Medical Services,LAB,88189,LEUK & LYMPH MARKERS - 88189,312,92.5,98.26,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,22.2,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,74,80% of total billed charges,22.42,24.24% of total billed charges,46.62,50.4% of total billed charges,69.38,75% of total billed charges,22.64,24.48% of total billed charges,98.26,Fee Schedule,22.2,24% of total billed charges,28.86,31.2% of total billed charges,74,80% of total billed charges,22.2,24% of total billed charges,22.2,24% of total billed charges,22.2,98.26,46.25
Outpatient Medical Services,LAB,88311,PATH DECALCIFICATION - 88311,312,34,15.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,8.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,27.2,80% of total billed charges,8.24,24.24% of total billed charges,17.14,50.4% of total billed charges,25.5,75% of total billed charges,8.32,24.48% of total billed charges,15.45,Fee Schedule,8.16,24% of total billed charges,10.61,31.2% of total billed charges,27.2,80% of total billed charges,8.16,24% of total billed charges,8.16,24% of total billed charges,8.16,27.2,17
Outpatient Medical Services,LAB,88311,PATH DECALCIFICATION TECH CHG - 88311TC,312,20.5,15.45,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,4.92,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,16.4,80% of total billed charges,4.97,24.24% of total billed charges,10.33,50.4% of total billed charges,15.38,75% of total billed charges,5.02,24.48% of total billed charges,15.45,Fee Schedule,4.92,24% of total billed charges,6.4,31.2% of total billed charges,16.4,80% of total billed charges,4.92,24% of total billed charges,4.92,24% of total billed charges,4.92,16.4,10.25
Outpatient Medical Services,LAB,88312,PATH SPECIAL STAINS GROUP 1 -88312,312,432.5,43.39,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,103.8,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,346,80% of total billed charges,104.84,24.24% of total billed charges,217.98,50.4% of total billed charges,324.38,75% of total billed charges,105.88,24.48% of total billed charges,43.39,Fee Schedule,103.8,24% of total billed charges,134.94,31.2% of total billed charges,346,80% of total billed charges,103.8,24% of total billed charges,103.8,24% of total billed charges,43.39,346,216.25
Outpatient Medical Services,LAB,88312,PATH STAIN GROUP 1 -88312-TC,312,302,43.39,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,72.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,241.6,80% of total billed charges,73.2,24.24% of total billed charges,152.21,50.4% of total billed charges,226.5,75% of total billed charges,73.93,24.48% of total billed charges,43.39,Fee Schedule,72.48,24% of total billed charges,94.22,31.2% of total billed charges,241.6,80% of total billed charges,72.48,24% of total billed charges,72.48,24% of total billed charges,43.39,241.6,151
Outpatient Medical Services,LAB,88313,PATH SPECIAL STAINS GROUP 2 - 88313,312,434.5,44.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,104.28,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,347.6,80% of total billed charges,105.32,24.24% of total billed charges,218.99,50.4% of total billed charges,325.88,75% of total billed charges,106.37,24.48% of total billed charges,44.91,Fee Schedule,104.28,24% of total billed charges,135.56,31.2% of total billed charges,347.6,80% of total billed charges,104.28,24% of total billed charges,104.28,24% of total billed charges,44.91,347.6,217.25
Outpatient Medical Services,LAB,88313,PATH SPECIAL STAINS GROUP 2 - 88313 TC,312,109,44.91,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,26.16,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,87.2,80% of total billed charges,26.42,24.24% of total billed charges,54.94,50.4% of total billed charges,81.75,75% of total billed charges,26.68,24.48% of total billed charges,44.91,Fee Schedule,26.16,24% of total billed charges,34.01,31.2% of total billed charges,87.2,80% of total billed charges,26.16,24% of total billed charges,26.16,24% of total billed charges,26.16,87.2,54.5
Outpatient Medical Services,LAB,88341,PATHOLOGY - ANTIBODY STAINS - 88341,312,207,57.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,49.68,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,165.6,80% of total billed charges,50.18,24.24% of total billed charges,104.33,50.4% of total billed charges,155.25,75% of total billed charges,50.67,24.48% of total billed charges,57.38,Fee Schedule,49.68,24% of total billed charges,64.58,31.2% of total billed charges,165.6,80% of total billed charges,49.68,24% of total billed charges,49.68,24% of total billed charges,49.68,165.6,103.5
Outpatient Medical Services,LAB,88341,PATHOLOGY - ABY STAINS - 88341 TC,312,185.5,57.38,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,44.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,148.4,80% of total billed charges,44.97,24.24% of total billed charges,93.49,50.4% of total billed charges,139.13,75% of total billed charges,45.41,24.48% of total billed charges,57.38,Fee Schedule,44.52,24% of total billed charges,57.88,31.2% of total billed charges,148.4,80% of total billed charges,44.52,24% of total billed charges,44.52,24% of total billed charges,44.52,148.4,92.75
Outpatient Medical Services,LAB,88342,PATH IMMUNO HISTOCHEMISTRY 88342,312,281,71.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,67.44,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,224.8,80% of total billed charges,68.11,24.24% of total billed charges,141.62,50.4% of total billed charges,210.75,75% of total billed charges,68.79,24.48% of total billed charges,71.58,Fee Schedule,67.44,24% of total billed charges,87.67,31.2% of total billed charges,224.8,80% of total billed charges,67.44,24% of total billed charges,67.44,24% of total billed charges,67.44,224.8,140.5
Outpatient Medical Services,LAB,88342,PATH IMMUNO HISTOCHEMISTRY 88342- TC,312,185.5,71.58,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,44.52,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,148.4,80% of total billed charges,44.97,24.24% of total billed charges,93.49,50.4% of total billed charges,139.13,75% of total billed charges,45.41,24.48% of total billed charges,71.58,Fee Schedule,44.52,24% of total billed charges,57.88,31.2% of total billed charges,148.4,80% of total billed charges,44.52,24% of total billed charges,44.52,24% of total billed charges,44.52,148.4,92.75
Outpatient Medical Services,LAB,88344,IHC ANTIBODY STAIN - 88344 TC,312,135,99.31,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,32.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,108,80% of total billed charges,32.72,24.24% of total billed charges,68.04,50.4% of total billed charges,101.25,75% of total billed charges,33.05,24.48% of total billed charges,99.31,Fee Schedule,32.4,24% of total billed charges,42.12,31.2% of total billed charges,108,80% of total billed charges,32.4,24% of total billed charges,32.4,24% of total billed charges,32.4,108,67.5
Outpatient Medical Services,LAB,88360,"Ki 67, IHC",312,414,97.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,99.36,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,331.2,80% of total billed charges,100.35,24.24% of total billed charges,208.66,50.4% of total billed charges,310.5,75% of total billed charges,101.35,24.48% of total billed charges,97.65,Fee Schedule,99.36,24% of total billed charges,129.17,31.2% of total billed charges,331.2,80% of total billed charges,99.36,24% of total billed charges,99.36,24% of total billed charges,97.65,331.2,207
Outpatient Medical Services,LAB,88360,"HER 2, IHC",312,177,97.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,42.48,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,141.6,80% of total billed charges,42.9,24.24% of total billed charges,89.21,50.4% of total billed charges,132.75,75% of total billed charges,43.33,24.48% of total billed charges,97.65,Fee Schedule,42.48,24% of total billed charges,55.22,31.2% of total billed charges,141.6,80% of total billed charges,42.48,24% of total billed charges,42.48,24% of total billed charges,42.48,141.6,88.5
Outpatient Medical Services,LAB,88360,TUMOR IMMUNOHISTOCHEMISTRY STAIN,312,397.5,97.65,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,95.4,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,318,80% of total billed charges,96.35,24.24% of total billed charges,200.34,50.4% of total billed charges,298.13,75% of total billed charges,97.31,24.48% of total billed charges,97.65,Fee Schedule,95.4,24% of total billed charges,124.02,31.2% of total billed charges,318,80% of total billed charges,95.4,24% of total billed charges,95.4,24% of total billed charges,95.4,318,198.75
Outpatient Medical Services,LAB,88377,"HER 2, FISH, PARAFFIN",312,604.5,181.64,Fee Schedule,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,145.08,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,483.6,80% of total billed charges,146.53,24.24% of total billed charges,304.67,50.4% of total billed charges,453.38,75% of total billed charges,147.98,24.48% of total billed charges,181.64,Fee Schedule,145.08,24% of total billed charges,188.6,31.2% of total billed charges,483.6,80% of total billed charges,145.08,24% of total billed charges,145.08,24% of total billed charges,145.08,483.6,302.25
Outpatient Medical Services,RADIOLOGY,62270,FLUORO  FOR ASPIRATION OF SPINAL FLUID,320,360.5,96.83,26.86% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,86.52,24% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,288.4,80% of total billed charges,87.39,24.24% of total billed charges,181.69,50.4% of total billed charges,270.38,75% of total billed charges,88.25,24.48% of total billed charges,96.83,26.86% of total billed charges,86.52,24% of total billed charges,112.48,31.2% of total billed charges,288.4,80% of total billed charges,86.52,24% of total billed charges,86.52,24% of total billed charges,86.52,288.4,180.25
Outpatient Medical Services,RADIOLOGY,70030,ORBIT 1 VIEW FOR FOREGIN BODY LT,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70030,ORBIT 1 VIEW FOR FOREGIN BODY RT,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70100,MANDIBLE LESS THAN 4 VIEWS,320,148.5,39.89,26.86% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,35.64,24% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,118.8,80% of total billed charges,36,24.24% of total billed charges,74.84,50.4% of total billed charges,111.38,75% of total billed charges,36.35,24.48% of total billed charges,39.89,26.86% of total billed charges,35.64,24% of total billed charges,46.33,31.2% of total billed charges,118.8,80% of total billed charges,35.64,24% of total billed charges,35.64,24% of total billed charges,35.64,118.8,74.25
Outpatient Medical Services,RADIOLOGY,70110,MANDIBLE COMPLETE,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,70120,MASTOIDS LESS THAN THREE VIEWS,320,148.5,39.89,26.86% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,35.64,24% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,118.8,80% of total billed charges,36,24.24% of total billed charges,74.84,50.4% of total billed charges,111.38,75% of total billed charges,36.35,24.48% of total billed charges,39.89,26.86% of total billed charges,35.64,24% of total billed charges,46.33,31.2% of total billed charges,118.8,80% of total billed charges,35.64,24% of total billed charges,35.64,24% of total billed charges,35.64,118.8,74.25
Outpatient Medical Services,RADIOLOGY,70130,MASTOIDS COMPLETE,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70140,FACIAL BONES LESS THAN 3 VIEWS,320,190.5,51.17,26.86% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,45.72,24% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,152.4,80% of total billed charges,46.18,24.24% of total billed charges,96.01,50.4% of total billed charges,142.88,75% of total billed charges,46.63,24.48% of total billed charges,51.17,26.86% of total billed charges,45.72,24% of total billed charges,59.44,31.2% of total billed charges,152.4,80% of total billed charges,45.72,24% of total billed charges,45.72,24% of total billed charges,45.72,152.4,95.25
Outpatient Medical Services,RADIOLOGY,70150,FACIAL BONES COMPLETE,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,70160,NASAL BONES,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,70200,ORBITS COMPLETE,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70200,XR ORBIT LT,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,70200,XR ORBIT RT,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,70210,SINUSES LESS THAN THREE VIEWS,320,190.5,51.17,26.86% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,45.72,24% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,152.4,80% of total billed charges,46.18,24.24% of total billed charges,96.01,50.4% of total billed charges,142.88,75% of total billed charges,46.63,24.48% of total billed charges,51.17,26.86% of total billed charges,45.72,24% of total billed charges,59.44,31.2% of total billed charges,152.4,80% of total billed charges,45.72,24% of total billed charges,45.72,24% of total billed charges,45.72,152.4,95.25
Outpatient Medical Services,RADIOLOGY,70220,SINUSES COMPLETE,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,70250,SKULL LESS THAN FOUR VIEW,320,219.5,58.96,26.86% of total billed charges,164.63,75% of total billed charges,164.63,75% of total billed charges,52.68,24% of total billed charges,164.63,75% of total billed charges,164.63,75% of total billed charges,175.6,80% of total billed charges,53.21,24.24% of total billed charges,110.63,50.4% of total billed charges,164.63,75% of total billed charges,53.73,24.48% of total billed charges,58.96,26.86% of total billed charges,52.68,24% of total billed charges,68.48,31.2% of total billed charges,175.6,80% of total billed charges,52.68,24% of total billed charges,52.68,24% of total billed charges,52.68,175.6,109.75
Outpatient Medical Services,RADIOLOGY,70260,SKULL COMPLETE,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70328,BILATERAL TMJ,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,70328,UNILATERAL TMJ LT,320,202,54.26,26.86% of total billed charges,151.5,75% of total billed charges,151.5,75% of total billed charges,48.48,24% of total billed charges,151.5,75% of total billed charges,151.5,75% of total billed charges,161.6,80% of total billed charges,48.96,24.24% of total billed charges,101.81,50.4% of total billed charges,151.5,75% of total billed charges,49.45,24.48% of total billed charges,54.26,26.86% of total billed charges,48.48,24% of total billed charges,63.02,31.2% of total billed charges,161.6,80% of total billed charges,48.48,24% of total billed charges,48.48,24% of total billed charges,48.48,161.6,101
Outpatient Medical Services,RADIOLOGY,70328,UNILATERAL TMJ RT,320,202,54.26,26.86% of total billed charges,151.5,75% of total billed charges,151.5,75% of total billed charges,48.48,24% of total billed charges,151.5,75% of total billed charges,151.5,75% of total billed charges,161.6,80% of total billed charges,48.96,24.24% of total billed charges,101.81,50.4% of total billed charges,151.5,75% of total billed charges,49.45,24.48% of total billed charges,54.26,26.86% of total billed charges,48.48,24% of total billed charges,63.02,31.2% of total billed charges,161.6,80% of total billed charges,48.48,24% of total billed charges,48.48,24% of total billed charges,48.48,161.6,101
Outpatient Medical Services,RADIOLOGY,70360,SOFT TISSUE NECK,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,71047,DO NOT USE,320,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71100,XR RIBS LATERAL,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,71101,UNILATERAL RIBS 3 VIEW LT,320,323.5,86.89,26.86% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,77.64,24% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,258.8,80% of total billed charges,78.42,24.24% of total billed charges,163.04,50.4% of total billed charges,242.63,75% of total billed charges,79.19,24.48% of total billed charges,86.89,26.86% of total billed charges,77.64,24% of total billed charges,100.93,31.2% of total billed charges,258.8,80% of total billed charges,77.64,24% of total billed charges,77.64,24% of total billed charges,77.64,258.8,161.75
Outpatient Medical Services,RADIOLOGY,71101,UNILATERAL RIBS 3 VIEWS RT,320,323.5,86.89,26.86% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,77.64,24% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,258.8,80% of total billed charges,78.42,24.24% of total billed charges,163.04,50.4% of total billed charges,242.63,75% of total billed charges,79.19,24.48% of total billed charges,86.89,26.86% of total billed charges,77.64,24% of total billed charges,100.93,31.2% of total billed charges,258.8,80% of total billed charges,77.64,24% of total billed charges,77.64,24% of total billed charges,77.64,258.8,161.75
Outpatient Medical Services,RADIOLOGY,71110,XR RIBS BILATERAL,320,447,120.06,26.86% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,107.28,24% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,357.6,80% of total billed charges,108.35,24.24% of total billed charges,225.29,50.4% of total billed charges,335.25,75% of total billed charges,109.43,24.48% of total billed charges,120.06,26.86% of total billed charges,107.28,24% of total billed charges,139.46,31.2% of total billed charges,357.6,80% of total billed charges,107.28,24% of total billed charges,107.28,24% of total billed charges,107.28,357.6,223.5
Outpatient Medical Services,RADIOLOGY,71111,BILATERAL RIBS 4 VIEWS,320,345,92.67,26.86% of total billed charges,258.75,75% of total billed charges,258.75,75% of total billed charges,82.8,24% of total billed charges,258.75,75% of total billed charges,258.75,75% of total billed charges,276,80% of total billed charges,83.63,24.24% of total billed charges,173.88,50.4% of total billed charges,258.75,75% of total billed charges,84.46,24.48% of total billed charges,92.67,26.86% of total billed charges,82.8,24% of total billed charges,107.64,31.2% of total billed charges,276,80% of total billed charges,82.8,24% of total billed charges,82.8,24% of total billed charges,82.8,276,172.5
Outpatient Medical Services,RADIOLOGY,71120,STERNUM,320,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,RADIOLOGY,71130,SC JOINTS STERNOCLAVICULAR JOINTS,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,71130,XR STERNOCLAVICULAR JOINTS LT,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,71130,XR STERNOCLAVICULAR JOINTS RT,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,72040,CERVICAL SPINE 3 VIEWS OR LESS,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,72050,CERVICAL SPINE COMPLETE,320,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,72052,CERVICAL SPINE W FLEXION AND EXT VIEWS,320,456.5,122.62,26.86% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,109.56,24% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,365.2,80% of total billed charges,110.66,24.24% of total billed charges,230.08,50.4% of total billed charges,342.38,75% of total billed charges,111.75,24.48% of total billed charges,122.62,26.86% of total billed charges,109.56,24% of total billed charges,142.43,31.2% of total billed charges,365.2,80% of total billed charges,109.56,24% of total billed charges,109.56,24% of total billed charges,109.56,365.2,228.25
Outpatient Medical Services,RADIOLOGY,72070,THORACIC SPINE,320,545,146.39,26.86% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,130.8,24% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,436,80% of total billed charges,132.11,24.24% of total billed charges,274.68,50.4% of total billed charges,408.75,75% of total billed charges,133.42,24.48% of total billed charges,146.39,26.86% of total billed charges,130.8,24% of total billed charges,170.04,31.2% of total billed charges,436,80% of total billed charges,130.8,24% of total billed charges,130.8,24% of total billed charges,130.8,436,272.5
Outpatient Medical Services,RADIOLOGY,72081,SCOLIOSIS SPINE,320,254.5,68.36,26.86% of total billed charges,190.88,75% of total billed charges,190.88,75% of total billed charges,61.08,24% of total billed charges,190.88,75% of total billed charges,190.88,75% of total billed charges,203.6,80% of total billed charges,61.69,24.24% of total billed charges,128.27,50.4% of total billed charges,190.88,75% of total billed charges,62.3,24.48% of total billed charges,68.36,26.86% of total billed charges,61.08,24% of total billed charges,79.4,31.2% of total billed charges,203.6,80% of total billed charges,61.08,24% of total billed charges,61.08,24% of total billed charges,61.08,203.6,127.25
Outpatient Medical Services,RADIOLOGY,72100,LUMBAR SPINE 2 OR 3 VIEWS,320,323.5,86.89,26.86% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,77.64,24% of total billed charges,242.63,75% of total billed charges,242.63,75% of total billed charges,258.8,80% of total billed charges,78.42,24.24% of total billed charges,163.04,50.4% of total billed charges,242.63,75% of total billed charges,79.19,24.48% of total billed charges,86.89,26.86% of total billed charges,77.64,24% of total billed charges,100.93,31.2% of total billed charges,258.8,80% of total billed charges,77.64,24% of total billed charges,77.64,24% of total billed charges,77.64,258.8,161.75
Outpatient Medical Services,RADIOLOGY,72110,LUMBAR SPINE COMPLETE,320,545,146.39,26.86% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,130.8,24% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,436,80% of total billed charges,132.11,24.24% of total billed charges,274.68,50.4% of total billed charges,408.75,75% of total billed charges,133.42,24.48% of total billed charges,146.39,26.86% of total billed charges,130.8,24% of total billed charges,170.04,31.2% of total billed charges,436,80% of total billed charges,130.8,24% of total billed charges,130.8,24% of total billed charges,130.8,436,272.5
Outpatient Medical Services,RADIOLOGY,72114,LUMBAR SPINE WITH FLEX AND EXT VIEWS,320,586,157.4,26.86% of total billed charges,439.5,75% of total billed charges,439.5,75% of total billed charges,140.64,24% of total billed charges,439.5,75% of total billed charges,439.5,75% of total billed charges,468.8,80% of total billed charges,142.05,24.24% of total billed charges,295.34,50.4% of total billed charges,439.5,75% of total billed charges,143.45,24.48% of total billed charges,157.4,26.86% of total billed charges,140.64,24% of total billed charges,182.83,31.2% of total billed charges,468.8,80% of total billed charges,140.64,24% of total billed charges,140.64,24% of total billed charges,140.64,468.8,293
Outpatient Medical Services,RADIOLOGY,72170,PELVIS,320,219.5,58.96,26.86% of total billed charges,164.63,75% of total billed charges,164.63,75% of total billed charges,52.68,24% of total billed charges,164.63,75% of total billed charges,164.63,75% of total billed charges,175.6,80% of total billed charges,53.21,24.24% of total billed charges,110.63,50.4% of total billed charges,164.63,75% of total billed charges,53.73,24.48% of total billed charges,58.96,26.86% of total billed charges,52.68,24% of total billed charges,68.48,31.2% of total billed charges,175.6,80% of total billed charges,52.68,24% of total billed charges,52.68,24% of total billed charges,52.68,175.6,109.75
Outpatient Medical Services,RADIOLOGY,72190,XR PELVIS 3 VIEWS,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,72202,SI JOINTS,320,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,RADIOLOGY,72202,XR SACROILIAC JOINT LT,320,292,78.43,26.86% of total billed charges,219,75% of total billed charges,219,75% of total billed charges,70.08,24% of total billed charges,219,75% of total billed charges,219,75% of total billed charges,233.6,80% of total billed charges,70.78,24.24% of total billed charges,147.17,50.4% of total billed charges,219,75% of total billed charges,71.48,24.48% of total billed charges,78.43,26.86% of total billed charges,70.08,24% of total billed charges,91.1,31.2% of total billed charges,233.6,80% of total billed charges,70.08,24% of total billed charges,70.08,24% of total billed charges,70.08,233.6,146
Outpatient Medical Services,RADIOLOGY,72202,XR SACROILIAC JOINT RT,320,292,78.43,26.86% of total billed charges,219,75% of total billed charges,219,75% of total billed charges,70.08,24% of total billed charges,219,75% of total billed charges,219,75% of total billed charges,233.6,80% of total billed charges,70.78,24.24% of total billed charges,147.17,50.4% of total billed charges,219,75% of total billed charges,71.48,24.48% of total billed charges,78.43,26.86% of total billed charges,70.08,24% of total billed charges,91.1,31.2% of total billed charges,233.6,80% of total billed charges,70.08,24% of total billed charges,70.08,24% of total billed charges,70.08,233.6,146
Outpatient Medical Services,RADIOLOGY,72220,XR SACRUM,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,72220,SACRUM AND OR COCCYX,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,72240,CERVICAL MYELOGRAPHY,320,244,65.54,26.86% of total billed charges,183,75% of total billed charges,183,75% of total billed charges,58.56,24% of total billed charges,183,75% of total billed charges,183,75% of total billed charges,195.2,80% of total billed charges,59.15,24.24% of total billed charges,122.98,50.4% of total billed charges,183,75% of total billed charges,59.73,24.48% of total billed charges,65.54,26.86% of total billed charges,58.56,24% of total billed charges,76.13,31.2% of total billed charges,195.2,80% of total billed charges,58.56,24% of total billed charges,58.56,24% of total billed charges,58.56,195.2,122
Outpatient Medical Services,RADIOLOGY,72255,THORACIC MYELOGRAPHY,320,414,111.2,26.86% of total billed charges,310.5,75% of total billed charges,310.5,75% of total billed charges,99.36,24% of total billed charges,310.5,75% of total billed charges,310.5,75% of total billed charges,331.2,80% of total billed charges,100.35,24.24% of total billed charges,208.66,50.4% of total billed charges,310.5,75% of total billed charges,101.35,24.48% of total billed charges,111.2,26.86% of total billed charges,99.36,24% of total billed charges,129.17,31.2% of total billed charges,331.2,80% of total billed charges,99.36,24% of total billed charges,99.36,24% of total billed charges,99.36,331.2,207
Outpatient Medical Services,RADIOLOGY,72265,LUMBARSACRAL MYELOGRAPHY,320,446,119.8,26.86% of total billed charges,334.5,75% of total billed charges,334.5,75% of total billed charges,107.04,24% of total billed charges,334.5,75% of total billed charges,334.5,75% of total billed charges,356.8,80% of total billed charges,108.11,24.24% of total billed charges,224.78,50.4% of total billed charges,334.5,75% of total billed charges,109.18,24.48% of total billed charges,119.8,26.86% of total billed charges,107.04,24% of total billed charges,139.15,31.2% of total billed charges,356.8,80% of total billed charges,107.04,24% of total billed charges,107.04,24% of total billed charges,107.04,356.8,223
Outpatient Medical Services,RADIOLOGY,73000,XR CLAVICLE,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73000,CLAVICLE LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73000,CLAVICLE RT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73010,XR SCAPULA,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73010,SCAPULA LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73010,SCAPULA RT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73030,SHOULDER LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73030,SHOULDER RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73040,SHOULDER ARTHROGRAM LT,320,360.5,96.83,26.86% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,86.52,24% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,288.4,80% of total billed charges,87.39,24.24% of total billed charges,181.69,50.4% of total billed charges,270.38,75% of total billed charges,88.25,24.48% of total billed charges,96.83,26.86% of total billed charges,86.52,24% of total billed charges,112.48,31.2% of total billed charges,288.4,80% of total billed charges,86.52,24% of total billed charges,86.52,24% of total billed charges,86.52,288.4,180.25
Outpatient Medical Services,RADIOLOGY,73040,SHOULDER ARTHROGRAM RT,320,360.5,96.83,26.86% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,86.52,24% of total billed charges,270.38,75% of total billed charges,270.38,75% of total billed charges,288.4,80% of total billed charges,87.39,24.24% of total billed charges,181.69,50.4% of total billed charges,270.38,75% of total billed charges,88.25,24.48% of total billed charges,96.83,26.86% of total billed charges,86.52,24% of total billed charges,112.48,31.2% of total billed charges,288.4,80% of total billed charges,86.52,24% of total billed charges,86.52,24% of total billed charges,86.52,288.4,180.25
Outpatient Medical Services,RADIOLOGY,73050,BILATERAL AC JOINTS WWO WEIGHTS,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73060,HUMERUS LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73060,HUMERUS  RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73070,XR ELBOW LT 3 VWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73070,ELBOW LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73070,ELBOW RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW AP LAT OBLIQUE,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73085,ELBOW ARTHROGRAM LT,320,392.5,105.43,26.86% of total billed charges,294.38,75% of total billed charges,294.38,75% of total billed charges,94.2,24% of total billed charges,294.38,75% of total billed charges,294.38,75% of total billed charges,314,80% of total billed charges,95.14,24.24% of total billed charges,197.82,50.4% of total billed charges,294.38,75% of total billed charges,96.08,24.48% of total billed charges,105.43,26.86% of total billed charges,94.2,24% of total billed charges,122.46,31.2% of total billed charges,314,80% of total billed charges,94.2,24% of total billed charges,94.2,24% of total billed charges,94.2,314,196.25
Outpatient Medical Services,RADIOLOGY,73085,ELBOW ARTHROGRAM RT,320,392.5,105.43,26.86% of total billed charges,294.38,75% of total billed charges,294.38,75% of total billed charges,94.2,24% of total billed charges,294.38,75% of total billed charges,294.38,75% of total billed charges,314,80% of total billed charges,95.14,24.24% of total billed charges,197.82,50.4% of total billed charges,294.38,75% of total billed charges,96.08,24.48% of total billed charges,105.43,26.86% of total billed charges,94.2,24% of total billed charges,122.46,31.2% of total billed charges,314,80% of total billed charges,94.2,24% of total billed charges,94.2,24% of total billed charges,94.2,314,196.25
Outpatient Medical Services,RADIOLOGY,73090,XR FOREARM,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73090,FOREARM LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73090,FOREARM RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73092,XR UPPER EXT,320,125,33.58,26.86% of total billed charges,93.75,75% of total billed charges,93.75,75% of total billed charges,30,24% of total billed charges,93.75,75% of total billed charges,93.75,75% of total billed charges,100,80% of total billed charges,30.3,24.24% of total billed charges,63,50.4% of total billed charges,93.75,75% of total billed charges,30.6,24.48% of total billed charges,33.58,26.86% of total billed charges,30,24% of total billed charges,39,31.2% of total billed charges,100,80% of total billed charges,30,24% of total billed charges,30,24% of total billed charges,30,100,62.5
Outpatient Medical Services,RADIOLOGY,73092,UPPER EXTREMITY INFANT LT,320,133,35.72,26.86% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,31.92,24% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,35.72,26.86% of total billed charges,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,31.92,106.4,66.5
Outpatient Medical Services,RADIOLOGY,73092,UPPER EXTREMITY INFANT RT,320,133,35.72,26.86% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,31.92,24% of total billed charges,99.75,75% of total billed charges,99.75,75% of total billed charges,106.4,80% of total billed charges,32.24,24.24% of total billed charges,67.03,50.4% of total billed charges,99.75,75% of total billed charges,32.56,24.48% of total billed charges,35.72,26.86% of total billed charges,31.92,24% of total billed charges,41.5,31.2% of total billed charges,106.4,80% of total billed charges,31.92,24% of total billed charges,31.92,24% of total billed charges,31.92,106.4,66.5
Outpatient Medical Services,RADIOLOGY,73100,XR WRIST 2 VIEWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73110,XR WRIST,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73110,WRIST LT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73110,WRIST RT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73115,WRIST ARTHROGRAM LT,320,546,146.66,26.86% of total billed charges,409.5,75% of total billed charges,409.5,75% of total billed charges,131.04,24% of total billed charges,409.5,75% of total billed charges,409.5,75% of total billed charges,436.8,80% of total billed charges,132.35,24.24% of total billed charges,275.18,50.4% of total billed charges,409.5,75% of total billed charges,133.66,24.48% of total billed charges,146.66,26.86% of total billed charges,131.04,24% of total billed charges,170.35,31.2% of total billed charges,436.8,80% of total billed charges,131.04,24% of total billed charges,131.04,24% of total billed charges,131.04,436.8,273
Outpatient Medical Services,RADIOLOGY,73115,WRIST ARTHROGRAM RT,320,546,146.66,26.86% of total billed charges,409.5,75% of total billed charges,409.5,75% of total billed charges,131.04,24% of total billed charges,409.5,75% of total billed charges,409.5,75% of total billed charges,436.8,80% of total billed charges,132.35,24.24% of total billed charges,275.18,50.4% of total billed charges,409.5,75% of total billed charges,133.66,24.48% of total billed charges,146.66,26.86% of total billed charges,131.04,24% of total billed charges,170.35,31.2% of total billed charges,436.8,80% of total billed charges,131.04,24% of total billed charges,131.04,24% of total billed charges,131.04,436.8,273
Outpatient Medical Services,RADIOLOGY,73120,XR HAND 2 VWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73130,XR HAND 3 VWS,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73130,HAND LT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73130,HAND RT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73140,XR FINGER,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73140,FINGERS LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73140,FINGERS RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73501,INFANT PELVIS AND HIPS,320,244,65.54,26.86% of total billed charges,183,75% of total billed charges,183,75% of total billed charges,58.56,24% of total billed charges,183,75% of total billed charges,183,75% of total billed charges,195.2,80% of total billed charges,59.15,24.24% of total billed charges,122.98,50.4% of total billed charges,183,75% of total billed charges,59.73,24.48% of total billed charges,65.54,26.86% of total billed charges,58.56,24% of total billed charges,76.13,31.2% of total billed charges,195.2,80% of total billed charges,58.56,24% of total billed charges,58.56,24% of total billed charges,58.56,195.2,122
Outpatient Medical Services,RADIOLOGY,73502,XR HIP 2 VWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73502,HIP LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73502,HIP RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73521,BILATERAL HIPS,320,466.5,125.3,26.86% of total billed charges,349.88,75% of total billed charges,349.88,75% of total billed charges,111.96,24% of total billed charges,349.88,75% of total billed charges,349.88,75% of total billed charges,373.2,80% of total billed charges,113.08,24.24% of total billed charges,235.12,50.4% of total billed charges,349.88,75% of total billed charges,114.2,24.48% of total billed charges,125.3,26.86% of total billed charges,111.96,24% of total billed charges,145.55,31.2% of total billed charges,373.2,80% of total billed charges,111.96,24% of total billed charges,111.96,24% of total billed charges,111.96,373.2,233.25
Outpatient Medical Services,RADIOLOGY,73525,HIP ARTHROGRAM LT,320,615,165.19,26.86% of total billed charges,461.25,75% of total billed charges,461.25,75% of total billed charges,147.6,24% of total billed charges,461.25,75% of total billed charges,461.25,75% of total billed charges,492,80% of total billed charges,149.08,24.24% of total billed charges,309.96,50.4% of total billed charges,461.25,75% of total billed charges,150.55,24.48% of total billed charges,165.19,26.86% of total billed charges,147.6,24% of total billed charges,191.88,31.2% of total billed charges,492,80% of total billed charges,147.6,24% of total billed charges,147.6,24% of total billed charges,147.6,492,307.5
Outpatient Medical Services,RADIOLOGY,73525,HIP ARTHROGRAM RT,320,615,165.19,26.86% of total billed charges,461.25,75% of total billed charges,461.25,75% of total billed charges,147.6,24% of total billed charges,461.25,75% of total billed charges,461.25,75% of total billed charges,492,80% of total billed charges,149.08,24.24% of total billed charges,309.96,50.4% of total billed charges,461.25,75% of total billed charges,150.55,24.48% of total billed charges,165.19,26.86% of total billed charges,147.6,24% of total billed charges,191.88,31.2% of total billed charges,492,80% of total billed charges,147.6,24% of total billed charges,147.6,24% of total billed charges,147.6,492,307.5
Outpatient Medical Services,RADIOLOGY,73552,XR FEMUR,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73552,FEMUR LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73552,FEMUR RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73560,XR KNEE AP LATERAL,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73562,XR KNEE 3 VWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73562,KNEE LT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73562,KNEE RT,320,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,73565,BILATERAL STANDING KNEES,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73580,KNEE ARTHROGRAM  LT,320,368.5,98.98,26.86% of total billed charges,276.38,75% of total billed charges,276.38,75% of total billed charges,88.44,24% of total billed charges,276.38,75% of total billed charges,276.38,75% of total billed charges,294.8,80% of total billed charges,89.32,24.24% of total billed charges,185.72,50.4% of total billed charges,276.38,75% of total billed charges,90.21,24.48% of total billed charges,98.98,26.86% of total billed charges,88.44,24% of total billed charges,114.97,31.2% of total billed charges,294.8,80% of total billed charges,88.44,24% of total billed charges,88.44,24% of total billed charges,88.44,294.8,184.25
Outpatient Medical Services,RADIOLOGY,73580,KNEE ARTHROGRAM  RT,320,368.5,98.98,26.86% of total billed charges,276.38,75% of total billed charges,276.38,75% of total billed charges,88.44,24% of total billed charges,276.38,75% of total billed charges,276.38,75% of total billed charges,294.8,80% of total billed charges,89.32,24.24% of total billed charges,185.72,50.4% of total billed charges,276.38,75% of total billed charges,90.21,24.48% of total billed charges,98.98,26.86% of total billed charges,88.44,24% of total billed charges,114.97,31.2% of total billed charges,294.8,80% of total billed charges,88.44,24% of total billed charges,88.44,24% of total billed charges,88.44,294.8,184.25
Outpatient Medical Services,RADIOLOGY,73590,XR TIBIA FIBULA,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73590,TIB FIB LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73590,TIB FIB RT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73592,XR LOWER EXT BILATERAL,320,140,37.6,26.86% of total billed charges,105,75% of total billed charges,105,75% of total billed charges,33.6,24% of total billed charges,105,75% of total billed charges,105,75% of total billed charges,112,80% of total billed charges,33.94,24.24% of total billed charges,70.56,50.4% of total billed charges,105,75% of total billed charges,34.27,24.48% of total billed charges,37.6,26.86% of total billed charges,33.6,24% of total billed charges,43.68,31.2% of total billed charges,112,80% of total billed charges,33.6,24% of total billed charges,33.6,24% of total billed charges,33.6,112,70
Outpatient Medical Services,RADIOLOGY,73592,LOWER EXTREMITY INFANT LT,320,148.5,39.89,26.86% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,35.64,24% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,118.8,80% of total billed charges,36,24.24% of total billed charges,74.84,50.4% of total billed charges,111.38,75% of total billed charges,36.35,24.48% of total billed charges,39.89,26.86% of total billed charges,35.64,24% of total billed charges,46.33,31.2% of total billed charges,118.8,80% of total billed charges,35.64,24% of total billed charges,35.64,24% of total billed charges,35.64,118.8,74.25
Outpatient Medical Services,RADIOLOGY,73592,LOWER EXTREMITY INFANT RT,320,148.5,39.89,26.86% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,35.64,24% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,118.8,80% of total billed charges,36,24.24% of total billed charges,74.84,50.4% of total billed charges,111.38,75% of total billed charges,36.35,24.48% of total billed charges,39.89,26.86% of total billed charges,35.64,24% of total billed charges,46.33,31.2% of total billed charges,118.8,80% of total billed charges,35.64,24% of total billed charges,35.64,24% of total billed charges,35.64,118.8,74.25
Outpatient Medical Services,RADIOLOGY,73600,XR ANKLE AP LAT,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE 3 VWS,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73610,ANKLE LT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73610,ANKLE RT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73615,ANKLE ARTHROGRAM LT,320,397.5,106.77,26.86% of total billed charges,298.13,75% of total billed charges,298.13,75% of total billed charges,95.4,24% of total billed charges,298.13,75% of total billed charges,298.13,75% of total billed charges,318,80% of total billed charges,96.35,24.24% of total billed charges,200.34,50.4% of total billed charges,298.13,75% of total billed charges,97.31,24.48% of total billed charges,106.77,26.86% of total billed charges,95.4,24% of total billed charges,124.02,31.2% of total billed charges,318,80% of total billed charges,95.4,24% of total billed charges,95.4,24% of total billed charges,95.4,318,198.75
Outpatient Medical Services,RADIOLOGY,73615,ANKLE ARTHROGRAM RT,320,397.5,106.77,26.86% of total billed charges,298.13,75% of total billed charges,298.13,75% of total billed charges,95.4,24% of total billed charges,298.13,75% of total billed charges,298.13,75% of total billed charges,318,80% of total billed charges,96.35,24.24% of total billed charges,200.34,50.4% of total billed charges,298.13,75% of total billed charges,97.31,24.48% of total billed charges,106.77,26.86% of total billed charges,95.4,24% of total billed charges,124.02,31.2% of total billed charges,318,80% of total billed charges,95.4,24% of total billed charges,95.4,24% of total billed charges,95.4,318,198.75
Outpatient Medical Services,RADIOLOGY,73620,XR FOOT 2 VWS,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73630,XR FOOT 3 VWS,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,73630,FOOT LT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73630,FOOT RT,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,73650,XR CALCANEUS SINGLE VW,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73650,HEEL LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73650,HEEL RT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73660,XR TOES,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,73660,TOES LT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,73660,TOES RT,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,74018,KUB SINGLE VIEW,320,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,74019,XR ABD AP LAT,320,447,120.06,26.86% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,107.28,24% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,357.6,80% of total billed charges,108.35,24.24% of total billed charges,225.29,50.4% of total billed charges,335.25,75% of total billed charges,109.43,24.48% of total billed charges,120.06,26.86% of total billed charges,107.28,24% of total billed charges,139.46,31.2% of total billed charges,357.6,80% of total billed charges,107.28,24% of total billed charges,107.28,24% of total billed charges,107.28,357.6,223.5
Outpatient Medical Services,RADIOLOGY,74019,ABDOMEN 2 VIEWS,320,545,146.39,26.86% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,130.8,24% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,436,80% of total billed charges,132.11,24.24% of total billed charges,274.68,50.4% of total billed charges,408.75,75% of total billed charges,133.42,24.48% of total billed charges,146.39,26.86% of total billed charges,130.8,24% of total billed charges,170.04,31.2% of total billed charges,436,80% of total billed charges,130.8,24% of total billed charges,130.8,24% of total billed charges,130.8,436,272.5
Outpatient Medical Services,RADIOLOGY,74021,XR ABD AP SUPINE UPRIGHT,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,74021,ABDOMEN M OR MORE VIEWS,320,545,146.39,26.86% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,130.8,24% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,436,80% of total billed charges,132.11,24.24% of total billed charges,274.68,50.4% of total billed charges,408.75,75% of total billed charges,133.42,24.48% of total billed charges,146.39,26.86% of total billed charges,130.8,24% of total billed charges,170.04,31.2% of total billed charges,436,80% of total billed charges,130.8,24% of total billed charges,130.8,24% of total billed charges,130.8,436,272.5
Outpatient Medical Services,RADIOLOGY,74022,ABDOMEN SERIES W/PA CHEST,320,545,146.39,26.86% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,130.8,24% of total billed charges,408.75,75% of total billed charges,408.75,75% of total billed charges,436,80% of total billed charges,132.11,24.24% of total billed charges,274.68,50.4% of total billed charges,408.75,75% of total billed charges,133.42,24.48% of total billed charges,146.39,26.86% of total billed charges,130.8,24% of total billed charges,170.04,31.2% of total billed charges,436,80% of total billed charges,130.8,24% of total billed charges,130.8,24% of total billed charges,130.8,436,272.5
Outpatient Medical Services,RADIOLOGY,74210,BARIUM SWALLOW,320,710.5,190.84,26.86% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,170.52,24% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,568.4,80% of total billed charges,172.23,24.24% of total billed charges,358.09,50.4% of total billed charges,532.88,75% of total billed charges,173.93,24.48% of total billed charges,190.84,26.86% of total billed charges,170.52,24% of total billed charges,221.68,31.2% of total billed charges,568.4,80% of total billed charges,170.52,24% of total billed charges,170.52,24% of total billed charges,170.52,568.4,355.25
Outpatient Medical Services,RADIOLOGY,74230,XR ESOPHAGUS FLUORO W BARIUM CONT,320,670,179.96,26.86% of total billed charges,502.5,75% of total billed charges,502.5,75% of total billed charges,160.8,24% of total billed charges,502.5,75% of total billed charges,502.5,75% of total billed charges,536,80% of total billed charges,162.41,24.24% of total billed charges,337.68,50.4% of total billed charges,502.5,75% of total billed charges,164.02,24.48% of total billed charges,179.96,26.86% of total billed charges,160.8,24% of total billed charges,209.04,31.2% of total billed charges,536,80% of total billed charges,160.8,24% of total billed charges,160.8,24% of total billed charges,160.8,536,335
Outpatient Medical Services,RADIOLOGY,74230,MODIFIED BARIUM SWALLOW,320,710.5,190.84,26.86% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,170.52,24% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,568.4,80% of total billed charges,172.23,24.24% of total billed charges,358.09,50.4% of total billed charges,532.88,75% of total billed charges,173.93,24.48% of total billed charges,190.84,26.86% of total billed charges,170.52,24% of total billed charges,221.68,31.2% of total billed charges,568.4,80% of total billed charges,170.52,24% of total billed charges,170.52,24% of total billed charges,170.52,568.4,355.25
Outpatient Medical Services,RADIOLOGY,74246,UPPER GI SERIES WITH SMALL BOWEL FOLLOW,320,724,194.47,26.86% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,173.76,24% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,579.2,80% of total billed charges,175.5,24.24% of total billed charges,364.9,50.4% of total billed charges,543,75% of total billed charges,177.24,24.48% of total billed charges,194.47,26.86% of total billed charges,173.76,24% of total billed charges,225.89,31.2% of total billed charges,579.2,80% of total billed charges,173.76,24% of total billed charges,173.76,24% of total billed charges,173.76,579.2,362
Outpatient Medical Services,RADIOLOGY,74246,UPPER GI SERIES WITH KUB,320,710.5,190.84,26.86% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,170.52,24% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,568.4,80% of total billed charges,172.23,24.24% of total billed charges,358.09,50.4% of total billed charges,532.88,75% of total billed charges,173.93,24.48% of total billed charges,190.84,26.86% of total billed charges,170.52,24% of total billed charges,221.68,31.2% of total billed charges,568.4,80% of total billed charges,170.52,24% of total billed charges,170.52,24% of total billed charges,170.52,568.4,355.25
Outpatient Medical Services,RADIOLOGY,74250,SMALL BOWEL FOLLOW THROUGH,320,818,219.71,26.86% of total billed charges,613.5,75% of total billed charges,613.5,75% of total billed charges,196.32,24% of total billed charges,613.5,75% of total billed charges,613.5,75% of total billed charges,654.4,80% of total billed charges,198.28,24.24% of total billed charges,412.27,50.4% of total billed charges,613.5,75% of total billed charges,200.25,24.48% of total billed charges,219.71,26.86% of total billed charges,196.32,24% of total billed charges,255.22,31.2% of total billed charges,654.4,80% of total billed charges,196.32,24% of total billed charges,196.32,24% of total billed charges,196.32,654.4,409
Outpatient Medical Services,RADIOLOGY,74270,BARIUM ENEMA,320,710.5,190.84,26.86% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,170.52,24% of total billed charges,532.88,75% of total billed charges,532.88,75% of total billed charges,568.4,80% of total billed charges,172.23,24.24% of total billed charges,358.09,50.4% of total billed charges,532.88,75% of total billed charges,173.93,24.48% of total billed charges,190.84,26.86% of total billed charges,170.52,24% of total billed charges,221.68,31.2% of total billed charges,568.4,80% of total billed charges,170.52,24% of total billed charges,170.52,24% of total billed charges,170.52,568.4,355.25
Outpatient Medical Services,RADIOLOGY,74280,XR BARIUM ENEMA WITH AIR CONTRAST,320,894,240.13,26.86% of total billed charges,670.5,75% of total billed charges,670.5,75% of total billed charges,214.56,24% of total billed charges,670.5,75% of total billed charges,670.5,75% of total billed charges,715.2,80% of total billed charges,216.71,24.24% of total billed charges,450.58,50.4% of total billed charges,670.5,75% of total billed charges,218.85,24.48% of total billed charges,240.13,26.86% of total billed charges,214.56,24% of total billed charges,278.93,31.2% of total billed charges,715.2,80% of total billed charges,214.56,24% of total billed charges,214.56,24% of total billed charges,214.56,715.2,447
Outpatient Medical Services,RADIOLOGY,74400,IVP,320,474,127.32,26.86% of total billed charges,355.5,75% of total billed charges,355.5,75% of total billed charges,113.76,24% of total billed charges,355.5,75% of total billed charges,355.5,75% of total billed charges,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,127.32,26.86% of total billed charges,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,113.76,379.2,237
Outpatient Medical Services,RADIOLOGY,76000,XR UNSPECIFIED BODY REGION FLUOROSCOPY 1,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,76000,XR UNSPECIFIED BODY REGION FLUOROSCOPY G,320,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,76000,FLUOROSCOPY UP TO ONE HOUR,320,317,85.15,26.86% of total billed charges,237.75,75% of total billed charges,237.75,75% of total billed charges,76.08,24% of total billed charges,237.75,75% of total billed charges,237.75,75% of total billed charges,253.6,80% of total billed charges,76.84,24.24% of total billed charges,159.77,50.4% of total billed charges,237.75,75% of total billed charges,77.6,24.48% of total billed charges,85.15,26.86% of total billed charges,76.08,24% of total billed charges,98.9,31.2% of total billed charges,253.6,80% of total billed charges,76.08,24% of total billed charges,76.08,24% of total billed charges,76.08,253.6,158.5
Outpatient Medical Services,RADIOLOGY,76000,FLUOROSCOPY MORE THAN ONE HOUR,320,185.5,49.83,26.86% of total billed charges,139.13,75% of total billed charges,139.13,75% of total billed charges,44.52,24% of total billed charges,139.13,75% of total billed charges,139.13,75% of total billed charges,148.4,80% of total billed charges,44.97,24.24% of total billed charges,93.49,50.4% of total billed charges,139.13,75% of total billed charges,45.41,24.48% of total billed charges,49.83,26.86% of total billed charges,44.52,24% of total billed charges,57.88,31.2% of total billed charges,148.4,80% of total billed charges,44.52,24% of total billed charges,44.52,24% of total billed charges,44.52,148.4,92.75
Outpatient Medical Services,RADIOLOGY,76010,NOSE TO RECTUM FORIGN BODY FOR CHILD,320,190.5,51.17,26.86% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,45.72,24% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,152.4,80% of total billed charges,46.18,24.24% of total billed charges,96.01,50.4% of total billed charges,142.88,75% of total billed charges,46.63,24.48% of total billed charges,51.17,26.86% of total billed charges,45.72,24% of total billed charges,59.44,31.2% of total billed charges,152.4,80% of total billed charges,45.72,24% of total billed charges,45.72,24% of total billed charges,45.72,152.4,95.25
Outpatient Medical Services,RADIOLOGY,76098,BREAST SPECIMEN MAMMOGRAPHY,320,190.5,51.17,26.86% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,45.72,24% of total billed charges,142.88,75% of total billed charges,142.88,75% of total billed charges,152.4,80% of total billed charges,46.18,24.24% of total billed charges,96.01,50.4% of total billed charges,142.88,75% of total billed charges,46.63,24.48% of total billed charges,51.17,26.86% of total billed charges,45.72,24% of total billed charges,59.44,31.2% of total billed charges,152.4,80% of total billed charges,45.72,24% of total billed charges,45.72,24% of total billed charges,45.72,152.4,95.25
Outpatient Medical Services,RADIOLOGY,76499,DEXA BODY COMPOSITION,320,125,33.58,26.86% of total billed charges,93.75,75% of total billed charges,93.75,75% of total billed charges,30,24% of total billed charges,93.75,75% of total billed charges,93.75,75% of total billed charges,100,80% of total billed charges,30.3,24.24% of total billed charges,63,50.4% of total billed charges,93.75,75% of total billed charges,30.6,24.48% of total billed charges,33.58,26.86% of total billed charges,30,24% of total billed charges,39,31.2% of total billed charges,100,80% of total billed charges,30,24% of total billed charges,30,24% of total billed charges,30,100,62.5
Outpatient Medical Services,RADIOLOGY,77002,XR FLUORO GUIDE FOR NEEDLE LOCAL,320,223,59.9,26.86% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,53.52,24% of total billed charges,167.25,75% of total billed charges,167.25,75% of total billed charges,178.4,80% of total billed charges,54.06,24.24% of total billed charges,112.39,50.4% of total billed charges,167.25,75% of total billed charges,54.59,24.48% of total billed charges,59.9,26.86% of total billed charges,53.52,24% of total billed charges,69.58,31.2% of total billed charges,178.4,80% of total billed charges,53.52,24% of total billed charges,53.52,24% of total billed charges,53.52,178.4,111.5
Outpatient Medical Services,RADIOLOGY,77002,FLUOROSCOPY GUIDANCE FOR NEEDLE PLACE,320,180.5,48.48,26.86% of total billed charges,135.38,75% of total billed charges,135.38,75% of total billed charges,43.32,24% of total billed charges,135.38,75% of total billed charges,135.38,75% of total billed charges,144.4,80% of total billed charges,43.75,24.24% of total billed charges,90.97,50.4% of total billed charges,135.38,75% of total billed charges,44.19,24.48% of total billed charges,48.48,26.86% of total billed charges,43.32,24% of total billed charges,56.32,31.2% of total billed charges,144.4,80% of total billed charges,43.32,24% of total billed charges,43.32,24% of total billed charges,43.32,144.4,90.25
Outpatient Medical Services,RADIOLOGY,77072,BONE AGE STUDIES,320,237,63.66,26.86% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,56.88,24% of total billed charges,177.75,75% of total billed charges,177.75,75% of total billed charges,189.6,80% of total billed charges,57.45,24.24% of total billed charges,119.45,50.4% of total billed charges,177.75,75% of total billed charges,58.02,24.48% of total billed charges,63.66,26.86% of total billed charges,56.88,24% of total billed charges,73.94,31.2% of total billed charges,189.6,80% of total billed charges,56.88,24% of total billed charges,56.88,24% of total billed charges,56.88,189.6,118.5
Outpatient Medical Services,RADIOLOGY,77073,BONE LENGTH STUDIES,320,372,99.92,26.86% of total billed charges,279,75% of total billed charges,279,75% of total billed charges,89.28,24% of total billed charges,279,75% of total billed charges,279,75% of total billed charges,297.6,80% of total billed charges,90.17,24.24% of total billed charges,187.49,50.4% of total billed charges,279,75% of total billed charges,91.07,24.48% of total billed charges,99.92,26.86% of total billed charges,89.28,24% of total billed charges,116.06,31.2% of total billed charges,297.6,80% of total billed charges,89.28,24% of total billed charges,89.28,24% of total billed charges,89.28,297.6,186
Outpatient Medical Services,RADIOLOGY,77075,OSSEOUS BONE SURVEY COMPLETE FOR METASTI,320,818,219.71,26.86% of total billed charges,613.5,75% of total billed charges,613.5,75% of total billed charges,196.32,24% of total billed charges,613.5,75% of total billed charges,613.5,75% of total billed charges,654.4,80% of total billed charges,198.28,24.24% of total billed charges,412.27,50.4% of total billed charges,613.5,75% of total billed charges,200.25,24.48% of total billed charges,219.71,26.86% of total billed charges,196.32,24% of total billed charges,255.22,31.2% of total billed charges,654.4,80% of total billed charges,196.32,24% of total billed charges,196.32,24% of total billed charges,196.32,654.4,409
Outpatient Medical Services,RADIOLOGY,77080,DEXA BONE DENSITY SCAN,320,701.5,188.42,26.86% of total billed charges,526.13,75% of total billed charges,526.13,75% of total billed charges,168.36,24% of total billed charges,526.13,75% of total billed charges,526.13,75% of total billed charges,561.2,80% of total billed charges,170.04,24.24% of total billed charges,353.56,50.4% of total billed charges,526.13,75% of total billed charges,171.73,24.48% of total billed charges,188.42,26.86% of total billed charges,168.36,24% of total billed charges,218.87,31.2% of total billed charges,561.2,80% of total billed charges,168.36,24% of total billed charges,168.36,24% of total billed charges,168.36,561.2,350.75
Outpatient Medical Services,RADIOLOGY,71045,CHEST 1 VIEW,324,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,65.28,24% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,65.93,24.24% of total billed charges,137.09,50.4% of total billed charges,204,75% of total billed charges,66.59,24.48% of total billed charges,73.06,26.86% of total billed charges,65.28,24% of total billed charges,84.86,31.2% of total billed charges,217.6,80% of total billed charges,65.28,24% of total billed charges,65.28,24% of total billed charges,65.28,217.6,136
Outpatient Medical Services,RADIOLOGY,71046,CHEST PA AND LATERAL,324,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,71047,CHEST 3 VIEWS,324,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,71048,XR CHEST PA AP LAT DECUBIT,324,336,90.25,26.86% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,80.64,24% of total billed charges,252,75% of total billed charges,252,75% of total billed charges,268.8,80% of total billed charges,81.45,24.24% of total billed charges,169.34,50.4% of total billed charges,252,75% of total billed charges,82.25,24.48% of total billed charges,90.25,26.86% of total billed charges,80.64,24% of total billed charges,104.83,31.2% of total billed charges,268.8,80% of total billed charges,80.64,24% of total billed charges,80.64,24% of total billed charges,80.64,268.8,168
Outpatient Medical Services,RADIOLOGY,71048,CHEST 4 OR MORE VIEWS,324,410,110.13,26.86% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,98.4,24% of total billed charges,307.5,75% of total billed charges,307.5,75% of total billed charges,328,80% of total billed charges,99.38,24.24% of total billed charges,206.64,50.4% of total billed charges,307.5,75% of total billed charges,100.37,24.48% of total billed charges,110.13,26.86% of total billed charges,98.4,24% of total billed charges,127.92,31.2% of total billed charges,328,80% of total billed charges,98.4,24% of total billed charges,98.4,24% of total billed charges,98.4,328,205
Outpatient Medical Services,RADIOLOGY,78012,NM THYROID SCAN AND UPTAKE,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78070,NM PARATHYROID,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78070,NM PARATHYROID IMAGING,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78071,NM PARATHYROID IMAGING W SPECT,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78201,NM LIVER IMAGING STATIC ONLY,341,2086,560.3,26.86% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,500.64,24% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,1668.8,80% of total billed charges,505.65,24.24% of total billed charges,1051.34,50.4% of total billed charges,1564.5,75% of total billed charges,510.65,24.48% of total billed charges,560.3,26.86% of total billed charges,500.64,24% of total billed charges,650.83,31.2% of total billed charges,1668.8,80% of total billed charges,500.64,24% of total billed charges,500.64,24% of total billed charges,500.64,1668.8,1043
Outpatient Medical Services,RADIOLOGY,78215,NM LIVER SPLEEN IMAGING,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78226,NM HEPATOBILIARY WO EF,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78227,NM HEPATOBILIARY W EF,341,2086,560.3,26.86% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,500.64,24% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,1668.8,80% of total billed charges,505.65,24.24% of total billed charges,1051.34,50.4% of total billed charges,1564.5,75% of total billed charges,510.65,24.48% of total billed charges,560.3,26.86% of total billed charges,500.64,24% of total billed charges,650.83,31.2% of total billed charges,1668.8,80% of total billed charges,500.64,24% of total billed charges,500.64,24% of total billed charges,500.64,1668.8,1043
Outpatient Medical Services,RADIOLOGY,78264,NM GASTRIC EMPTYING,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78300,NM LIMITED BONE SCAN,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78305,NM LIMITED BONE SCAN MULTIPLE AREAS,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78306,NM WHOLE BODY BONE SCAN,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78315,NM 3 PHASE BONE SCAN,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78472,NM MUGA,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78579,NM LUNG SCAN VENTILATION IMAGES ONLY,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78597,NM QUANTITATIVE LUNG SCAN,341,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78707,NM RENAL SCAN PLAIN,341,2086,560.3,26.86% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,500.64,24% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,1668.8,80% of total billed charges,505.65,24.24% of total billed charges,1051.34,50.4% of total billed charges,1564.5,75% of total billed charges,510.65,24.48% of total billed charges,560.3,26.86% of total billed charges,500.64,24% of total billed charges,650.83,31.2% of total billed charges,1668.8,80% of total billed charges,500.64,24% of total billed charges,500.64,24% of total billed charges,500.64,1668.8,1043
Outpatient Medical Services,RADIOLOGY,78708,NM RENAL SCAN CAPTOPRIL,341,2086,560.3,26.86% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,500.64,24% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,1668.8,80% of total billed charges,505.65,24.24% of total billed charges,1051.34,50.4% of total billed charges,1564.5,75% of total billed charges,510.65,24.48% of total billed charges,560.3,26.86% of total billed charges,500.64,24% of total billed charges,650.83,31.2% of total billed charges,1668.8,80% of total billed charges,500.64,24% of total billed charges,500.64,24% of total billed charges,500.64,1668.8,1043
Outpatient Medical Services,RADIOLOGY,78708,NM RENAL SCAN LASIX,341,424.5,114.02,26.86% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,101.88,24% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,114.02,26.86% of total billed charges,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,101.88,339.6,212.25
Outpatient Medical Services,RADIOLOGY,78803,NM LIVER IMAGING SPECT,341,5459,1466.29,26.86% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,1310.16,24% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,4367.2,80% of total billed charges,1323.26,24.24% of total billed charges,2751.34,50.4% of total billed charges,4094.25,75% of total billed charges,1336.36,24.48% of total billed charges,1466.29,26.86% of total billed charges,1310.16,24% of total billed charges,1703.21,31.2% of total billed charges,4367.2,80% of total billed charges,1310.16,24% of total billed charges,1310.16,24% of total billed charges,1310.16,4367.2,2729.5
Outpatient Medical Services,RADIOLOGY,78803,NM BONE SPECT,341,5459,1466.29,26.86% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,1310.16,24% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,4367.2,80% of total billed charges,1323.26,24.24% of total billed charges,2751.34,50.4% of total billed charges,4094.25,75% of total billed charges,1336.36,24.48% of total billed charges,1466.29,26.86% of total billed charges,1310.16,24% of total billed charges,1703.21,31.2% of total billed charges,4367.2,80% of total billed charges,1310.16,24% of total billed charges,1310.16,24% of total billed charges,1310.16,4367.2,2729.5
Outpatient Medical Services,RADIOLOGY,78803,NM HEMANGIOMA,341,1125,302.18,26.86% of total billed charges,843.75,75% of total billed charges,843.75,75% of total billed charges,270,24% of total billed charges,843.75,75% of total billed charges,843.75,75% of total billed charges,900,80% of total billed charges,272.7,24.24% of total billed charges,567,50.4% of total billed charges,843.75,75% of total billed charges,275.4,24.48% of total billed charges,302.18,26.86% of total billed charges,270,24% of total billed charges,351,31.2% of total billed charges,900,80% of total billed charges,270,24% of total billed charges,270,24% of total billed charges,270,900,562.5
Outpatient Medical Services,RADIOLOGY,78452,NM CARDIAC REST/STRESS,343,5459,1466.29,26.86% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,1310.16,24% of total billed charges,4094.25,75% of total billed charges,4094.25,75% of total billed charges,4367.2,80% of total billed charges,1323.26,24.24% of total billed charges,2751.34,50.4% of total billed charges,4094.25,75% of total billed charges,1336.36,24.48% of total billed charges,1466.29,26.86% of total billed charges,1310.16,24% of total billed charges,1703.21,31.2% of total billed charges,4367.2,80% of total billed charges,1310.16,24% of total billed charges,1310.16,24% of total billed charges,1310.16,4367.2,2729.5
Outpatient Medical Services,RADIOLOGY,78580,NM LUNG SCAN PERFUSION IMAGES ONLY,343,1596.5,428.82,26.86% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,383.16,24% of total billed charges,1197.38,75% of total billed charges,1197.38,75% of total billed charges,1277.2,80% of total billed charges,386.99,24.24% of total billed charges,804.64,50.4% of total billed charges,1197.38,75% of total billed charges,390.82,24.48% of total billed charges,428.82,26.86% of total billed charges,383.16,24% of total billed charges,498.11,31.2% of total billed charges,1277.2,80% of total billed charges,383.16,24% of total billed charges,383.16,24% of total billed charges,383.16,1277.2,798.25
Outpatient Medical Services,RADIOLOGY,78582,NM PULMONARY VENTILATION PERFUSION IMA,343,2086,560.3,26.86% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,500.64,24% of total billed charges,1564.5,75% of total billed charges,1564.5,75% of total billed charges,1668.8,80% of total billed charges,505.65,24.24% of total billed charges,1051.34,50.4% of total billed charges,1564.5,75% of total billed charges,510.65,24.48% of total billed charges,560.3,26.86% of total billed charges,500.64,24% of total billed charges,650.83,31.2% of total billed charges,1668.8,80% of total billed charges,500.64,24% of total billed charges,500.64,24% of total billed charges,500.64,1668.8,1043
Outpatient Medical Services,RADIOLOGY,78800,NM WBC IMAGING,343,1114.5,299.35,26.86% of total billed charges,835.88,75% of total billed charges,835.88,75% of total billed charges,267.48,24% of total billed charges,835.88,75% of total billed charges,835.88,75% of total billed charges,891.6,80% of total billed charges,270.15,24.24% of total billed charges,561.71,50.4% of total billed charges,835.88,75% of total billed charges,272.83,24.48% of total billed charges,299.35,26.86% of total billed charges,267.48,24% of total billed charges,347.72,31.2% of total billed charges,891.6,80% of total billed charges,267.48,24% of total billed charges,267.48,24% of total billed charges,267.48,891.6,557.25
Outpatient Medical Services,RADIOLOGY,93015,NM CARDIAC NUCLEAR STRESS TESTING,343,1591.5,427.48,26.86% of total billed charges,1193.63,75% of total billed charges,1193.63,75% of total billed charges,381.96,24% of total billed charges,1193.63,75% of total billed charges,1193.63,75% of total billed charges,1273.2,80% of total billed charges,385.78,24.24% of total billed charges,802.12,50.4% of total billed charges,1193.63,75% of total billed charges,389.6,24.48% of total billed charges,427.48,26.86% of total billed charges,381.96,24% of total billed charges,496.55,31.2% of total billed charges,1273.2,80% of total billed charges,381.96,24% of total billed charges,381.96,24% of total billed charges,381.96,1273.2,795.75
Outpatient Medical Services,RADIOLOGY,A9500,TC-99M SESTAMIBI,343,400.5,107.57,26.86% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,96.12,24% of total billed charges,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,320.4,80% of total billed charges,97.08,24.24% of total billed charges,201.85,50.4% of total billed charges,300.38,75% of total billed charges,98.04,24.48% of total billed charges,107.57,26.86% of total billed charges,96.12,24% of total billed charges,124.96,31.2% of total billed charges,320.4,80% of total billed charges,96.12,24% of total billed charges,96.12,24% of total billed charges,96.12,320.4,200.25
Outpatient Medical Services,RADIOLOGY,A9503,TC-99M MDP,343,124.5,33.44,26.86% of total billed charges,93.38,75% of total billed charges,93.38,75% of total billed charges,29.88,24% of total billed charges,93.38,75% of total billed charges,93.38,75% of total billed charges,99.6,80% of total billed charges,30.18,24.24% of total billed charges,62.75,50.4% of total billed charges,93.38,75% of total billed charges,30.48,24.48% of total billed charges,33.44,26.86% of total billed charges,29.88,24% of total billed charges,38.84,31.2% of total billed charges,99.6,80% of total billed charges,29.88,24% of total billed charges,29.88,24% of total billed charges,29.88,99.6,62.25
Outpatient Medical Services,RADIOLOGY,A9509,IODINE -123,343,414,111.2,26.86% of total billed charges,310.5,75% of total billed charges,310.5,75% of total billed charges,99.36,24% of total billed charges,310.5,75% of total billed charges,310.5,75% of total billed charges,331.2,80% of total billed charges,100.35,24.24% of total billed charges,208.66,50.4% of total billed charges,310.5,75% of total billed charges,101.35,24.48% of total billed charges,111.2,26.86% of total billed charges,99.36,24% of total billed charges,129.17,31.2% of total billed charges,331.2,80% of total billed charges,99.36,24% of total billed charges,99.36,24% of total billed charges,99.36,331.2,207
Outpatient Medical Services,RADIOLOGY,A9521,TC-99M CERETEC,343,5040,1353.74,26.86% of total billed charges,3780,75% of total billed charges,3780,75% of total billed charges,1209.6,24% of total billed charges,3780,75% of total billed charges,3780,75% of total billed charges,4032,80% of total billed charges,1221.7,24.24% of total billed charges,2540.16,50.4% of total billed charges,3780,75% of total billed charges,1233.79,24.48% of total billed charges,1353.74,26.86% of total billed charges,1209.6,24% of total billed charges,1572.48,31.2% of total billed charges,4032,80% of total billed charges,1209.6,24% of total billed charges,1209.6,24% of total billed charges,1209.6,4032,2520
Outpatient Medical Services,RADIOLOGY,A9537,TC-99MMEBROFENIN,343,306,82.19,26.86% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,73.44,24% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,244.8,80% of total billed charges,74.17,24.24% of total billed charges,154.22,50.4% of total billed charges,229.5,75% of total billed charges,74.91,24.48% of total billed charges,82.19,26.86% of total billed charges,73.44,24% of total billed charges,95.47,31.2% of total billed charges,244.8,80% of total billed charges,73.44,24% of total billed charges,73.44,24% of total billed charges,73.44,244.8,153
Outpatient Medical Services,RADIOLOGY,A9540,TC-99M MAA,343,217.5,58.42,26.86% of total billed charges,163.13,75% of total billed charges,163.13,75% of total billed charges,52.2,24% of total billed charges,163.13,75% of total billed charges,163.13,75% of total billed charges,174,80% of total billed charges,52.72,24.24% of total billed charges,109.62,50.4% of total billed charges,163.13,75% of total billed charges,53.24,24.48% of total billed charges,58.42,26.86% of total billed charges,52.2,24% of total billed charges,67.86,31.2% of total billed charges,174,80% of total billed charges,52.2,24% of total billed charges,52.2,24% of total billed charges,52.2,174,108.75
Outpatient Medical Services,RADIOLOGY,A9541,TC-99M SULFUR COLLOID,343,525.5,141.15,26.86% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,126.12,24% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,420.4,80% of total billed charges,127.38,24.24% of total billed charges,264.85,50.4% of total billed charges,394.13,75% of total billed charges,128.64,24.48% of total billed charges,141.15,26.86% of total billed charges,126.12,24% of total billed charges,163.96,31.2% of total billed charges,420.4,80% of total billed charges,126.12,24% of total billed charges,126.12,24% of total billed charges,126.12,420.4,262.75
Outpatient Medical Services,RADIOLOGY,A9560,TC-99M LABELED RBC,343,806.5,216.63,26.86% of total billed charges,604.88,75% of total billed charges,604.88,75% of total billed charges,193.56,24% of total billed charges,604.88,75% of total billed charges,604.88,75% of total billed charges,645.2,80% of total billed charges,195.5,24.24% of total billed charges,406.48,50.4% of total billed charges,604.88,75% of total billed charges,197.43,24.48% of total billed charges,216.63,26.86% of total billed charges,193.56,24% of total billed charges,251.63,31.2% of total billed charges,645.2,80% of total billed charges,193.56,24% of total billed charges,193.56,24% of total billed charges,193.56,645.2,403.25
Outpatient Medical Services,RADIOLOGY,A9562,TC-99M MAG-3,343,1559.5,418.88,26.86% of total billed charges,1169.63,75% of total billed charges,1169.63,75% of total billed charges,374.28,24% of total billed charges,1169.63,75% of total billed charges,1169.63,75% of total billed charges,1247.6,80% of total billed charges,378.02,24.24% of total billed charges,785.99,50.4% of total billed charges,1169.63,75% of total billed charges,381.77,24.48% of total billed charges,418.88,26.86% of total billed charges,374.28,24% of total billed charges,486.56,31.2% of total billed charges,1247.6,80% of total billed charges,374.28,24% of total billed charges,374.28,24% of total billed charges,374.28,1247.6,779.75
Outpatient Medical Services,RADIOLOGY,A9567,TC-99M DTPA AEROSOL,343,308,82.73,26.86% of total billed charges,231,75% of total billed charges,231,75% of total billed charges,73.92,24% of total billed charges,231,75% of total billed charges,231,75% of total billed charges,246.4,80% of total billed charges,74.66,24.24% of total billed charges,155.23,50.4% of total billed charges,231,75% of total billed charges,75.4,24.48% of total billed charges,82.73,26.86% of total billed charges,73.92,24% of total billed charges,96.1,31.2% of total billed charges,246.4,80% of total billed charges,73.92,24% of total billed charges,73.92,24% of total billed charges,73.92,246.4,154
Outpatient Medical Services,RADIOLOGY,76376,3D RECONSTRUCTION REPORT OF CT,350,2334,626.91,26.86% of total billed charges,1750.5,75% of total billed charges,1750.5,75% of total billed charges,560.16,24% of total billed charges,1750.5,75% of total billed charges,1750.5,75% of total billed charges,1867.2,80% of total billed charges,565.76,24.24% of total billed charges,1176.34,50.4% of total billed charges,1750.5,75% of total billed charges,571.36,24.48% of total billed charges,626.91,26.86% of total billed charges,560.16,24% of total billed charges,728.21,31.2% of total billed charges,1867.2,80% of total billed charges,560.16,24% of total billed charges,560.16,24% of total billed charges,560.16,1867.2,1167
Outpatient Medical Services,RADIOLOGY,76377,3D RECONSTRUCTION CT REQ INDEPEND WS,350,3501,940.37,26.86% of total billed charges,2625.75,75% of total billed charges,2625.75,75% of total billed charges,840.24,24% of total billed charges,2625.75,75% of total billed charges,2625.75,75% of total billed charges,2800.8,80% of total billed charges,848.64,24.24% of total billed charges,1764.5,50.4% of total billed charges,2625.75,75% of total billed charges,857.04,24.48% of total billed charges,940.37,26.86% of total billed charges,840.24,24% of total billed charges,1092.31,31.2% of total billed charges,2800.8,80% of total billed charges,840.24,24% of total billed charges,840.24,24% of total billed charges,840.24,2800.8,1750.5
Outpatient Medical Services,RADIOLOGY,70450,CT HEAD/BRAIN WO CONT,351,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,70460,CT HEAD/BRAIN W CONT,351,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,70470,CT HEAD/BRAIN WWO CONT,351,3584.5,962.8,26.86% of total billed charges,2688.38,75% of total billed charges,2688.38,75% of total billed charges,860.28,24% of total billed charges,2688.38,75% of total billed charges,2688.38,75% of total billed charges,2867.6,80% of total billed charges,868.88,24.24% of total billed charges,1806.59,50.4% of total billed charges,2688.38,75% of total billed charges,877.49,24.48% of total billed charges,962.8,26.86% of total billed charges,860.28,24% of total billed charges,1118.36,31.2% of total billed charges,2867.6,80% of total billed charges,860.28,24% of total billed charges,860.28,24% of total billed charges,860.28,2867.6,1792.25
Outpatient Medical Services,RADIOLOGY,70480,CT INTERNAL AUDITORY CANAL,351,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,70480,CT ORBIT/IAC/MASTOIDS WO CONTRST MATERIA,351,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,70481,CT ORBIT/IAC/MASTOIDS WITH CONTRAST MAT,351,2844,763.9,26.86% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,682.56,24% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,2275.2,80% of total billed charges,689.39,24.24% of total billed charges,1433.38,50.4% of total billed charges,2133,75% of total billed charges,696.21,24.48% of total billed charges,763.9,26.86% of total billed charges,682.56,24% of total billed charges,887.33,31.2% of total billed charges,2275.2,80% of total billed charges,682.56,24% of total billed charges,682.56,24% of total billed charges,682.56,2275.2,1422
Outpatient Medical Services,RADIOLOGY,70482,CT ORBIT/IAC/MASTOIDS  WWO CONTRAST,351,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,70486,CT MAX/FACIAL/SINUS WITHOUT CONTRAST,351,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,70487,CT MAX/FACIAL/SINUS  WITH CONTRAST,351,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,70488,CT MAX/FACIAL/SINUS W/WO CONTRAST MATE,351,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,70490,CT SOFT TISSUE NECK WITHOUT CONTRAST MAT,351,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,70491,CT SOFT TISSUE NECK WITH CONTRAST MATERI,351,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,70492,CT SOFT TISSUE NECK WWO CONTRAST MATERIA,351,3584.5,962.8,26.86% of total billed charges,2688.38,75% of total billed charges,2688.38,75% of total billed charges,860.28,24% of total billed charges,2688.38,75% of total billed charges,2688.38,75% of total billed charges,2867.6,80% of total billed charges,868.88,24.24% of total billed charges,1806.59,50.4% of total billed charges,2688.38,75% of total billed charges,877.49,24.48% of total billed charges,962.8,26.86% of total billed charges,860.28,24% of total billed charges,1118.36,31.2% of total billed charges,2867.6,80% of total billed charges,860.28,24% of total billed charges,860.28,24% of total billed charges,860.28,2867.6,1792.25
Outpatient Medical Services,RADIOLOGY,70496,CTA HEAD WITH CONTRAST,351,4609.5,1238.11,26.86% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,1106.28,24% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,3687.6,80% of total billed charges,1117.34,24.24% of total billed charges,2323.19,50.4% of total billed charges,3457.13,75% of total billed charges,1128.41,24.48% of total billed charges,1238.11,26.86% of total billed charges,1106.28,24% of total billed charges,1438.16,31.2% of total billed charges,3687.6,80% of total billed charges,1106.28,24% of total billed charges,1106.28,24% of total billed charges,1106.28,3687.6,2304.75
Outpatient Medical Services,RADIOLOGY,70498,CTA NECK WITH CONTRAST MATERIAL,351,4609.5,1238.11,26.86% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,1106.28,24% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,3687.6,80% of total billed charges,1117.34,24.24% of total billed charges,2323.19,50.4% of total billed charges,3457.13,75% of total billed charges,1128.41,24.48% of total billed charges,1238.11,26.86% of total billed charges,1106.28,24% of total billed charges,1438.16,31.2% of total billed charges,3687.6,80% of total billed charges,1106.28,24% of total billed charges,1106.28,24% of total billed charges,1106.28,3687.6,2304.75
Outpatient Medical Services,RADIOLOGY,71250,CT CHEST WO CONTRAST MATERIAL,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,71250,CT CHEST ABDOMEN PELVIS WO CONTRAST,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71250,CTA CHEST W/CT ABD & PELVIS IV ONLY,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71250,CTA CHEST W/CT ABD & PEL ORAL &  IV,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71250,CTA HEAD AND NECK,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71260,CT CHEST W CONTRAST MATERIAL,352,3073.5,825.54,26.86% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,737.64,24% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,2458.8,80% of total billed charges,745.02,24.24% of total billed charges,1549.04,50.4% of total billed charges,2305.13,75% of total billed charges,752.39,24.48% of total billed charges,825.54,26.86% of total billed charges,737.64,24% of total billed charges,958.93,31.2% of total billed charges,2458.8,80% of total billed charges,737.64,24% of total billed charges,737.64,24% of total billed charges,737.64,2458.8,1536.75
Outpatient Medical Services,RADIOLOGY,71260,CT CHEST ABDOMEN PELVIS W CONTRAST,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71260,CT CHEST ABDOMEN PELVIS W/WO CONTRAST,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,71270,CT CHEST WWO CONTRAST MATERIAL,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,71271,CT THORAX LUNG CANCER SCREEN WO CONTRAST,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,71275,CTA CHEST NONCORONARY WITH CONTRAST MATE,352,4609.5,1238.11,26.86% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,1106.28,24% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,3687.6,80% of total billed charges,1117.34,24.24% of total billed charges,2323.19,50.4% of total billed charges,3457.13,75% of total billed charges,1128.41,24.48% of total billed charges,1238.11,26.86% of total billed charges,1106.28,24% of total billed charges,1438.16,31.2% of total billed charges,3687.6,80% of total billed charges,1106.28,24% of total billed charges,1106.28,24% of total billed charges,1106.28,3687.6,2304.75
Outpatient Medical Services,RADIOLOGY,71275,CTA CHEST AND ABD,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72125,CT CERVICAL SPINE  WO CONTRAST MATERIAL,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,72126,CT CERVICAL SPINE W CONTRAST MATERIAL,352,2440,655.38,26.86% of total billed charges,1830,75% of total billed charges,1830,75% of total billed charges,585.6,24% of total billed charges,1830,75% of total billed charges,1830,75% of total billed charges,1952,80% of total billed charges,591.46,24.24% of total billed charges,1229.76,50.4% of total billed charges,1830,75% of total billed charges,597.31,24.48% of total billed charges,655.38,26.86% of total billed charges,585.6,24% of total billed charges,761.28,31.2% of total billed charges,1952,80% of total billed charges,585.6,24% of total billed charges,585.6,24% of total billed charges,585.6,1952,1220
Outpatient Medical Services,RADIOLOGY,72127,CT CERVICAL SPINE WWO CONTRAST MATERIAL,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,72128,CT THORACIC SPINE WO CONTRAST MATERIAL,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,72129,CT THORACIC SPINE WITH CONTRAST MATERIAL,352,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,72130,CT THORACIC SPINE WWO CONTRAST MATERIAL,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,72131,CT LUMBAR SPINE WO CONTRAST MATERIAL,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,72132,CT LUMBAR  SPINE WITH CONTRAST MATERIAL,352,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,72133,CT LUMBAR SPINE  WWO CONTRAST MATERIAL,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,72191,CTA PELVIS WITH CONTRAST MATERIAL,352,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,72192,CT PELVIS WO CONTRAST,352,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,72192,CT PELVIS W/O ORAL & IV,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS W CONTRAST,352,3073.5,825.54,26.86% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,737.64,24% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,2458.8,80% of total billed charges,745.02,24.24% of total billed charges,1549.04,50.4% of total billed charges,2305.13,75% of total billed charges,752.39,24.48% of total billed charges,825.54,26.86% of total billed charges,737.64,24% of total billed charges,958.93,31.2% of total billed charges,2458.8,80% of total billed charges,737.64,24% of total billed charges,737.64,24% of total billed charges,737.64,2458.8,1536.75
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS W ORAL ONLY,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS W IV ONLY,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS W IV & ORAL,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72194,CT PELVIS WWO CONTRAST,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,73200,CT UPPER EXT WO CONT BILAT,352,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,73200,CT UPPER EXT WO CONT LT,352,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,73200,CT UPPER EXT WO CONT RT,352,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,73201,CT UPPER EXT LTD W CONT BIL,352,2372,637.12,26.86% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,569.28,24% of total billed charges,1779,75% of total billed charges,1779,75% of total billed charges,1897.6,80% of total billed charges,574.97,24.24% of total billed charges,1195.49,50.4% of total billed charges,1779,75% of total billed charges,580.67,24.48% of total billed charges,637.12,26.86% of total billed charges,569.28,24% of total billed charges,740.06,31.2% of total billed charges,1897.6,80% of total billed charges,569.28,24% of total billed charges,569.28,24% of total billed charges,569.28,1897.6,1186
Outpatient Medical Services,RADIOLOGY,73201,CT UPPER EXT WITH CONTRAST MATERIAL LT,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,73201,CT UPPER EXT  W CONTRAST RT,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,73202,CT UPPER EXT WWO CONT BIL,352,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,73202,CT UPPER EXT WWO CONT LT,352,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,73202,CT UPPER EXT WWO CONT RT,352,2845,764.17,26.86% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,682.8,24% of total billed charges,2133.75,75% of total billed charges,2133.75,75% of total billed charges,2276,80% of total billed charges,689.63,24.24% of total billed charges,1433.88,50.4% of total billed charges,2133.75,75% of total billed charges,696.46,24.48% of total billed charges,764.17,26.86% of total billed charges,682.8,24% of total billed charges,887.64,31.2% of total billed charges,2276,80% of total billed charges,682.8,24% of total billed charges,682.8,24% of total billed charges,682.8,2276,1422.5
Outpatient Medical Services,RADIOLOGY,73206,CTA UPPER EXTREMITY W CONTRAST LT,352,2371,636.85,26.86% of total billed charges,1778.25,75% of total billed charges,1778.25,75% of total billed charges,569.04,24% of total billed charges,1778.25,75% of total billed charges,1778.25,75% of total billed charges,1896.8,80% of total billed charges,574.73,24.24% of total billed charges,1194.98,50.4% of total billed charges,1778.25,75% of total billed charges,580.42,24.48% of total billed charges,636.85,26.86% of total billed charges,569.04,24% of total billed charges,739.75,31.2% of total billed charges,1896.8,80% of total billed charges,569.04,24% of total billed charges,569.04,24% of total billed charges,569.04,1896.8,1185.5
Outpatient Medical Services,RADIOLOGY,73206,CTA UPPER EXTREMITY W CONTRAST RT,352,2371,636.85,26.86% of total billed charges,1778.25,75% of total billed charges,1778.25,75% of total billed charges,569.04,24% of total billed charges,1778.25,75% of total billed charges,1778.25,75% of total billed charges,1896.8,80% of total billed charges,574.73,24.24% of total billed charges,1194.98,50.4% of total billed charges,1778.25,75% of total billed charges,580.42,24.48% of total billed charges,636.85,26.86% of total billed charges,569.04,24% of total billed charges,739.75,31.2% of total billed charges,1896.8,80% of total billed charges,569.04,24% of total billed charges,569.04,24% of total billed charges,569.04,1896.8,1185.5
Outpatient Medical Services,RADIOLOGY,73700,CT LOWER EXT WO CONT LT,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,73700,CT LOWER EXT WO CONT RT,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,73701,CT LOWER EXTREMITY W CONTRAST LT,352,3073.5,825.54,26.86% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,737.64,24% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,2458.8,80% of total billed charges,745.02,24.24% of total billed charges,1549.04,50.4% of total billed charges,2305.13,75% of total billed charges,752.39,24.48% of total billed charges,825.54,26.86% of total billed charges,737.64,24% of total billed charges,958.93,31.2% of total billed charges,2458.8,80% of total billed charges,737.64,24% of total billed charges,737.64,24% of total billed charges,737.64,2458.8,1536.75
Outpatient Medical Services,RADIOLOGY,73701,CT LOWER EXTREMITY W CONTRAST RT,352,3073.5,825.54,26.86% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,737.64,24% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,2458.8,80% of total billed charges,745.02,24.24% of total billed charges,1549.04,50.4% of total billed charges,2305.13,75% of total billed charges,752.39,24.48% of total billed charges,825.54,26.86% of total billed charges,737.64,24% of total billed charges,958.93,31.2% of total billed charges,2458.8,80% of total billed charges,737.64,24% of total billed charges,737.64,24% of total billed charges,737.64,2458.8,1536.75
Outpatient Medical Services,RADIOLOGY,73702,CT LOWER EXT WWO CONT BIL,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,73702,CT LOWER EXT WWO CONT LT,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,73702,CT LOWER EXT WWO CONT RT,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,73706,CTA LOWER EXTREMITY W CONTRAST LT,352,2844,763.9,26.86% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,682.56,24% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,2275.2,80% of total billed charges,689.39,24.24% of total billed charges,1433.38,50.4% of total billed charges,2133,75% of total billed charges,696.21,24.48% of total billed charges,763.9,26.86% of total billed charges,682.56,24% of total billed charges,887.33,31.2% of total billed charges,2275.2,80% of total billed charges,682.56,24% of total billed charges,682.56,24% of total billed charges,682.56,2275.2,1422
Outpatient Medical Services,RADIOLOGY,73706,CTA LOWER EXTREMITY W CONTRAST BIL,352,2844,763.9,26.86% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,682.56,24% of total billed charges,2133,75% of total billed charges,2133,75% of total billed charges,2275.2,80% of total billed charges,689.39,24.24% of total billed charges,1433.38,50.4% of total billed charges,2133,75% of total billed charges,696.21,24.48% of total billed charges,763.9,26.86% of total billed charges,682.56,24% of total billed charges,887.33,31.2% of total billed charges,2275.2,80% of total billed charges,682.56,24% of total billed charges,682.56,24% of total billed charges,682.56,2275.2,1422
Outpatient Medical Services,RADIOLOGY,74150,CT ABDOMEN WITHOUT CONTRAST,352,2561.5,688.02,26.86% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,614.76,24% of total billed charges,1921.13,75% of total billed charges,1921.13,75% of total billed charges,2049.2,80% of total billed charges,620.91,24.24% of total billed charges,1291,50.4% of total billed charges,1921.13,75% of total billed charges,627.06,24.48% of total billed charges,688.02,26.86% of total billed charges,614.76,24% of total billed charges,799.19,31.2% of total billed charges,2049.2,80% of total billed charges,614.76,24% of total billed charges,614.76,24% of total billed charges,614.76,2049.2,1280.75
Outpatient Medical Services,RADIOLOGY,74150,CT ABD W/O ORAL OR IV,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,74160,CT ABDOMEN WITH CONTRAST,352,3073.5,825.54,26.86% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,737.64,24% of total billed charges,2305.13,75% of total billed charges,2305.13,75% of total billed charges,2458.8,80% of total billed charges,745.02,24.24% of total billed charges,1549.04,50.4% of total billed charges,2305.13,75% of total billed charges,752.39,24.48% of total billed charges,825.54,26.86% of total billed charges,737.64,24% of total billed charges,958.93,31.2% of total billed charges,2458.8,80% of total billed charges,737.64,24% of total billed charges,737.64,24% of total billed charges,737.64,2458.8,1536.75
Outpatient Medical Services,RADIOLOGY,74160,CT ABD W ORAL ONLY,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,74160,CT ABD W IV ONLY,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,74160,CT ABD W ORAL & IV,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,74170,CT ABDOMEN  WWO  CONTRAST,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,74170,CT ABDOMEN  WWO IV CONTRAST,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,74170,CT ABDOMEN  WWO ORAL/IV CONTRAST,352,3319.5,891.62,26.86% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,796.68,24% of total billed charges,2489.63,75% of total billed charges,2489.63,75% of total billed charges,2655.6,80% of total billed charges,804.65,24.24% of total billed charges,1673.03,50.4% of total billed charges,2489.63,75% of total billed charges,812.61,24.48% of total billed charges,891.62,26.86% of total billed charges,796.68,24% of total billed charges,1035.68,31.2% of total billed charges,2655.6,80% of total billed charges,796.68,24% of total billed charges,796.68,24% of total billed charges,796.68,2655.6,1659.75
Outpatient Medical Services,RADIOLOGY,74174,CTA  ABDOMEN AND PELVIS W CONTRAST MATER,352,4243.5,1139.8,26.86% of total billed charges,3182.63,75% of total billed charges,3182.63,75% of total billed charges,1018.44,24% of total billed charges,3182.63,75% of total billed charges,3182.63,75% of total billed charges,3394.8,80% of total billed charges,1028.62,24.24% of total billed charges,2138.72,50.4% of total billed charges,3182.63,75% of total billed charges,1038.81,24.48% of total billed charges,1139.8,26.86% of total billed charges,1018.44,24% of total billed charges,1323.97,31.2% of total billed charges,3394.8,80% of total billed charges,1018.44,24% of total billed charges,1018.44,24% of total billed charges,1018.44,3394.8,2121.75
Outpatient Medical Services,RADIOLOGY,74174,CT AORTA ANGIO W CONT,352,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,74175,CTA ABDOMEN  WITH CONTRAST MATERIAL,352,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,74176,CT ABDOMEN PELVIS WO CONTRAST,352,3841,1031.69,26.86% of total billed charges,2880.75,75% of total billed charges,2880.75,75% of total billed charges,921.84,24% of total billed charges,2880.75,75% of total billed charges,2880.75,75% of total billed charges,3072.8,80% of total billed charges,931.06,24.24% of total billed charges,1935.86,50.4% of total billed charges,2880.75,75% of total billed charges,940.28,24.48% of total billed charges,1031.69,26.86% of total billed charges,921.84,24% of total billed charges,1198.39,31.2% of total billed charges,3072.8,80% of total billed charges,921.84,24% of total billed charges,921.84,24% of total billed charges,921.84,3072.8,1920.5
Outpatient Medical Services,RADIOLOGY,74177,CT ABDOMEN PELVIS WITH  CONTRAST,352,4609.5,1238.11,26.86% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,1106.28,24% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,3687.6,80% of total billed charges,1117.34,24.24% of total billed charges,2323.19,50.4% of total billed charges,3457.13,75% of total billed charges,1128.41,24.48% of total billed charges,1238.11,26.86% of total billed charges,1106.28,24% of total billed charges,1438.16,31.2% of total billed charges,3687.6,80% of total billed charges,1106.28,24% of total billed charges,1106.28,24% of total billed charges,1106.28,3687.6,2304.75
Outpatient Medical Services,RADIOLOGY,74177,CT ENTEROGRAPHY,352,4609.5,1238.11,26.86% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,1106.28,24% of total billed charges,3457.13,75% of total billed charges,3457.13,75% of total billed charges,3687.6,80% of total billed charges,1117.34,24.24% of total billed charges,2323.19,50.4% of total billed charges,3457.13,75% of total billed charges,1128.41,24.48% of total billed charges,1238.11,26.86% of total billed charges,1106.28,24% of total billed charges,1438.16,31.2% of total billed charges,3687.6,80% of total billed charges,1106.28,24% of total billed charges,1106.28,24% of total billed charges,1106.28,3687.6,2304.75
Outpatient Medical Services,RADIOLOGY,74178,CT ABDOMEN PELVIS WWO  CONTRAST,352,5376.5,1444.13,26.86% of total billed charges,4032.38,75% of total billed charges,4032.38,75% of total billed charges,1290.36,24% of total billed charges,4032.38,75% of total billed charges,4032.38,75% of total billed charges,4301.2,80% of total billed charges,1303.26,24.24% of total billed charges,2709.76,50.4% of total billed charges,4032.38,75% of total billed charges,1316.17,24.48% of total billed charges,1444.13,26.86% of total billed charges,1290.36,24% of total billed charges,1677.47,31.2% of total billed charges,4301.2,80% of total billed charges,1290.36,24% of total billed charges,1290.36,24% of total billed charges,1290.36,4301.2,2688.25
Outpatient Medical Services,RADIOLOGY,74178,CT ABDOMEN PELVIS WWO  IV CONTRAST,352,4979,1337.36,26.86% of total billed charges,3734.25,75% of total billed charges,3734.25,75% of total billed charges,1194.96,24% of total billed charges,3734.25,75% of total billed charges,3734.25,75% of total billed charges,3983.2,80% of total billed charges,1206.91,24.24% of total billed charges,2509.42,50.4% of total billed charges,3734.25,75% of total billed charges,1218.86,24.48% of total billed charges,1337.36,26.86% of total billed charges,1194.96,24% of total billed charges,1553.45,31.2% of total billed charges,3983.2,80% of total billed charges,1194.96,24% of total billed charges,1194.96,24% of total billed charges,1194.96,3983.2,2489.5
Outpatient Medical Services,RADIOLOGY,74178,CT ABDOMEN PELVIS WWO  ORAL/IV CONTRAST,352,4979,1337.36,26.86% of total billed charges,3734.25,75% of total billed charges,3734.25,75% of total billed charges,1194.96,24% of total billed charges,3734.25,75% of total billed charges,3734.25,75% of total billed charges,3983.2,80% of total billed charges,1206.91,24.24% of total billed charges,2509.42,50.4% of total billed charges,3734.25,75% of total billed charges,1218.86,24.48% of total billed charges,1337.36,26.86% of total billed charges,1194.96,24% of total billed charges,1553.45,31.2% of total billed charges,3983.2,80% of total billed charges,1194.96,24% of total billed charges,1194.96,24% of total billed charges,1194.96,3983.2,2489.5
Outpatient Medical Services,RADIOLOGY,75571,CT CARDIAC SCORING,352,150,40.29,26.86% of total billed charges,112.5,75% of total billed charges,112.5,75% of total billed charges,36,24% of total billed charges,112.5,75% of total billed charges,112.5,75% of total billed charges,120,80% of total billed charges,36.36,24.24% of total billed charges,75.6,50.4% of total billed charges,112.5,75% of total billed charges,36.72,24.48% of total billed charges,40.29,26.86% of total billed charges,36,24% of total billed charges,46.8,31.2% of total billed charges,120,80% of total billed charges,36,24% of total billed charges,36,24% of total billed charges,36,120,75
Outpatient Medical Services,RADIOLOGY,75635,CTA ABD AOR AND BIL LLIFEMORAL RUNOFF WI,352,5928.5,1592.4,26.86% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,1422.84,24% of total billed charges,4394,75% of total billed charges,4394,75% of total billed charges,4742.8,80% of total billed charges,1437.07,24.24% of total billed charges,2987.96,50.4% of total billed charges,4446.38,75% of total billed charges,1451.3,24.48% of total billed charges,1592.4,26.86% of total billed charges,1422.84,24% of total billed charges,1849.69,31.2% of total billed charges,4742.8,80% of total billed charges,1422.84,24% of total billed charges,1422.84,24% of total billed charges,1422.84,4742.8,2964.25
Outpatient Medical Services,RADIOLOGY,76376,CT UNSPECIFIED BODY REGION 3D RECONSTR,352,1031,276.93,26.86% of total billed charges,773.25,75% of total billed charges,773.25,75% of total billed charges,247.44,24% of total billed charges,773.25,75% of total billed charges,773.25,75% of total billed charges,824.8,80% of total billed charges,249.91,24.24% of total billed charges,519.62,50.4% of total billed charges,773.25,75% of total billed charges,252.39,24.48% of total billed charges,276.93,26.86% of total billed charges,247.44,24% of total billed charges,321.67,31.2% of total billed charges,824.8,80% of total billed charges,247.44,24% of total billed charges,247.44,24% of total billed charges,247.44,824.8,515.5
Outpatient Medical Services,RADIOLOGY,77012,CT GUIDED BIOPSY,352,1251.5,336.15,26.86% of total billed charges,938.63,75% of total billed charges,938.63,75% of total billed charges,300.36,24% of total billed charges,938.63,75% of total billed charges,938.63,75% of total billed charges,1001.2,80% of total billed charges,303.36,24.24% of total billed charges,630.76,50.4% of total billed charges,938.63,75% of total billed charges,306.37,24.48% of total billed charges,336.15,26.86% of total billed charges,300.36,24% of total billed charges,390.47,31.2% of total billed charges,1001.2,80% of total billed charges,300.36,24% of total billed charges,300.36,24% of total billed charges,300.36,1001.2,625.75
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,"$1,167.00 ",313.46,26.86% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,280.08,24% of total billed charges,875.25,75% of total billed charges,875.25,75% of total billed charges,933.6,80% of total billed charges,282.88,24.24% of total billed charges,588.17,50.4% of total billed charges,875.25,75% of total billed charges,285.68,24.48% of total billed charges,313.46,26.86% of total billed charges,280.08,24% of total billed charges,364.1,31.2% of total billed charges,933.6,80% of total billed charges,280.08,24% of total billed charges,280.08,24% of total billed charges,280.08,933.6,583.5
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,352,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,19281,MM GUIDE NEEDLE LOCAL MASS OF BREAST,401,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,19281,MM GUIDE NEEDLE LOCAL MASS OF BREAST,401,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,77061,MM UNILATERAL DIAGNOSTIC BREAST TOMO LT,401,112.5,30.22,26.86% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,27,24% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,90,80% of total billed charges,27.27,24.24% of total billed charges,56.7,50.4% of total billed charges,84.38,75% of total billed charges,27.54,24.48% of total billed charges,30.22,26.86% of total billed charges,27,24% of total billed charges,35.1,31.2% of total billed charges,90,80% of total billed charges,27,24% of total billed charges,27,24% of total billed charges,27,90,56.25
Outpatient Medical Services,RADIOLOGY,77061,MM UNILAT DIAGNOSTIC MAMMO and TOMO LT,401,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77061,MM UNILATERAL DIAGNOSTIC BREAST TOMO RT,401,112.5,30.22,26.86% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,27,24% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,90,80% of total billed charges,27.27,24.24% of total billed charges,56.7,50.4% of total billed charges,84.38,75% of total billed charges,27.54,24.48% of total billed charges,30.22,26.86% of total billed charges,27,24% of total billed charges,35.1,31.2% of total billed charges,90,80% of total billed charges,27,24% of total billed charges,27,24% of total billed charges,27,90,56.25
Outpatient Medical Services,RADIOLOGY,77061,MM UNILAT DIAGNOSTIC MAMMO and TOMO RT,401,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77062,MM BILATERAL DIAGNOSTIC BREAST TOMO,401,112.5,30.22,26.86% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,27,24% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,90,80% of total billed charges,27.27,24.24% of total billed charges,56.7,50.4% of total billed charges,84.38,75% of total billed charges,27.54,24.48% of total billed charges,30.22,26.86% of total billed charges,27,24% of total billed charges,35.1,31.2% of total billed charges,90,80% of total billed charges,27,24% of total billed charges,27,24% of total billed charges,27,90,56.25
Outpatient Medical Services,RADIOLOGY,77062,MM BILATERAL DIAGNOSTIC MAMMO and TOMO,401,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77065,MM UNILATERAL MAMMOGRAM LT W/CAD,401,424.5,114.02,26.86% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,101.88,24% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,114.02,26.86% of total billed charges,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,101.88,339.6,212.25
Outpatient Medical Services,RADIOLOGY,77065,MM UNILATERAL MAMMOGRAM W/CAD RT,401,424.5,114.02,26.86% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,101.88,24% of total billed charges,318.38,75% of total billed charges,318.38,75% of total billed charges,339.6,80% of total billed charges,102.9,24.24% of total billed charges,213.95,50.4% of total billed charges,318.38,75% of total billed charges,103.92,24.48% of total billed charges,114.02,26.86% of total billed charges,101.88,24% of total billed charges,132.44,31.2% of total billed charges,339.6,80% of total billed charges,101.88,24% of total billed charges,101.88,24% of total billed charges,101.88,339.6,212.25
Outpatient Medical Services,RADIOLOGY,77066,MM BILATERAL DIAGNOSTIC MAMMOGRAM W/CAD,401,535.5,143.84,26.86% of total billed charges,401.63,75% of total billed charges,401.63,75% of total billed charges,128.52,24% of total billed charges,401.63,75% of total billed charges,401.63,75% of total billed charges,428.4,80% of total billed charges,129.81,24.24% of total billed charges,269.89,50.4% of total billed charges,401.63,75% of total billed charges,131.09,24.48% of total billed charges,143.84,26.86% of total billed charges,128.52,24% of total billed charges,167.08,31.2% of total billed charges,428.4,80% of total billed charges,128.52,24% of total billed charges,128.52,24% of total billed charges,128.52,428.4,267.75
Outpatient Medical Services,RADIOLOGY,76536,XR HEAD NECK,402,447,120.06,26.86% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,107.28,24% of total billed charges,335.25,75% of total billed charges,335.25,75% of total billed charges,357.6,80% of total billed charges,108.35,24.24% of total billed charges,225.29,50.4% of total billed charges,335.25,75% of total billed charges,109.43,24.48% of total billed charges,120.06,26.86% of total billed charges,107.28,24% of total billed charges,139.46,31.2% of total billed charges,357.6,80% of total billed charges,107.28,24% of total billed charges,107.28,24% of total billed charges,107.28,357.6,223.5
Outpatient Medical Services,RADIOLOGY,76536,US THYROID/NECK,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76604,US CHEST,402,147.5,39.62,26.86% of total billed charges,110.63,75% of total billed charges,110.63,75% of total billed charges,35.4,24% of total billed charges,110.63,75% of total billed charges,110.63,75% of total billed charges,118,80% of total billed charges,35.75,24.24% of total billed charges,74.34,50.4% of total billed charges,110.63,75% of total billed charges,36.11,24.48% of total billed charges,39.62,26.86% of total billed charges,35.4,24% of total billed charges,46.02,31.2% of total billed charges,118,80% of total billed charges,35.4,24% of total billed charges,35.4,24% of total billed charges,35.4,118,73.75
Outpatient Medical Services,RADIOLOGY,76641,US AXILLA LT,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76641,US AXILLA RT,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76642,US BREAST BIL,402,265.5,71.31,26.86% of total billed charges,199.13,75% of total billed charges,199.13,75% of total billed charges,63.72,24% of total billed charges,199.13,75% of total billed charges,199.13,75% of total billed charges,212.4,80% of total billed charges,64.36,24.24% of total billed charges,133.81,50.4% of total billed charges,199.13,75% of total billed charges,64.99,24.48% of total billed charges,71.31,26.86% of total billed charges,63.72,24% of total billed charges,82.84,31.2% of total billed charges,212.4,80% of total billed charges,63.72,24% of total billed charges,63.72,24% of total billed charges,63.72,212.4,132.75
Outpatient Medical Services,RADIOLOGY,76642,US BREAST LT,402,306,82.19,26.86% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,73.44,24% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,244.8,80% of total billed charges,74.17,24.24% of total billed charges,154.22,50.4% of total billed charges,229.5,75% of total billed charges,74.91,24.48% of total billed charges,82.19,26.86% of total billed charges,73.44,24% of total billed charges,95.47,31.2% of total billed charges,244.8,80% of total billed charges,73.44,24% of total billed charges,73.44,24% of total billed charges,73.44,244.8,153
Outpatient Medical Services,RADIOLOGY,76642,US BREAST RT,402,306,82.19,26.86% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,73.44,24% of total billed charges,229.5,75% of total billed charges,229.5,75% of total billed charges,244.8,80% of total billed charges,74.17,24.24% of total billed charges,154.22,50.4% of total billed charges,229.5,75% of total billed charges,74.91,24.48% of total billed charges,82.19,26.86% of total billed charges,73.44,24% of total billed charges,95.47,31.2% of total billed charges,244.8,80% of total billed charges,73.44,24% of total billed charges,73.44,24% of total billed charges,73.44,244.8,153
Outpatient Medical Services,RADIOLOGY,76700,US ABDOMEN COMPLETE,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76705,US LIVER,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76705,US GALLBLADDER,402,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,76705,US PANCREAS,402,2652.5,712.46,26.86% of total billed charges,1989.38,75% of total billed charges,1989.38,75% of total billed charges,636.6,24% of total billed charges,1989.38,75% of total billed charges,1989.38,75% of total billed charges,2122,80% of total billed charges,642.97,24.24% of total billed charges,1336.86,50.4% of total billed charges,1989.38,75% of total billed charges,649.33,24.48% of total billed charges,712.46,26.86% of total billed charges,636.6,24% of total billed charges,827.58,31.2% of total billed charges,2122,80% of total billed charges,636.6,24% of total billed charges,636.6,24% of total billed charges,636.6,2122,1326.25
Outpatient Medical Services,RADIOLOGY,76705,US SPLEEN,402,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,76705,US ABDOMEN LIMITED,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76706,US AORTA SCREENING,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76770,US RENAL,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76770,US AORTA,402,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,76775,US AORTA/AAA,402,742.5,199.44,26.86% of total billed charges,556.88,75% of total billed charges,556.88,75% of total billed charges,178.2,24% of total billed charges,556.88,75% of total billed charges,556.88,75% of total billed charges,594,80% of total billed charges,179.98,24.24% of total billed charges,374.22,50.4% of total billed charges,556.88,75% of total billed charges,181.76,24.48% of total billed charges,199.44,26.86% of total billed charges,178.2,24% of total billed charges,231.66,31.2% of total billed charges,594,80% of total billed charges,178.2,24% of total billed charges,178.2,24% of total billed charges,178.2,594,371.25
Outpatient Medical Services,RADIOLOGY,76801,OB TRANSABDOMINAL 1ST TRIMESTER,402,445,119.53,26.86% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,106.8,24% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,356,80% of total billed charges,107.87,24.24% of total billed charges,224.28,50.4% of total billed charges,333.75,75% of total billed charges,108.94,24.48% of total billed charges,119.53,26.86% of total billed charges,106.8,24% of total billed charges,138.84,31.2% of total billed charges,356,80% of total billed charges,106.8,24% of total billed charges,106.8,24% of total billed charges,106.8,356,222.5
Outpatient Medical Services,RADIOLOGY,76801,US OB <14 WEEKS,402,445,119.53,26.86% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,106.8,24% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,356,80% of total billed charges,107.87,24.24% of total billed charges,224.28,50.4% of total billed charges,333.75,75% of total billed charges,108.94,24.48% of total billed charges,119.53,26.86% of total billed charges,106.8,24% of total billed charges,138.84,31.2% of total billed charges,356,80% of total billed charges,106.8,24% of total billed charges,106.8,24% of total billed charges,106.8,356,222.5
Outpatient Medical Services,RADIOLOGY,76801,US PREGNANCY COMPLETE,402,445,119.53,26.86% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,106.8,24% of total billed charges,333.75,75% of total billed charges,333.75,75% of total billed charges,356,80% of total billed charges,107.87,24.24% of total billed charges,224.28,50.4% of total billed charges,333.75,75% of total billed charges,108.94,24.48% of total billed charges,119.53,26.86% of total billed charges,106.8,24% of total billed charges,138.84,31.2% of total billed charges,356,80% of total billed charges,106.8,24% of total billed charges,106.8,24% of total billed charges,106.8,356,222.5
Outpatient Medical Services,RADIOLOGY,76815,US OB LIMITED,402,433.5,116.44,26.86% of total billed charges,325.13,75% of total billed charges,325.13,75% of total billed charges,104.04,24% of total billed charges,325.13,75% of total billed charges,325.13,75% of total billed charges,346.8,80% of total billed charges,105.08,24.24% of total billed charges,218.48,50.4% of total billed charges,325.13,75% of total billed charges,106.12,24.48% of total billed charges,116.44,26.86% of total billed charges,104.04,24% of total billed charges,135.25,31.2% of total billed charges,346.8,80% of total billed charges,104.04,24% of total billed charges,104.04,24% of total billed charges,104.04,346.8,216.75
Outpatient Medical Services,RADIOLOGY,76817,US OB TRANSVAGINAL,402,560.5,150.55,26.86% of total billed charges,420.38,75% of total billed charges,420.38,75% of total billed charges,134.52,24% of total billed charges,420.38,75% of total billed charges,420.38,75% of total billed charges,448.4,80% of total billed charges,135.87,24.24% of total billed charges,282.49,50.4% of total billed charges,420.38,75% of total billed charges,137.21,24.48% of total billed charges,150.55,26.86% of total billed charges,134.52,24% of total billed charges,174.88,31.2% of total billed charges,448.4,80% of total billed charges,134.52,24% of total billed charges,134.52,24% of total billed charges,134.52,448.4,280.25
Outpatient Medical Services,RADIOLOGY,76830,US TRANSVAGINAL,402,750,201.45,26.86% of total billed charges,562.5,75% of total billed charges,562.5,75% of total billed charges,180,24% of total billed charges,562.5,75% of total billed charges,562.5,75% of total billed charges,600,80% of total billed charges,181.8,24.24% of total billed charges,378,50.4% of total billed charges,562.5,75% of total billed charges,183.6,24.48% of total billed charges,201.45,26.86% of total billed charges,180,24% of total billed charges,234,31.2% of total billed charges,600,80% of total billed charges,180,24% of total billed charges,180,24% of total billed charges,180,600,375
Outpatient Medical Services,RADIOLOGY,76856,US URINARY BLADDER,402,593.5,159.41,26.86% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,142.44,24% of total billed charges,445.13,75% of total billed charges,445.13,75% of total billed charges,474.8,80% of total billed charges,143.86,24.24% of total billed charges,299.12,50.4% of total billed charges,445.13,75% of total billed charges,145.29,24.48% of total billed charges,159.41,26.86% of total billed charges,142.44,24% of total billed charges,185.17,31.2% of total billed charges,474.8,80% of total billed charges,142.44,24% of total billed charges,142.44,24% of total billed charges,142.44,474.8,296.75
Outpatient Medical Services,RADIOLOGY,76856,US PELVIC NON OB,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76870,US SCROTUM AND CONTENTS,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76882,US EXT RT,402,525.5,141.15,26.86% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,126.12,24% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,420.4,80% of total billed charges,127.38,24.24% of total billed charges,264.85,50.4% of total billed charges,394.13,75% of total billed charges,128.64,24.48% of total billed charges,141.15,26.86% of total billed charges,126.12,24% of total billed charges,163.96,31.2% of total billed charges,420.4,80% of total billed charges,126.12,24% of total billed charges,126.12,24% of total billed charges,126.12,420.4,262.75
Outpatient Medical Services,RADIOLOGY,76882,US SOFT TISSUE/NON VASCULAR,402,456.5,122.62,26.86% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,109.56,24% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,365.2,80% of total billed charges,110.66,24.24% of total billed charges,230.08,50.4% of total billed charges,342.38,75% of total billed charges,111.75,24.48% of total billed charges,122.62,26.86% of total billed charges,109.56,24% of total billed charges,142.43,31.2% of total billed charges,365.2,80% of total billed charges,109.56,24% of total billed charges,109.56,24% of total billed charges,109.56,365.2,228.25
Outpatient Medical Services,RADIOLOGY,76882,US EXT RT,402,525.5,141.15,26.86% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,126.12,24% of total billed charges,394.13,75% of total billed charges,394.13,75% of total billed charges,420.4,80% of total billed charges,127.38,24.24% of total billed charges,264.85,50.4% of total billed charges,394.13,75% of total billed charges,128.64,24.48% of total billed charges,141.15,26.86% of total billed charges,126.12,24% of total billed charges,163.96,31.2% of total billed charges,420.4,80% of total billed charges,126.12,24% of total billed charges,126.12,24% of total billed charges,126.12,420.4,262.75
Outpatient Medical Services,RADIOLOGY,76937,ULTRASOUND GUIDANCE FOR VASCULAR ACCESS,402,274,73.6,26.86% of total billed charges,205.5,75% of total billed charges,205.5,75% of total billed charges,65.76,24% of total billed charges,205.5,75% of total billed charges,205.5,75% of total billed charges,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,73.6,26.86% of total billed charges,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,65.76,219.2,137
Outpatient Medical Services,RADIOLOGY,76937,US VASCULAR ACCESS,402,274,73.6,26.86% of total billed charges,205.5,75% of total billed charges,205.5,75% of total billed charges,65.76,24% of total billed charges,205.5,75% of total billed charges,205.5,75% of total billed charges,219.2,80% of total billed charges,66.42,24.24% of total billed charges,138.1,50.4% of total billed charges,205.5,75% of total billed charges,67.08,24.48% of total billed charges,73.6,26.86% of total billed charges,65.76,24% of total billed charges,85.49,31.2% of total billed charges,219.2,80% of total billed charges,65.76,24% of total billed charges,65.76,24% of total billed charges,65.76,219.2,137
Outpatient Medical Services,RADIOLOGY,76942,US GUIDE FOR BIOPSY,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,76942,ULTRASOUND GUIDANCE NEEDLE PLACEMENT,402,308,82.73,26.86% of total billed charges,231,75% of total billed charges,231,75% of total billed charges,73.92,24% of total billed charges,231,75% of total billed charges,231,75% of total billed charges,246.4,80% of total billed charges,74.66,24.24% of total billed charges,155.23,50.4% of total billed charges,231,75% of total billed charges,75.4,24.48% of total billed charges,82.73,26.86% of total billed charges,73.92,24% of total billed charges,96.1,31.2% of total billed charges,246.4,80% of total billed charges,73.92,24% of total billed charges,73.92,24% of total billed charges,73.92,246.4,154
Outpatient Medical Services,RADIOLOGY,76998,US GUIDANCE DURING SURGERY,402,474,127.32,26.86% of total billed charges,355.5,75% of total billed charges,355.5,75% of total billed charges,113.76,24% of total billed charges,355.5,75% of total billed charges,355.5,75% of total billed charges,379.2,80% of total billed charges,114.9,24.24% of total billed charges,238.9,50.4% of total billed charges,355.5,75% of total billed charges,116.04,24.48% of total billed charges,127.32,26.86% of total billed charges,113.76,24% of total billed charges,147.89,31.2% of total billed charges,379.2,80% of total billed charges,113.76,24% of total billed charges,113.76,24% of total billed charges,113.76,379.2,237
Outpatient Medical Services,RADIOLOGY,76999,DO NOT USE,402,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,93980,US PENILE DOPPLER,402,682,183.19,26.86% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,163.68,24% of total billed charges,511.5,75% of total billed charges,511.5,75% of total billed charges,545.6,80% of total billed charges,165.32,24.24% of total billed charges,343.73,50.4% of total billed charges,511.5,75% of total billed charges,166.95,24.48% of total billed charges,183.19,26.86% of total billed charges,163.68,24% of total billed charges,212.78,31.2% of total billed charges,545.6,80% of total billed charges,163.68,24% of total billed charges,163.68,24% of total billed charges,163.68,545.6,341
Outpatient Medical Services,RADIOLOGY,77063,MM BILATERAL SCREENING BREAST TOMO,403,112.5,30.22,26.86% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,27,24% of total billed charges,84.38,75% of total billed charges,84.38,75% of total billed charges,90,80% of total billed charges,27.27,24.24% of total billed charges,56.7,50.4% of total billed charges,84.38,75% of total billed charges,27.54,24.48% of total billed charges,30.22,26.86% of total billed charges,27,24% of total billed charges,35.1,31.2% of total billed charges,90,80% of total billed charges,27,24% of total billed charges,27,24% of total billed charges,27,90,56.25
Outpatient Medical Services,RADIOLOGY,77063,MM BILATERAL SCREENING MAMMO and TOMO,403,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77067,MM BILATERAL SCREENING MAMMOGRAM W/CAD,403,456.5,122.62,26.86% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,109.56,24% of total billed charges,342.38,75% of total billed charges,342.38,75% of total billed charges,365.2,80% of total billed charges,110.66,24.24% of total billed charges,230.08,50.4% of total billed charges,342.38,75% of total billed charges,111.75,24.48% of total billed charges,122.62,26.86% of total billed charges,109.56,24% of total billed charges,142.43,31.2% of total billed charges,365.2,80% of total billed charges,109.56,24% of total billed charges,109.56,24% of total billed charges,109.56,365.2,228.25
Outpatient Medical Services,RADIOLOGY,70336,MRI TEMPOROMANDIBULAR JOINT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,70540,MRI FACE ORBIT NECK WO CONTRAST MATERIAL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,70542,MRI FACE ORBIT NECK W CONTRAST MATERIAL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70543,MRI FACE ORBIT NECK WWO CONTRAST MATERIA,610,4694.5,1260.94,26.86% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,1126.68,24% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,3755.6,80% of total billed charges,1137.95,24.24% of total billed charges,2366.03,50.4% of total billed charges,3520.88,75% of total billed charges,1149.21,24.48% of total billed charges,1260.94,26.86% of total billed charges,1126.68,24% of total billed charges,1464.68,31.2% of total billed charges,3755.6,80% of total billed charges,1126.68,24% of total billed charges,1126.68,24% of total billed charges,1126.68,3755.6,2347.25
Outpatient Medical Services,RADIOLOGY,71550,MRI CHEST WO CONTRAST MATERIAL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,71551,MRI CHEST W CONTRAST MATERIAL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,71552,MRI CHEST WWO CONTRAST MATERIAL,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,72148,MRI LUMBAR SPINE WO CONTRAST MATERIAL,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,72195,MRI PELVIS/SACRUM/COCCYX WO CONTRAST,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,72196,MRI PELVIS/SACRUM/COCCYX WITH CONTRAST,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,72197,MRI PELVIS/SACRUM/COCCYX WWO,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73218,MRI UPPER EXT OTHER THAN JOINT WO RT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73218,MRI UPPER EXT OTHER THAN JOINT WO LT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73219,MRI UPPER EXT W CONT BIL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73219,MRI UPPER EXT OTHER THAN JOINT W CON LT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73219,MRI UPPER EXT OTHER THAN JOINT W CON RT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73220,MRI UPPER EXT OTHER THAN JOINT WWO LT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73220,MRI UPPER EXT JOINT WWO CONT BIL,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73220,MRI UPPER EXT JOINT WWO CONT LT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73220,MRI UPPER EXT OTHER THAN JOINT WWO RT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER EXT JOINT BIL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73221,MRI WRIST WO CONT,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER EXT JOINT WO CONTRAST LT,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER EXT JOINT WO CONTRAST RT,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,73222,MRI UPPER EXT JOINT W CONT BIL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73222,MRI WRIST W CONT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73223,MRI UPPER EXTREMITY JOINT WWO CON MAT LT,610,4031.5,1082.86,26.86% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,967.56,24% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,3225.2,80% of total billed charges,977.24,24.24% of total billed charges,2031.88,50.4% of total billed charges,3023.63,75% of total billed charges,986.91,24.48% of total billed charges,1082.86,26.86% of total billed charges,967.56,24% of total billed charges,1257.83,31.2% of total billed charges,3225.2,80% of total billed charges,967.56,24% of total billed charges,967.56,24% of total billed charges,967.56,3225.2,2015.75
Outpatient Medical Services,RADIOLOGY,73223,MRI UPPER EXTREMITY JOINT WWO CON MAT RT,610,4031.5,1082.86,26.86% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,967.56,24% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,3225.2,80% of total billed charges,977.24,24.24% of total billed charges,2031.88,50.4% of total billed charges,3023.63,75% of total billed charges,986.91,24.48% of total billed charges,1082.86,26.86% of total billed charges,967.56,24% of total billed charges,1257.83,31.2% of total billed charges,3225.2,80% of total billed charges,967.56,24% of total billed charges,967.56,24% of total billed charges,967.56,3225.2,2015.75
Outpatient Medical Services,RADIOLOGY,73718,MRI LOWER EXT WO CONT BIL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73718,MRI LOWER EXT OTHER THAN JOINT WO LT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73718,MRI LOWER EXT OTHER THAN JOINT WO RT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73719,MRI LOWER EXT W CONT BIL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73719,MRI FOOT W CONT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73719,MRI LOWER EXT OTHER THAN JOINT W LT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73719,MRI LOWER EXT OTHER THAN JOINT W RT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT LTD BIL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT WO CONTRAST LT,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT WO CONTRAST RT,610,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,73722,MRI LOWER EXT JOINT W CONT BIL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73723,MRI LOWER EXT JOINT WWO CONT BIL,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73723,MRI LOWER EXT JOINT WWO CONTRAST  LT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73723,MRI LOWER EXT JOINT WWO CONTRAST RT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73725,MRI LOWER EXT VEINS ANGIO,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73725,MRI LOWER LEG VESSELS ANGIO W CONT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73725,MRI LOWER EXT VEINS ANGIO WWO CONT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73725,MRA LOWER EXT WWO CONTRAST LT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73725,MRA LOWER EXT WWO CONTRAST RT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,74181,MRI ABDOMEN WO CONTRAST MATERIAL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,74181,MRI ABD MRCP WO CONT,610,2334,626.91,26.86% of total billed charges,1750.5,75% of total billed charges,1750.5,75% of total billed charges,560.16,24% of total billed charges,1750.5,75% of total billed charges,1750.5,75% of total billed charges,1867.2,80% of total billed charges,565.76,24.24% of total billed charges,1176.34,50.4% of total billed charges,1750.5,75% of total billed charges,571.36,24.48% of total billed charges,626.91,26.86% of total billed charges,560.16,24% of total billed charges,728.21,31.2% of total billed charges,1867.2,80% of total billed charges,560.16,24% of total billed charges,560.16,24% of total billed charges,560.16,1867.2,1167
Outpatient Medical Services,RADIOLOGY,74182,MRI ABDOMEN  W CONTRAST MATERIAL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,74183,MRI ABDOMEN WWO CONTRAST MATERIAL,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,74183,MRI LIVER W CONT,610,2970.5,797.88,26.86% of total billed charges,2227.88,75% of total billed charges,2227.88,75% of total billed charges,712.92,24% of total billed charges,2227.88,75% of total billed charges,2227.88,75% of total billed charges,2376.4,80% of total billed charges,720.05,24.24% of total billed charges,1497.13,50.4% of total billed charges,2227.88,75% of total billed charges,727.18,24.48% of total billed charges,797.88,26.86% of total billed charges,712.92,24% of total billed charges,926.8,31.2% of total billed charges,2376.4,80% of total billed charges,712.92,24% of total billed charges,712.92,24% of total billed charges,712.92,2376.4,1485.25
Outpatient Medical Services,RADIOLOGY,74185,MRA ABD WO CONTRAST MATERIAL,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,74185,MRA ABDOMEN WWO  CONTRAST,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,74185,MRA ABDOMEN WWO CONTRAST MATERIAL,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,77046,MRI BREAST UNIL WO CONT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,77047,MRI BREAST BIL WO CONT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,77048,MRI BREAST UNIL  WWO CONTRAST LT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,77048,MRI BREAST UNIL WWO CONTRAST RT,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,77049,MRI BREAST BIL WWO CONT,610,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,2845.2,80% of total billed charges,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,77084,MRI BONE MARROW BLOOD SUPPLY,610,796,213.81,26.86% of total billed charges,597,75% of total billed charges,597,75% of total billed charges,191.04,24% of total billed charges,597,75% of total billed charges,597,75% of total billed charges,636.8,80% of total billed charges,192.95,24.24% of total billed charges,401.18,50.4% of total billed charges,597,75% of total billed charges,194.86,24.48% of total billed charges,213.81,26.86% of total billed charges,191.04,24% of total billed charges,248.35,31.2% of total billed charges,636.8,80% of total billed charges,191.04,24% of total billed charges,191.04,24% of total billed charges,191.04,636.8,398
Outpatient Medical Services,RADIOLOGY,C8905,MRI BREAST UNIL WWO CONT BIL,610,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,C8906,MRI BREAST UNIL W CONT,610,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70551,MRI BRAIN WITHOUT CONTRAST MATERIAL,611,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,70552,MRI HEAD WITH CONTRAST MATERIAL,611,4174.5,1121.27,26.86% of total billed charges,3130.88,75% of total billed charges,3130.88,75% of total billed charges,1001.88,24% of total billed charges,3130.88,75% of total billed charges,3130.88,75% of total billed charges,3339.6,80% of total billed charges,1011.9,24.24% of total billed charges,2103.95,50.4% of total billed charges,3130.88,75% of total billed charges,1021.92,24.48% of total billed charges,1121.27,26.86% of total billed charges,1001.88,24% of total billed charges,1302.44,31.2% of total billed charges,3339.6,80% of total billed charges,1001.88,24% of total billed charges,1001.88,24% of total billed charges,1001.88,3339.6,2087.25
Outpatient Medical Services,RADIOLOGY,70553,MRI HEAD WWO CONTRAST MATERIAL,611,4694.5,1260.94,26.86% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,1126.68,24% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,3755.6,80% of total billed charges,1137.95,24.24% of total billed charges,2366.03,50.4% of total billed charges,3520.88,75% of total billed charges,1149.21,24.48% of total billed charges,1260.94,26.86% of total billed charges,1126.68,24% of total billed charges,1464.68,31.2% of total billed charges,3755.6,80% of total billed charges,1126.68,24% of total billed charges,1126.68,24% of total billed charges,1126.68,3755.6,2347.25
Outpatient Medical Services,RADIOLOGY,70553,MRI PITUITARY SELLA TURCICA,611,4694.5,1260.94,26.86% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,1126.68,24% of total billed charges,3520.88,75% of total billed charges,3520.88,75% of total billed charges,3755.6,80% of total billed charges,1137.95,24.24% of total billed charges,2366.03,50.4% of total billed charges,3520.88,75% of total billed charges,1149.21,24.48% of total billed charges,1260.94,26.86% of total billed charges,1126.68,24% of total billed charges,1464.68,31.2% of total billed charges,3755.6,80% of total billed charges,1126.68,24% of total billed charges,1126.68,24% of total billed charges,1126.68,3755.6,2347.25
Outpatient Medical Services,RADIOLOGY,72141,MRI CERVICAL SPINE WITHOUT CONTRAST,612,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,72142,MRI CERVICAL SPINE W CONTRAST MATERIAL,612,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,72146,MRI THORACIC SPINE WO CONTRAST MATERIAL,612,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,72147,MRI THORACIC SPINE W CONTRAST MATERIAL,612,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,72149,MRI LUMBAR SPINE W CONTRAST MATERIAL,612,4174.5,1121.27,26.86% of total billed charges,3130.88,75% of total billed charges,3130.88,75% of total billed charges,1001.88,24% of total billed charges,3130.88,75% of total billed charges,3130.88,75% of total billed charges,3339.6,80% of total billed charges,1011.9,24.24% of total billed charges,2103.95,50.4% of total billed charges,3130.88,75% of total billed charges,1021.92,24.48% of total billed charges,1121.27,26.86% of total billed charges,1001.88,24% of total billed charges,1302.44,31.2% of total billed charges,3339.6,80% of total billed charges,1001.88,24% of total billed charges,1001.88,24% of total billed charges,1001.88,3339.6,2087.25
Outpatient Medical Services,RADIOLOGY,72156,MRI CERVICAL  SPINE WWO CONT MATERIAL,612,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,72157,MRI THORACIC SPINE WWO CONT MATERIAL,612,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,72158,MRI LUMBAR SPINE WWO CONT MATERIAL,612,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,73222,MRI UPPER EXT JOINT W CONT LT,614,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73222,MRI UPPER EXT JOINT W CONT RT,614,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT OTHER THAN JOINT WWO LT,614,4267.5,1146.25,26.86% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,1024.2,24% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,3414,80% of total billed charges,1034.44,24.24% of total billed charges,2150.82,50.4% of total billed charges,3200.63,75% of total billed charges,1044.68,24.48% of total billed charges,1146.25,26.86% of total billed charges,1024.2,24% of total billed charges,1331.46,31.2% of total billed charges,N/A,Not Separately reimbursable,1024.2,24% of total billed charges,1024.2,24% of total billed charges,1024.2,3414,2133.75
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT OTHER THAN JOINT WWO LT,614,4267.5,1146.25,26.86% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,1024.2,24% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,3414,80% of total billed charges,1034.44,24.24% of total billed charges,2150.82,50.4% of total billed charges,3200.63,75% of total billed charges,1044.68,24.48% of total billed charges,1146.25,26.86% of total billed charges,1024.2,24% of total billed charges,1331.46,31.2% of total billed charges,N/A,Not Separately reimbursable,1024.2,24% of total billed charges,1024.2,24% of total billed charges,1024.2,3414,2133.75
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT OTHER THAN JOINT WWO RT,614,4267.5,1146.25,26.86% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,1024.2,24% of total billed charges,3200.63,75% of total billed charges,3200.63,75% of total billed charges,3414,80% of total billed charges,1034.44,24.24% of total billed charges,2150.82,50.4% of total billed charges,3200.63,75% of total billed charges,1044.68,24.48% of total billed charges,1146.25,26.86% of total billed charges,1024.2,24% of total billed charges,1331.46,31.2% of total billed charges,N/A,Not Separately reimbursable,1024.2,24% of total billed charges,1024.2,24% of total billed charges,1024.2,3414,2133.75
Outpatient Medical Services,RADIOLOGY,73722,MRI LOWER EXT JOINT W CONTRAST  LT,614,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73722,MRI LOWER EXT JOINT W CONTRAST RT,614,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70544,MRV BRAIN,615,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70544,MRA HEAD WITHOUT CONTRAST MATERIAL,615,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,70545,MRA HEAD WITH  CONTRAST MATERIAL,615,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70546,MRA HEAD  WWO CONTRAST MATERIAL,615,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,70547,MRA NECK WITHOUT CONTRAST MATERIAL,615,3912,1050.76,26.86% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,938.88,24% of total billed charges,2934,75% of total billed charges,2934,75% of total billed charges,3129.6,80% of total billed charges,948.27,24.24% of total billed charges,1971.65,50.4% of total billed charges,2934,75% of total billed charges,957.66,24.48% of total billed charges,1050.76,26.86% of total billed charges,938.88,24% of total billed charges,1220.54,31.2% of total billed charges,3129.6,80% of total billed charges,938.88,24% of total billed charges,938.88,24% of total billed charges,938.88,3129.6,1956
Outpatient Medical Services,RADIOLOGY,70548,MRA NECK WITH CONTRAST MATERIAL,615,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,3035.6,80% of total billed charges,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,70549,MRA NECK WWO CONTRAST MATERIAL,615,4268.5,1146.52,26.86% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,1024.44,24% of total billed charges,3201.38,75% of total billed charges,3201.38,75% of total billed charges,3414.8,80% of total billed charges,1034.68,24.24% of total billed charges,2151.32,50.4% of total billed charges,3201.38,75% of total billed charges,1044.93,24.48% of total billed charges,1146.52,26.86% of total billed charges,1024.44,24% of total billed charges,1331.77,31.2% of total billed charges,3414.8,80% of total billed charges,1024.44,24% of total billed charges,1024.44,24% of total billed charges,1024.44,3414.8,2134.25
Outpatient Medical Services,RADIOLOGY,71555,MRA CHEST EXCLUDING MYOCARD WWO CONTRAST,618,3760.5,1010.07,26.86% of total billed charges,2820.38,75% of total billed charges,2820.38,75% of total billed charges,902.52,24% of total billed charges,2820.38,75% of total billed charges,2820.38,75% of total billed charges,3008.4,80% of total billed charges,911.55,24.24% of total billed charges,1895.29,50.4% of total billed charges,2820.38,75% of total billed charges,920.57,24.48% of total billed charges,1010.07,26.86% of total billed charges,902.52,24% of total billed charges,1173.28,31.2% of total billed charges,N/A,Not Separately reimbursable,902.52,24% of total billed charges,902.52,24% of total billed charges,902.52,3008.4,1880.25
Outpatient Medical Services,RADIOLOGY,72159,MRA SPINAL CANAL WWO CONTRAST MATERIAL,618,4031.5,1082.86,26.86% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,967.56,24% of total billed charges,3023.63,75% of total billed charges,3023.63,75% of total billed charges,3225.2,80% of total billed charges,977.24,24.24% of total billed charges,2031.88,50.4% of total billed charges,3023.63,75% of total billed charges,986.91,24.48% of total billed charges,1082.86,26.86% of total billed charges,967.56,24% of total billed charges,1257.83,31.2% of total billed charges,N/A,Not Separately reimbursable,967.56,24% of total billed charges,967.56,24% of total billed charges,967.56,3225.2,2015.75
Outpatient Medical Services,RADIOLOGY,72198,MRA PELVIS WWO CONTRAST MATERIAL,618,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,RADIOLOGY,73225,MRA UPPER EXT WWO CONT MAT LT,618,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,N/A,Not Separately reimbursable,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73225,MRA UPPER EXT WWO CONT MAT RT,618,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,N/A,Not Separately reimbursable,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,73225,MRA UPPER EXT WWO CONT,618,3556.5,955.28,26.86% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,853.56,24% of total billed charges,2667.38,75% of total billed charges,2667.38,75% of total billed charges,2845.2,80% of total billed charges,862.1,24.24% of total billed charges,1792.48,50.4% of total billed charges,2667.38,75% of total billed charges,870.63,24.48% of total billed charges,955.28,26.86% of total billed charges,853.56,24% of total billed charges,1109.63,31.2% of total billed charges,N/A,Not Separately reimbursable,853.56,24% of total billed charges,853.56,24% of total billed charges,853.56,2845.2,1778.25
Outpatient Medical Services,RADIOLOGY,72198,MRA PELVIS  WWO CONT,619,3794.5,1019.2,26.86% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,910.68,24% of total billed charges,2845.88,75% of total billed charges,2845.88,75% of total billed charges,3035.6,80% of total billed charges,919.79,24.24% of total billed charges,1912.43,50.4% of total billed charges,2845.88,75% of total billed charges,928.89,24.48% of total billed charges,1019.2,26.86% of total billed charges,910.68,24% of total billed charges,1183.88,31.2% of total billed charges,N/A,Not Separately reimbursable,910.68,24% of total billed charges,910.68,24% of total billed charges,910.68,3035.6,1897.25
Outpatient Medical Services,SLEEP,95805,MAINTENANCE OF WAKEFULNESS TEST,740,3682.5,989.12,26.86% of total billed charges,2761.88,75% of total billed charges,2761.88,75% of total billed charges,883.8,24% of total billed charges,2761.88,75% of total billed charges,2761.88,75% of total billed charges,2946,80% of total billed charges,892.64,24.24% of total billed charges,1855.98,50.4% of total billed charges,2761.88,75% of total billed charges,901.48,24.48% of total billed charges,989.12,26.86% of total billed charges,883.8,24% of total billed charges,1148.94,31.2% of total billed charges,2946,80% of total billed charges,883.8,24% of total billed charges,883.8,24% of total billed charges,883.8,2946,1841.25
Outpatient Medical Services,SLEEP,95805,MULTIPLE SLEEP LATENCY TEST,740,3676,987.37,26.86% of total billed charges,2757,75% of total billed charges,2757,75% of total billed charges,882.24,24% of total billed charges,2757,75% of total billed charges,2757,75% of total billed charges,2940.8,80% of total billed charges,891.06,24.24% of total billed charges,1852.7,50.4% of total billed charges,2757,75% of total billed charges,899.88,24.48% of total billed charges,987.37,26.86% of total billed charges,882.24,24% of total billed charges,1146.91,31.2% of total billed charges,2940.8,80% of total billed charges,882.24,24% of total billed charges,882.24,24% of total billed charges,882.24,2940.8,1838
Outpatient Medical Services,SLEEP,95806,SLEEP STUDY UNATTENDED,740,724,194.47,26.86% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,173.76,24% of total billed charges,543,75% of total billed charges,543,75% of total billed charges,579.2,80% of total billed charges,175.5,24.24% of total billed charges,364.9,50.4% of total billed charges,543,75% of total billed charges,177.24,24.48% of total billed charges,194.47,26.86% of total billed charges,173.76,24% of total billed charges,225.89,31.2% of total billed charges,579.2,80% of total billed charges,173.76,24% of total billed charges,173.76,24% of total billed charges,173.76,579.2,362
Outpatient Medical Services,SLEEP,95807,PAP NAP,740,585,157.13,26.86% of total billed charges,438.75,75% of total billed charges,438.75,75% of total billed charges,140.4,24% of total billed charges,438.75,75% of total billed charges,438.75,75% of total billed charges,468,80% of total billed charges,141.8,24.24% of total billed charges,294.84,50.4% of total billed charges,438.75,75% of total billed charges,143.21,24.48% of total billed charges,157.13,26.86% of total billed charges,140.4,24% of total billed charges,182.52,31.2% of total billed charges,468,80% of total billed charges,140.4,24% of total billed charges,140.4,24% of total billed charges,140.4,468,292.5
Outpatient Medical Services,SLEEP,95810,POLYSOMNOGRAPHY P>4 ATTEND TECH,740,3617.5,971.66,26.86% of total billed charges,2713.13,75% of total billed charges,2713.13,75% of total billed charges,868.2,24% of total billed charges,2713.13,75% of total billed charges,2713.13,75% of total billed charges,2894,80% of total billed charges,876.88,24.24% of total billed charges,1823.22,50.4% of total billed charges,2713.13,75% of total billed charges,885.56,24.48% of total billed charges,971.66,26.86% of total billed charges,868.2,24% of total billed charges,1128.66,31.2% of total billed charges,2894,80% of total billed charges,868.2,24% of total billed charges,868.2,24% of total billed charges,868.2,2894,1808.75
Outpatient Medical Services,SLEEP,95811,POLYSOMNOGRAPHY P >4 INIT CPAP,740,4567,1226.7,26.86% of total billed charges,3425.25,75% of total billed charges,3425.25,75% of total billed charges,1096.08,24% of total billed charges,3425.25,75% of total billed charges,3425.25,75% of total billed charges,3653.6,80% of total billed charges,1107.04,24.24% of total billed charges,2301.77,50.4% of total billed charges,3425.25,75% of total billed charges,1118,24.48% of total billed charges,1226.7,26.86% of total billed charges,1096.08,24% of total billed charges,1424.9,31.2% of total billed charges,3653.6,80% of total billed charges,1096.08,24% of total billed charges,1096.08,24% of total billed charges,1096.08,3653.6,2283.5
Outpatient Medical Services,THERAPY,29580,PT UNNA BOOT APPLICATIO,420,122.5,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,90901,PT BIOFEEDBACK,420,96,25.79,26.86% of total billed charges,72,75% of total billed charges,72,75% of total billed charges,23.04,24% of total billed charges,72,75% of total billed charges,72,75% of total billed charges,76.8,80% of total billed charges,23.27,24.24% of total billed charges,48.38,50.4% of total billed charges,72,75% of total billed charges,23.5,24.48% of total billed charges,25.79,26.86% of total billed charges,23.04,24% of total billed charges,29.95,31.2% of total billed charges,76.8,80% of total billed charges,23.04,24% of total billed charges,23.04,24% of total billed charges,23.04,76.8,48
Outpatient Medical Services,THERAPY,95851,PT LIMB MUSCLE TESTING,420,78,20.95,26.86% of total billed charges,58.5,75% of total billed charges,58.5,75% of total billed charges,18.72,24% of total billed charges,58.5,75% of total billed charges,58.5,75% of total billed charges,62.4,80% of total billed charges,18.91,24.24% of total billed charges,39.31,50.4% of total billed charges,58.5,75% of total billed charges,19.09,24.48% of total billed charges,20.95,26.86% of total billed charges,18.72,24% of total billed charges,24.34,31.2% of total billed charges,62.4,80% of total billed charges,18.72,24% of total billed charges,18.72,24% of total billed charges,18.72,62.4,39
Outpatient Medical Services,THERAPY,95851,ROM MEASURMENTS OT,420,66,17.73,26.86% of total billed charges,49.5,75% of total billed charges,49.5,75% of total billed charges,15.84,24% of total billed charges,49.5,75% of total billed charges,49.5,75% of total billed charges,52.8,80% of total billed charges,16,24.24% of total billed charges,33.26,50.4% of total billed charges,49.5,75% of total billed charges,16.16,24.48% of total billed charges,17.73,26.86% of total billed charges,15.84,24% of total billed charges,20.59,31.2% of total billed charges,52.8,80% of total billed charges,15.84,24% of total billed charges,15.84,24% of total billed charges,15.84,52.8,33
Outpatient Medical Services,THERAPY,95851,PT MUSCLE TEST BODY W/O,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,95851,ROM MEASURMENTS PT,420,66,17.73,26.86% of total billed charges,49.5,75% of total billed charges,49.5,75% of total billed charges,15.84,24% of total billed charges,49.5,75% of total billed charges,49.5,75% of total billed charges,52.8,80% of total billed charges,16,24.24% of total billed charges,33.26,50.4% of total billed charges,49.5,75% of total billed charges,16.16,24.48% of total billed charges,17.73,26.86% of total billed charges,15.84,24% of total billed charges,20.59,31.2% of total billed charges,52.8,80% of total billed charges,15.84,24% of total billed charges,15.84,24% of total billed charges,15.84,52.8,33
Outpatient Medical Services,THERAPY,95852,PT MUSCLE TEST HAND,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,95992,PT CANALITH REPOSITIONING,420,148.5,39.89,26.86% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,35.64,24% of total billed charges,111.38,75% of total billed charges,111.38,75% of total billed charges,118.8,80% of total billed charges,36,24.24% of total billed charges,74.84,50.4% of total billed charges,111.38,75% of total billed charges,36.35,24.48% of total billed charges,39.89,26.86% of total billed charges,35.64,24% of total billed charges,46.33,31.2% of total billed charges,118.8,80% of total billed charges,35.64,24% of total billed charges,35.64,24% of total billed charges,35.64,118.8,74.25
Outpatient Medical Services,THERAPY,97010,PT MOIST HEAT COLD PACK,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97010,PT CRYOTHERAPY,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97012,PT TRACT MECH CERV&PELV,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97012,PT TRACTION PELVIC,420,70,18.8,26.86% of total billed charges,52.5,75% of total billed charges,52.5,75% of total billed charges,16.8,24% of total billed charges,52.5,75% of total billed charges,52.5,75% of total billed charges,56,80% of total billed charges,16.97,24.24% of total billed charges,35.28,50.4% of total billed charges,52.5,75% of total billed charges,17.14,24.48% of total billed charges,18.8,26.86% of total billed charges,16.8,24% of total billed charges,21.84,31.2% of total billed charges,56,80% of total billed charges,16.8,24% of total billed charges,16.8,24% of total billed charges,16.8,56,35
Outpatient Medical Services,THERAPY,97012,PT TRACTION CERVICAL,420,41,11.01,26.86% of total billed charges,30.75,75% of total billed charges,30.75,75% of total billed charges,9.84,24% of total billed charges,30.75,75% of total billed charges,30.75,75% of total billed charges,32.8,80% of total billed charges,9.94,24.24% of total billed charges,20.66,50.4% of total billed charges,30.75,75% of total billed charges,10.04,24.48% of total billed charges,11.01,26.86% of total billed charges,9.84,24% of total billed charges,12.79,31.2% of total billed charges,32.8,80% of total billed charges,9.84,24% of total billed charges,9.84,24% of total billed charges,9.84,32.8,20.5
Outpatient Medical Services,THERAPY,97014,PT TENS TREATMENT 30MIN,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97014,PT TENS FOLLOW UP,420,47.5,12.76,26.86% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,11.4,24% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,38,80% of total billed charges,11.51,24.24% of total billed charges,23.94,50.4% of total billed charges,35.63,75% of total billed charges,11.63,24.48% of total billed charges,12.76,26.86% of total billed charges,11.4,24% of total billed charges,14.82,31.2% of total billed charges,38,80% of total billed charges,11.4,24% of total billed charges,11.4,24% of total billed charges,11.4,38,23.75
Outpatient Medical Services,THERAPY,97016,.PT JOBST PUMP -PROCEDUR,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97018,PT PARAFFIN BATH,420,51.5,13.83,26.86% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,13.83,26.86% of total billed charges,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,41.2,25.75
Outpatient Medical Services,THERAPY,97022,PT EXT WP,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97022,PT FULL BODY WP,420,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,97022,PT STERILE FULL BODY WP,420,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,97022,PT PULSIVAC,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97022,PT STERILE EXT WP,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97024,PT DIATHERMY,420,49,13.16,26.86% of total billed charges,36.75,75% of total billed charges,36.75,75% of total billed charges,11.76,24% of total billed charges,36.75,75% of total billed charges,36.75,75% of total billed charges,39.2,80% of total billed charges,11.88,24.24% of total billed charges,24.7,50.4% of total billed charges,36.75,75% of total billed charges,12,24.48% of total billed charges,13.16,26.86% of total billed charges,11.76,24% of total billed charges,15.29,31.2% of total billed charges,39.2,80% of total billed charges,11.76,24% of total billed charges,11.76,24% of total billed charges,11.76,39.2,24.5
Outpatient Medical Services,THERAPY,97028,PT ULTRAVIOLET,420,45,12.09,26.86% of total billed charges,33.75,75% of total billed charges,33.75,75% of total billed charges,10.8,24% of total billed charges,33.75,75% of total billed charges,33.75,75% of total billed charges,36,80% of total billed charges,10.91,24.24% of total billed charges,22.68,50.4% of total billed charges,33.75,75% of total billed charges,11.02,24.48% of total billed charges,12.09,26.86% of total billed charges,10.8,24% of total billed charges,14.04,31.2% of total billed charges,36,80% of total billed charges,10.8,24% of total billed charges,10.8,24% of total billed charges,10.8,36,22.5
Outpatient Medical Services,THERAPY,97032,PT NEUROPROBE,420,74,19.88,26.86% of total billed charges,55.5,75% of total billed charges,55.5,75% of total billed charges,17.76,24% of total billed charges,55.5,75% of total billed charges,55.5,75% of total billed charges,59.2,80% of total billed charges,17.94,24.24% of total billed charges,37.3,50.4% of total billed charges,55.5,75% of total billed charges,18.12,24.48% of total billed charges,19.88,26.86% of total billed charges,17.76,24% of total billed charges,23.09,31.2% of total billed charges,59.2,80% of total billed charges,17.76,24% of total billed charges,17.76,24% of total billed charges,17.76,59.2,37
Outpatient Medical Services,THERAPY,97032,PT TENS INITIAL SET UP,420,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,97032,PT ELECT MUS STIM,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97033,PT IONTOPHORESIS,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97034,PT CONTRAST BATH,420,51.5,13.83,26.86% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,13.83,26.86% of total billed charges,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,41.2,25.75
Outpatient Medical Services,THERAPY,97035,PT ULTRASOUND,420,104,27.93,26.86% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,24.96,24% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,27.93,26.86% of total billed charges,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,24.96,83.2,52
Outpatient Medical Services,THERAPY,97035,PT PHONOPHORESIS,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97110,PT THERAPEUTIC EX 15M,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97112,PT NEUROMUSCULAR RE-ED,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97116,PT GAIT TRAIN 0-15 MIN,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97124,PT PT MASSAGE 15 MIN,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97124,PT ICE MASSAGE 15 MIN,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97129,PT COGNITIVE TRNING,420,111,29.81,26.86% of total billed charges,83.25,75% of total billed charges,83.25,75% of total billed charges,26.64,24% of total billed charges,83.25,75% of total billed charges,83.25,75% of total billed charges,88.8,80% of total billed charges,26.91,24.24% of total billed charges,55.94,50.4% of total billed charges,83.25,75% of total billed charges,27.17,24.48% of total billed charges,29.81,26.86% of total billed charges,26.64,24% of total billed charges,34.63,31.2% of total billed charges,88.8,80% of total billed charges,26.64,24% of total billed charges,26.64,24% of total billed charges,26.64,88.8,55.5
Outpatient Medical Services,THERAPY,97139,PT CAST REMOVAL,420,35,9.4,26.86% of total billed charges,26.25,75% of total billed charges,26.25,75% of total billed charges,8.4,24% of total billed charges,26.25,75% of total billed charges,26.25,75% of total billed charges,28,80% of total billed charges,8.48,24.24% of total billed charges,17.64,50.4% of total billed charges,26.25,75% of total billed charges,8.57,24.48% of total billed charges,9.4,26.86% of total billed charges,8.4,24% of total billed charges,10.92,31.2% of total billed charges,28,80% of total billed charges,8.4,24% of total billed charges,8.4,24% of total billed charges,8.4,28,17.5
Outpatient Medical Services,THERAPY,97139,PT TRAPZ/OVHDFRM(INPT),420,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,39.6,24% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,40,24.24% of total billed charges,83.16,50.4% of total billed charges,123.75,75% of total billed charges,40.39,24.48% of total billed charges,44.32,26.86% of total billed charges,39.6,24% of total billed charges,51.48,31.2% of total billed charges,132,80% of total billed charges,39.6,24% of total billed charges,39.6,24% of total billed charges,39.6,132,82.5
Outpatient Medical Services,THERAPY,97139,PT TRACT PELVCSETUP IP,420,184.5,49.56,26.86% of total billed charges,138.38,75% of total billed charges,138.38,75% of total billed charges,44.28,24% of total billed charges,138.38,75% of total billed charges,138.38,75% of total billed charges,147.6,80% of total billed charges,44.72,24.24% of total billed charges,92.99,50.4% of total billed charges,138.38,75% of total billed charges,45.17,24.48% of total billed charges,49.56,26.86% of total billed charges,44.28,24% of total billed charges,57.56,31.2% of total billed charges,147.6,80% of total billed charges,44.28,24% of total billed charges,44.28,24% of total billed charges,44.28,147.6,92.25
Outpatient Medical Services,THERAPY,97139,PT TRACTION 90/90 INPT,420,206,55.33,26.86% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,49.44,24% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,164.8,80% of total billed charges,49.93,24.24% of total billed charges,103.82,50.4% of total billed charges,154.5,75% of total billed charges,50.43,24.48% of total billed charges,55.33,26.86% of total billed charges,49.44,24% of total billed charges,64.27,31.2% of total billed charges,164.8,80% of total billed charges,49.44,24% of total billed charges,49.44,24% of total billed charges,49.44,164.8,103
Outpatient Medical Services,THERAPY,97139,PT TRACTCERV(INPT)SETUP,420,206,55.33,26.86% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,49.44,24% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,164.8,80% of total billed charges,49.93,24.24% of total billed charges,103.82,50.4% of total billed charges,154.5,75% of total billed charges,50.43,24.48% of total billed charges,55.33,26.86% of total billed charges,49.44,24% of total billed charges,64.27,31.2% of total billed charges,164.8,80% of total billed charges,49.44,24% of total billed charges,49.44,24% of total billed charges,49.44,164.8,103
Outpatient Medical Services,THERAPY,97139,PT TRACT RECHK&ADJ INPT,420,47.5,12.76,26.86% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,11.4,24% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,38,80% of total billed charges,11.51,24.24% of total billed charges,23.94,50.4% of total billed charges,35.63,75% of total billed charges,11.63,24.48% of total billed charges,12.76,26.86% of total billed charges,11.4,24% of total billed charges,14.82,31.2% of total billed charges,38,80% of total billed charges,11.4,24% of total billed charges,11.4,24% of total billed charges,11.4,38,23.75
Outpatient Medical Services,THERAPY,97139,PT UNSPECIFIED TREATMNT,420,59,15.85,26.86% of total billed charges,44.25,75% of total billed charges,44.25,75% of total billed charges,14.16,24% of total billed charges,44.25,75% of total billed charges,44.25,75% of total billed charges,47.2,80% of total billed charges,14.3,24.24% of total billed charges,29.74,50.4% of total billed charges,44.25,75% of total billed charges,14.44,24.48% of total billed charges,15.85,26.86% of total billed charges,14.16,24% of total billed charges,18.41,31.2% of total billed charges,47.2,80% of total billed charges,14.16,24% of total billed charges,14.16,24% of total billed charges,14.16,47.2,29.5
Outpatient Medical Services,THERAPY,97139,PT CPM DAILY MAINT,420,49.5,13.3,26.86% of total billed charges,37.13,75% of total billed charges,37.13,75% of total billed charges,11.88,24% of total billed charges,37.13,75% of total billed charges,37.13,75% of total billed charges,39.6,80% of total billed charges,12,24.24% of total billed charges,24.95,50.4% of total billed charges,37.13,75% of total billed charges,12.12,24.48% of total billed charges,13.3,26.86% of total billed charges,11.88,24% of total billed charges,15.44,31.2% of total billed charges,39.6,80% of total billed charges,11.88,24% of total billed charges,11.88,24% of total billed charges,11.88,39.6,24.75
Outpatient Medical Services,THERAPY,97140,PT MANUAL THPY-15 MIN,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97150,PT GROUP - THERAPEUTIC,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97162,PT PT EVALUATION WOUND CARE,420,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,97164,PT PT RE-EVALUATION,420,146,39.22,26.86% of total billed charges,109.5,75% of total billed charges,109.5,75% of total billed charges,35.04,24% of total billed charges,109.5,75% of total billed charges,109.5,75% of total billed charges,116.8,80% of total billed charges,35.39,24.24% of total billed charges,73.58,50.4% of total billed charges,109.5,75% of total billed charges,35.74,24.48% of total billed charges,39.22,26.86% of total billed charges,35.04,24% of total billed charges,45.55,31.2% of total billed charges,116.8,80% of total billed charges,35.04,24% of total billed charges,35.04,24% of total billed charges,35.04,116.8,73
Outpatient Medical Services,THERAPY,97250,PT MYOFASCIAL RELEASE,420,104,27.93,26.86% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,24.96,24% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,27.93,26.86% of total billed charges,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,24.96,83.2,52
Outpatient Medical Services,THERAPY,97265,PT JOINT MOBILIZATION,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97530,PT BACK SCHOOL,420,69,18.53,26.86% of total billed charges,51.75,75% of total billed charges,51.75,75% of total billed charges,16.56,24% of total billed charges,51.75,75% of total billed charges,51.75,75% of total billed charges,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,18.53,26.86% of total billed charges,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,16.56,55.2,34.5
Outpatient Medical Services,THERAPY,97530,PT POSTURE ANALY TEACH,420,54.5,14.64,26.86% of total billed charges,40.88,75% of total billed charges,40.88,75% of total billed charges,13.08,24% of total billed charges,40.88,75% of total billed charges,40.88,75% of total billed charges,43.6,80% of total billed charges,13.21,24.24% of total billed charges,27.47,50.4% of total billed charges,40.88,75% of total billed charges,13.34,24.48% of total billed charges,14.64,26.86% of total billed charges,13.08,24% of total billed charges,17,31.2% of total billed charges,43.6,80% of total billed charges,13.08,24% of total billed charges,13.08,24% of total billed charges,13.08,43.6,27.25
Outpatient Medical Services,THERAPY,97530,PT THERAP ACTIV-15 MIN,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97533,PT SENSORY INTEGRATION,420,74,19.88,26.86% of total billed charges,55.5,75% of total billed charges,55.5,75% of total billed charges,17.76,24% of total billed charges,55.5,75% of total billed charges,55.5,75% of total billed charges,59.2,80% of total billed charges,17.94,24.24% of total billed charges,37.3,50.4% of total billed charges,55.5,75% of total billed charges,18.12,24.48% of total billed charges,19.88,26.86% of total billed charges,17.76,24% of total billed charges,23.09,31.2% of total billed charges,59.2,80% of total billed charges,17.76,24% of total billed charges,17.76,24% of total billed charges,17.76,59.2,37
Outpatient Medical Services,THERAPY,97535,PT ADL TRAINING,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97537,PT COMM/WORK REINT 15 M,420,69,18.53,26.86% of total billed charges,51.75,75% of total billed charges,51.75,75% of total billed charges,16.56,24% of total billed charges,51.75,75% of total billed charges,51.75,75% of total billed charges,55.2,80% of total billed charges,16.73,24.24% of total billed charges,34.78,50.4% of total billed charges,51.75,75% of total billed charges,16.89,24.48% of total billed charges,18.53,26.86% of total billed charges,16.56,24% of total billed charges,21.53,31.2% of total billed charges,55.2,80% of total billed charges,16.56,24% of total billed charges,16.56,24% of total billed charges,16.56,55.2,34.5
Outpatient Medical Services,THERAPY,97542,PT WHEELCHAIR MGT/PROP,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97545,PT WORK HARDENING 2HRS,420,206,55.33,26.86% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,49.44,24% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,164.8,80% of total billed charges,49.93,24.24% of total billed charges,103.82,50.4% of total billed charges,154.5,75% of total billed charges,50.43,24.48% of total billed charges,55.33,26.86% of total billed charges,49.44,24% of total billed charges,64.27,31.2% of total billed charges,164.8,80% of total billed charges,49.44,24% of total billed charges,49.44,24% of total billed charges,49.44,164.8,103
Outpatient Medical Services,THERAPY,97546,PT WORK HARDENING/COND,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97597,PT DEBRIDEMENT < 20CM,420,154.5,41.5,26.86% of total billed charges,115.88,75% of total billed charges,115.88,75% of total billed charges,37.08,24% of total billed charges,115.88,75% of total billed charges,115.88,75% of total billed charges,123.6,80% of total billed charges,37.45,24.24% of total billed charges,77.87,50.4% of total billed charges,115.88,75% of total billed charges,37.82,24.48% of total billed charges,41.5,26.86% of total billed charges,37.08,24% of total billed charges,48.2,31.2% of total billed charges,123.6,80% of total billed charges,37.08,24% of total billed charges,37.08,24% of total billed charges,37.08,123.6,77.25
Outpatient Medical Services,THERAPY,97598,PT DEBRIDEMENT >20CM,420,176,47.27,26.86% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,42.24,24% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,140.8,80% of total billed charges,42.66,24.24% of total billed charges,88.7,50.4% of total billed charges,132,75% of total billed charges,43.08,24.48% of total billed charges,47.27,26.86% of total billed charges,42.24,24% of total billed charges,54.91,31.2% of total billed charges,140.8,80% of total billed charges,42.24,24% of total billed charges,42.24,24% of total billed charges,42.24,140.8,88
Outpatient Medical Services,THERAPY,97602,PT DRESSINGS-LARGE,420,104,27.93,26.86% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,24.96,24% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,27.93,26.86% of total billed charges,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,24.96,83.2,52
Outpatient Medical Services,THERAPY,97602,PT DRESSINGS-MEDIUM,420,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97602,PT DRESSINGS-SMALL,420,41,11.01,26.86% of total billed charges,30.75,75% of total billed charges,30.75,75% of total billed charges,9.84,24% of total billed charges,30.75,75% of total billed charges,30.75,75% of total billed charges,32.8,80% of total billed charges,9.94,24.24% of total billed charges,20.66,50.4% of total billed charges,30.75,75% of total billed charges,10.04,24.48% of total billed charges,11.01,26.86% of total billed charges,9.84,24% of total billed charges,12.79,31.2% of total billed charges,32.8,80% of total billed charges,9.84,24% of total billed charges,9.84,24% of total billed charges,9.84,32.8,20.5
Outpatient Medical Services,THERAPY,97602,PT DEBRIDEMENT NONSELEC,420,122.5,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,97605,PT NEG PRES WOUND THERA,420,199,53.45,26.86% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,47.76,24% of total billed charges,149.25,75% of total billed charges,149.25,75% of total billed charges,159.2,80% of total billed charges,48.24,24.24% of total billed charges,100.3,50.4% of total billed charges,149.25,75% of total billed charges,48.72,24.48% of total billed charges,53.45,26.86% of total billed charges,47.76,24% of total billed charges,62.09,31.2% of total billed charges,159.2,80% of total billed charges,47.76,24% of total billed charges,47.76,24% of total billed charges,47.76,159.2,99.5
Outpatient Medical Services,THERAPY,97750,OT MUSCLE TESTING MANUAL MMT,420,78.5,21.09,26.86% of total billed charges,58.88,75% of total billed charges,58.88,75% of total billed charges,18.84,24% of total billed charges,58.88,75% of total billed charges,58.88,75% of total billed charges,62.8,80% of total billed charges,19.03,24.24% of total billed charges,39.56,50.4% of total billed charges,58.88,75% of total billed charges,19.22,24.48% of total billed charges,21.09,26.86% of total billed charges,18.84,24% of total billed charges,24.49,31.2% of total billed charges,62.8,80% of total billed charges,18.84,24% of total billed charges,18.84,24% of total billed charges,18.84,62.8,39.25
Outpatient Medical Services,THERAPY,97750,PT PHYSICAL PERF TEST,420,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,97750,PT MUSCL TST BODY&HANDS,420,104,27.93,26.86% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,24.96,24% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,27.93,26.86% of total billed charges,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,24.96,83.2,52
Outpatient Medical Services,THERAPY,97750,PT MUSCLE TESTING MANUAL MMT,420,78.5,21.09,26.86% of total billed charges,58.88,75% of total billed charges,58.88,75% of total billed charges,18.84,24% of total billed charges,58.88,75% of total billed charges,58.88,75% of total billed charges,62.8,80% of total billed charges,19.03,24.24% of total billed charges,39.56,50.4% of total billed charges,58.88,75% of total billed charges,19.22,24.48% of total billed charges,21.09,26.86% of total billed charges,18.84,24% of total billed charges,24.49,31.2% of total billed charges,62.8,80% of total billed charges,18.84,24% of total billed charges,18.84,24% of total billed charges,18.84,62.8,39.25
Outpatient Medical Services,THERAPY,97760,PT ORTHOTICS TRNING/FIT,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97761,PT PROSTHETICS TRNING,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97763,PT ORTH/PROSTCHECK15MIN,420,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97799,PT PRE-EMPLOY SCREEN,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,98960,PT EDUC/SELF MGT 1 PATIENT,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,98961,PT EDUC/SELF MGT 2-4 PATIENTS,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,98962,PT EDUC/SELF MGT  5-8 PATIENTS,420,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,99203,PT FUNCTIONAL EVALUATIO,420,86,23.1,26.86% of total billed charges,64.5,75% of total billed charges,64.5,75% of total billed charges,20.64,24% of total billed charges,64.5,75% of total billed charges,64.5,75% of total billed charges,68.8,80% of total billed charges,20.85,24.24% of total billed charges,43.34,50.4% of total billed charges,64.5,75% of total billed charges,21.05,24.48% of total billed charges,23.1,26.86% of total billed charges,20.64,24% of total billed charges,26.83,31.2% of total billed charges,68.8,80% of total billed charges,20.64,24% of total billed charges,20.64,24% of total billed charges,20.64,68.8,43
Outpatient Medical Services,THERAPY,G0281,PT ESTIM W/WOUND CARE,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,G0283,PT MEDICARE ELECT STIM,420,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,G8978,.PT WALKING & MOVING AROUND: CURRENT STA,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.PT MOBILITY CURRENT  G8978- CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT WALKING & MOVING AROUND: PROJECTED G,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.PT MOBILITY GOAL G8979-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT WALKING & MOVING AROUND: DISCHARGE S,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.PT MOBILITY DC G8980-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT CHANGING/MAINTAINING BODY POSITION:,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.PT  BODY POS CURRENT G8981-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT CHANGING/MAINTAINING BODY POSITION:,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.PT BODY POS GOAL G8982-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT CHANGING/MAINTAINING BODY POSITION:,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.PT BODY POS DC G8983-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRYING MOVING & HANDLING: CURRENT,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.PT CARRY CURRENT  G8984 -CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT CARRYING MOVING & HANDLING: PROJECTE,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.PT  CARRY GOAL G8985-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT CARRYING MOVING & HANDLING: DISCHARG,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.PT  CARRY DC G8986-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF CARE: CURRENT STATUS,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.PT SELF-CARE CURRENT  G8987-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT SELF CARE: PROJECTED GOAL STATUS REP,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.PT  SELF-CARE GOAL G8988-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT SELF CARE: DISCHARGE STATUS,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.PT  SELF-CARE DC G8989-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT PRIMARY FL:CURRENT STATU,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.PT OTHER PT/OT CURRENT G8990-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT PRIMARY FL: PROJECTED GO,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.PT OTHER PT/OT GOAL G8991-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT PRIMARY FL: DISCHARGE ST,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.PT OTHER PT/OT DC G8992-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT OTHER PT/OT SUBSEQUENT FL: CURRENT S,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.PT SUB PT/OT CURRENT  G8993-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT OTHER PT/OT SUBS FL: PROJECTED GOAL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.PT  SUB PT/OT GOAL G8994-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT OTHER PT/OT SUBSEQUENT FL: DISCHARGE,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CH,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CI,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CJ,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CK,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CL,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CM,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.PT SUB PT/OT DC G8995-CN,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,420,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,97161,PT EVAL: LOW COMPLEXITY,424,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,97162,PT PT EVALUATION,424,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,97162,PT EVAL: MODERATE COMPLEXITY,424,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,97163,PT EVAL: HIGH COMPLEXITY,424,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,97164,PT RE EVALUATION,424,154.5,41.5,26.86% of total billed charges,115.88,75% of total billed charges,115.88,75% of total billed charges,37.08,24% of total billed charges,115.88,75% of total billed charges,115.88,75% of total billed charges,123.6,80% of total billed charges,37.45,24.24% of total billed charges,77.87,50.4% of total billed charges,115.88,75% of total billed charges,37.82,24.48% of total billed charges,41.5,26.86% of total billed charges,37.08,24% of total billed charges,48.2,31.2% of total billed charges,123.6,80% of total billed charges,37.08,24% of total billed charges,37.08,24% of total billed charges,37.08,123.6,77.25
Outpatient Medical Services,THERAPY,29105,OT APL LONG ARM SPLINT,430,186.5,50.09,26.86% of total billed charges,139.88,75% of total billed charges,139.88,75% of total billed charges,44.76,24% of total billed charges,139.88,75% of total billed charges,139.88,75% of total billed charges,149.2,80% of total billed charges,45.21,24.24% of total billed charges,94,50.4% of total billed charges,139.88,75% of total billed charges,45.66,24.48% of total billed charges,50.09,26.86% of total billed charges,44.76,24% of total billed charges,58.19,31.2% of total billed charges,149.2,80% of total billed charges,44.76,24% of total billed charges,44.76,24% of total billed charges,44.76,149.2,93.25
Outpatient Medical Services,THERAPY,29105,OT APPL LONG ARM SPLINT,430,186.5,50.09,26.86% of total billed charges,139.88,75% of total billed charges,139.88,75% of total billed charges,44.76,24% of total billed charges,139.88,75% of total billed charges,139.88,75% of total billed charges,149.2,80% of total billed charges,45.21,24.24% of total billed charges,94,50.4% of total billed charges,139.88,75% of total billed charges,45.66,24.48% of total billed charges,50.09,26.86% of total billed charges,44.76,24% of total billed charges,58.19,31.2% of total billed charges,149.2,80% of total billed charges,44.76,24% of total billed charges,44.76,24% of total billed charges,44.76,149.2,93.25
Outpatient Medical Services,THERAPY,29125,OT APP SH ARM ST,430,143,38.41,26.86% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,34.32,24% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,38.41,26.86% of total billed charges,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,34.32,114.4,71.5
Outpatient Medical Services,THERAPY,29125,OT APP SH ARM SPLINT ST - 29125,430,143,38.41,26.86% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,34.32,24% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,38.41,26.86% of total billed charges,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,34.32,114.4,71.5
Outpatient Medical Services,THERAPY,29126,OT APP SH ARM SPLINT DY,430,176,47.27,26.86% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,42.24,24% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,140.8,80% of total billed charges,42.66,24.24% of total billed charges,88.7,50.4% of total billed charges,132,75% of total billed charges,43.08,24.48% of total billed charges,47.27,26.86% of total billed charges,42.24,24% of total billed charges,54.91,31.2% of total billed charges,140.8,80% of total billed charges,42.24,24% of total billed charges,42.24,24% of total billed charges,42.24,140.8,88
Outpatient Medical Services,THERAPY,29126,OT APP SH ARM SPLINT DY - 29126,430,176,47.27,26.86% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,42.24,24% of total billed charges,132,75% of total billed charges,132,75% of total billed charges,140.8,80% of total billed charges,42.66,24.24% of total billed charges,88.7,50.4% of total billed charges,132,75% of total billed charges,43.08,24.48% of total billed charges,47.27,26.86% of total billed charges,42.24,24% of total billed charges,54.91,31.2% of total billed charges,140.8,80% of total billed charges,42.24,24% of total billed charges,42.24,24% of total billed charges,42.24,140.8,88
Outpatient Medical Services,THERAPY,29130,OT APP FINGER SPLINT ST,430,89.5,24.04,26.86% of total billed charges,67.13,75% of total billed charges,67.13,75% of total billed charges,21.48,24% of total billed charges,67.13,75% of total billed charges,67.13,75% of total billed charges,71.6,80% of total billed charges,21.69,24.24% of total billed charges,45.11,50.4% of total billed charges,67.13,75% of total billed charges,21.91,24.48% of total billed charges,24.04,26.86% of total billed charges,21.48,24% of total billed charges,27.92,31.2% of total billed charges,71.6,80% of total billed charges,21.48,24% of total billed charges,21.48,24% of total billed charges,21.48,71.6,44.75
Outpatient Medical Services,THERAPY,29130,OT APP FINGER SPLINT ST - 29130,430,89.5,24.04,26.86% of total billed charges,67.13,75% of total billed charges,67.13,75% of total billed charges,21.48,24% of total billed charges,67.13,75% of total billed charges,67.13,75% of total billed charges,71.6,80% of total billed charges,21.69,24.24% of total billed charges,45.11,50.4% of total billed charges,67.13,75% of total billed charges,21.91,24.48% of total billed charges,24.04,26.86% of total billed charges,21.48,24% of total billed charges,27.92,31.2% of total billed charges,71.6,80% of total billed charges,21.48,24% of total billed charges,21.48,24% of total billed charges,21.48,71.6,44.75
Outpatient Medical Services,THERAPY,29131,OTAPP FINGER SPLINT DY,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29131,OT APP FINGER SPLINT DY - 29131,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29200,OT STRAPPING THORAX,430,136,36.53,26.86% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,32.64,24% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,108.8,80% of total billed charges,32.97,24.24% of total billed charges,68.54,50.4% of total billed charges,102,75% of total billed charges,33.29,24.48% of total billed charges,36.53,26.86% of total billed charges,32.64,24% of total billed charges,42.43,31.2% of total billed charges,108.8,80% of total billed charges,32.64,24% of total billed charges,32.64,24% of total billed charges,32.64,108.8,68
Outpatient Medical Services,THERAPY,29240,OT STRAPPING SHOULDER,430,144,38.68,26.86% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,38.68,26.86% of total billed charges,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,34.56,115.2,72
Outpatient Medical Services,THERAPY,29240,OT STRAPPING SHOULDER,430,144,38.68,26.86% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,38.68,26.86% of total billed charges,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,34.56,115.2,72
Outpatient Medical Services,THERAPY,29260,OT STRAPPING ELBOW WRIST,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29260,OT STRAPPING ELBO/WRIS,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29280,OT STRAP HAND/FING,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29280,OT STRAPPING HAND/FING,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,29505,OT APP LONG LEG SPLINT,430,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,39.6,24% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,40,24.24% of total billed charges,83.16,50.4% of total billed charges,123.75,75% of total billed charges,40.39,24.48% of total billed charges,44.32,26.86% of total billed charges,39.6,24% of total billed charges,51.48,31.2% of total billed charges,132,80% of total billed charges,39.6,24% of total billed charges,39.6,24% of total billed charges,39.6,132,82.5
Outpatient Medical Services,THERAPY,29505,OT APP LONG LEG SPLINT,430,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,39.6,24% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,40,24.24% of total billed charges,83.16,50.4% of total billed charges,123.75,75% of total billed charges,40.39,24.48% of total billed charges,44.32,26.86% of total billed charges,39.6,24% of total billed charges,51.48,31.2% of total billed charges,132,80% of total billed charges,39.6,24% of total billed charges,39.6,24% of total billed charges,39.6,132,82.5
Outpatient Medical Services,THERAPY,29515,OT APP SHORT LEG SPLINT,430,144,38.68,26.86% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,34.56,24% of total billed charges,108,75% of total billed charges,108,75% of total billed charges,115.2,80% of total billed charges,34.91,24.24% of total billed charges,72.58,50.4% of total billed charges,108,75% of total billed charges,35.25,24.48% of total billed charges,38.68,26.86% of total billed charges,34.56,24% of total billed charges,44.93,31.2% of total billed charges,115.2,80% of total billed charges,34.56,24% of total billed charges,34.56,24% of total billed charges,34.56,115.2,72
Outpatient Medical Services,THERAPY,29515,OT APP SHORT LEG SPLINT,430,143,38.41,26.86% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,34.32,24% of total billed charges,107.25,75% of total billed charges,107.25,75% of total billed charges,114.4,80% of total billed charges,34.66,24.24% of total billed charges,72.07,50.4% of total billed charges,107.25,75% of total billed charges,35.01,24.48% of total billed charges,38.41,26.86% of total billed charges,34.32,24% of total billed charges,44.62,31.2% of total billed charges,114.4,80% of total billed charges,34.32,24% of total billed charges,34.32,24% of total billed charges,34.32,114.4,71.5
Outpatient Medical Services,THERAPY,29520,OT STRAPPING HIP,430,136,36.53,26.86% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,32.64,24% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,108.8,80% of total billed charges,32.97,24.24% of total billed charges,68.54,50.4% of total billed charges,102,75% of total billed charges,33.29,24.48% of total billed charges,36.53,26.86% of total billed charges,32.64,24% of total billed charges,42.43,31.2% of total billed charges,108.8,80% of total billed charges,32.64,24% of total billed charges,32.64,24% of total billed charges,32.64,108.8,68
Outpatient Medical Services,THERAPY,29520,OT STRAPPING HIP,430,136,36.53,26.86% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,32.64,24% of total billed charges,102,75% of total billed charges,102,75% of total billed charges,108.8,80% of total billed charges,32.97,24.24% of total billed charges,68.54,50.4% of total billed charges,102,75% of total billed charges,33.29,24.48% of total billed charges,36.53,26.86% of total billed charges,32.64,24% of total billed charges,42.43,31.2% of total billed charges,108.8,80% of total billed charges,32.64,24% of total billed charges,32.64,24% of total billed charges,32.64,108.8,68
Outpatient Medical Services,THERAPY,29530,OT STRAPPING OF KNEE,430,122.5,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,29530,OT STRAPPING OF KNEE,430,122.5,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,29540,OT STRAPPING OF ANKLE,430,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,29540,OT STRAPPING OF ANKLE,430,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,29799,OT STRAPPING LOW BACK,430,122.5,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,95852,OT ROM MEASURE - HAND,430,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97010,OT HOT PACK/COLD PACK,430,63,16.92,26.86% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,15.12,24% of total billed charges,47.25,75% of total billed charges,47.25,75% of total billed charges,50.4,80% of total billed charges,15.27,24.24% of total billed charges,31.75,50.4% of total billed charges,47.25,75% of total billed charges,15.42,24.48% of total billed charges,16.92,26.86% of total billed charges,15.12,24% of total billed charges,19.66,31.2% of total billed charges,50.4,80% of total billed charges,15.12,24% of total billed charges,15.12,24% of total billed charges,15.12,50.4,31.5
Outpatient Medical Services,THERAPY,97018,OT PARRAFIN BATH,430,47.5,12.76,26.86% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,11.4,24% of total billed charges,35.63,75% of total billed charges,35.63,75% of total billed charges,38,80% of total billed charges,11.51,24.24% of total billed charges,23.94,50.4% of total billed charges,35.63,75% of total billed charges,11.63,24.48% of total billed charges,12.76,26.86% of total billed charges,11.4,24% of total billed charges,14.82,31.2% of total billed charges,38,80% of total billed charges,11.4,24% of total billed charges,11.4,24% of total billed charges,11.4,38,23.75
Outpatient Medical Services,THERAPY,97110,OT THERAPEUTIC EXERCISE,430,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97112,OT NEUROMUSCLE REEDUCAT,430,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97124,OT OT MASSAGE - 15 MIN,430,67,18,26.86% of total billed charges,50.25,75% of total billed charges,50.25,75% of total billed charges,16.08,24% of total billed charges,50.25,75% of total billed charges,50.25,75% of total billed charges,53.6,80% of total billed charges,16.24,24.24% of total billed charges,33.77,50.4% of total billed charges,50.25,75% of total billed charges,16.4,24.48% of total billed charges,18,26.86% of total billed charges,16.08,24% of total billed charges,20.9,31.2% of total billed charges,53.6,80% of total billed charges,16.08,24% of total billed charges,16.08,24% of total billed charges,16.08,53.6,33.5
Outpatient Medical Services,THERAPY,97140,OT MANUAL THERAPY,430,95,25.52,26.86% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,22.8,24% of total billed charges,71.25,75% of total billed charges,71.25,75% of total billed charges,76,80% of total billed charges,23.03,24.24% of total billed charges,47.88,50.4% of total billed charges,71.25,75% of total billed charges,23.26,24.48% of total billed charges,25.52,26.86% of total billed charges,22.8,24% of total billed charges,29.64,31.2% of total billed charges,76,80% of total billed charges,22.8,24% of total billed charges,22.8,24% of total billed charges,22.8,76,47.5
Outpatient Medical Services,THERAPY,97150,OT GROUP THERAPY,430,72,19.34,26.86% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,17.28,24% of total billed charges,54,75% of total billed charges,54,75% of total billed charges,57.6,80% of total billed charges,17.45,24.24% of total billed charges,36.29,50.4% of total billed charges,54,75% of total billed charges,17.63,24.48% of total billed charges,19.34,26.86% of total billed charges,17.28,24% of total billed charges,22.46,31.2% of total billed charges,57.6,80% of total billed charges,17.28,24% of total billed charges,17.28,24% of total billed charges,17.28,57.6,36
Outpatient Medical Services,THERAPY,97166,OT OCC THPY EVALUATION,430,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,THERAPY,97168,OT OCC THPY RE-EVAL,430,178,47.81,26.86% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,42.72,24% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,47.81,26.86% of total billed charges,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,42.72,142.4,89
Outpatient Medical Services,THERAPY,97530,OT THERAPEUTIC ACTIVITY,430,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97535,OT ACT OF DAILY LIVING,430,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,97537,OT COMM/WORK INTEGRAT,430,73,19.61,26.86% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,17.52,24% of total billed charges,54.75,75% of total billed charges,54.75,75% of total billed charges,58.4,80% of total billed charges,17.7,24.24% of total billed charges,36.79,50.4% of total billed charges,54.75,75% of total billed charges,17.87,24.48% of total billed charges,19.61,26.86% of total billed charges,17.52,24% of total billed charges,22.78,31.2% of total billed charges,58.4,80% of total billed charges,17.52,24% of total billed charges,17.52,24% of total billed charges,17.52,58.4,36.5
Outpatient Medical Services,THERAPY,97542,OT WHEELCHAIR MGT/PROP,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,97750,OT MUSCLE TEST BODY&HAN,430,90.5,24.31,26.86% of total billed charges,67.88,75% of total billed charges,67.88,75% of total billed charges,21.72,24% of total billed charges,67.88,75% of total billed charges,67.88,75% of total billed charges,72.4,80% of total billed charges,21.94,24.24% of total billed charges,45.61,50.4% of total billed charges,67.88,75% of total billed charges,22.15,24.48% of total billed charges,24.31,26.86% of total billed charges,21.72,24% of total billed charges,28.24,31.2% of total billed charges,72.4,80% of total billed charges,21.72,24% of total billed charges,21.72,24% of total billed charges,21.72,72.4,45.25
Outpatient Medical Services,THERAPY,97750,OT FUNCTIONAL PERFORMANCE TESTING,430,114.5,30.75,26.86% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,27.48,24% of total billed charges,85.88,75% of total billed charges,85.88,75% of total billed charges,91.6,80% of total billed charges,27.75,24.24% of total billed charges,57.71,50.4% of total billed charges,85.88,75% of total billed charges,28.03,24.48% of total billed charges,30.75,26.86% of total billed charges,27.48,24% of total billed charges,35.72,31.2% of total billed charges,91.6,80% of total billed charges,27.48,24% of total billed charges,27.48,24% of total billed charges,27.48,91.6,57.25
Outpatient Medical Services,THERAPY,97760,OT ORTHOTICS TRNG/FITNG,430,51.5,13.83,26.86% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,12.36,24% of total billed charges,38.63,75% of total billed charges,38.63,75% of total billed charges,41.2,80% of total billed charges,12.48,24.24% of total billed charges,25.96,50.4% of total billed charges,38.63,75% of total billed charges,12.61,24.48% of total billed charges,13.83,26.86% of total billed charges,12.36,24% of total billed charges,16.07,31.2% of total billed charges,41.2,80% of total billed charges,12.36,24% of total billed charges,12.36,24% of total billed charges,12.36,41.2,25.75
Outpatient Medical Services,THERAPY,97763,OT ORTH CHK/PROSTH CHK,430,104,27.93,26.86% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,24.96,24% of total billed charges,78,75% of total billed charges,78,75% of total billed charges,83.2,80% of total billed charges,25.21,24.24% of total billed charges,52.42,50.4% of total billed charges,78,75% of total billed charges,25.46,24.48% of total billed charges,27.93,26.86% of total billed charges,24.96,24% of total billed charges,32.45,31.2% of total billed charges,83.2,80% of total billed charges,24.96,24% of total billed charges,24.96,24% of total billed charges,24.96,83.2,52
Outpatient Medical Services,THERAPY,97770,OT COGNITIVE TRAINING,430,97,26.05,26.86% of total billed charges,72.75,75% of total billed charges,72.75,75% of total billed charges,23.28,24% of total billed charges,72.75,75% of total billed charges,72.75,75% of total billed charges,77.6,80% of total billed charges,23.51,24.24% of total billed charges,48.89,50.4% of total billed charges,72.75,75% of total billed charges,23.75,24.48% of total billed charges,26.05,26.86% of total billed charges,23.28,24% of total billed charges,30.26,31.2% of total billed charges,77.6,80% of total billed charges,23.28,24% of total billed charges,23.28,24% of total billed charges,23.28,77.6,48.5
Outpatient Medical Services,THERAPY,98960,.OT PT EDU/SELF MGT 15 MIN 1 PATIENT,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,98961,.OT PT EDU/SELF MGT 15 MIN 2-4 PATIENTS,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,98962,.OT PT EDU/SELF MGT 15 MIN 5-8 PATIENTS,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8978,.OT MOBILITY CURRENT  G8978- CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8979,.OT MOBILITY GOAL G8979-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8980,.OT MOBILITY DC G8980-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8981,.OT  BODY POS CURRENT G8981-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8982,.OT BODY POS GOAL G8982-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8983,.OT BODY POS DC G8983-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8984,.OT CARRY CURRENT  G8984 -CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8985,.OT  CARRY GOAL G8985-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8986,.OT  CARRY DC G8986-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8987,.OT SELF-CARE CURRENT  G8987-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8988,.OT  SELF-CARE GOAL G8988-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8989,.OT  SELF-CARE DC G8989-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8990,.OT OTHER PT/OT CURRENT G8990-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8991,.OT OTHER PT/OT GOAL G8991-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8992,.OT OTHER PT/OT DC G8992-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8993,.OT SUB PT/OT CURRENT  G8993-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8994,.OT  SUB PT/OT GOAL G8994-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8995,.OT SUB PT/OT DC G8995-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9165,.OT  ATTEN CURRENT G9165-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9166,.OT  ATTEN GOAL G9166-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9167,.OT ATTEN DC G9167-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9168,.OT  MEMORY CURRENT G9168-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9169,.OT  MEMORY GOAL G9169-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CH,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CI,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CJ,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CK,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CL,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CM,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9170,.OT  MEMORY DC G9170-CN,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,430,$122.50 ,32.9,26.86% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,29.4,24% of total billed charges,91.88,75% of total billed charges,91.88,75% of total billed charges,98,80% of total billed charges,29.69,24.24% of total billed charges,61.74,50.4% of total billed charges,91.88,75% of total billed charges,29.99,24.48% of total billed charges,32.9,26.86% of total billed charges,29.4,24% of total billed charges,38.22,31.2% of total billed charges,98,80% of total billed charges,29.4,24% of total billed charges,29.4,24% of total billed charges,29.4,98,61.25
Outpatient Medical Services,THERAPY,,,430,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,97165,OT OCC THPY EVAL: LOW COMPLEXITY,434,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,THERAPY,97166,OT OCC THPY EVAL: MODERATE COMPLEXITY,434,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,THERAPY,97167,OT OCC THPY EVAL: HIGH COMPLEXITY,434,356.5,95.76,26.86% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,85.56,24% of total billed charges,267.38,75% of total billed charges,267.38,75% of total billed charges,285.2,80% of total billed charges,86.42,24.24% of total billed charges,179.68,50.4% of total billed charges,267.38,75% of total billed charges,87.27,24.48% of total billed charges,95.76,26.86% of total billed charges,85.56,24% of total billed charges,111.23,31.2% of total billed charges,285.2,80% of total billed charges,85.56,24% of total billed charges,85.56,24% of total billed charges,85.56,285.2,178.25
Outpatient Medical Services,THERAPY,97168,OT OCC THPY EVAL: RE-EVAL,434,178,47.81,26.86% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,42.72,24% of total billed charges,133.5,75% of total billed charges,133.5,75% of total billed charges,142.4,80% of total billed charges,43.15,24.24% of total billed charges,89.71,50.4% of total billed charges,133.5,75% of total billed charges,43.57,24.48% of total billed charges,47.81,26.86% of total billed charges,42.72,24% of total billed charges,55.54,31.2% of total billed charges,142.4,80% of total billed charges,42.72,24% of total billed charges,42.72,24% of total billed charges,42.72,142.4,89
Outpatient Medical Services,THERAPY,92507,ST TX SPEECH/AUD DISOR,440,290.5,78.03,26.86% of total billed charges,217.88,75% of total billed charges,217.88,75% of total billed charges,69.72,24% of total billed charges,217.88,75% of total billed charges,217.88,75% of total billed charges,232.4,80% of total billed charges,70.42,24.24% of total billed charges,146.41,50.4% of total billed charges,217.88,75% of total billed charges,71.11,24.48% of total billed charges,78.03,26.86% of total billed charges,69.72,24% of total billed charges,90.64,31.2% of total billed charges,232.4,80% of total billed charges,69.72,24% of total billed charges,69.72,24% of total billed charges,69.72,232.4,145.25
Outpatient Medical Services,THERAPY,92508,ST SPEECH GRP TREATMENT,440,82.5,22.16,26.86% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,19.8,24% of total billed charges,61.88,75% of total billed charges,61.88,75% of total billed charges,66,80% of total billed charges,20,24.24% of total billed charges,41.58,50.4% of total billed charges,61.88,75% of total billed charges,20.2,24.48% of total billed charges,22.16,26.86% of total billed charges,19.8,24% of total billed charges,25.74,31.2% of total billed charges,66,80% of total billed charges,19.8,24% of total billed charges,19.8,24% of total billed charges,19.8,66,41.25
Outpatient Medical Services,THERAPY,92521,ST INIT SPEECH EVAL,440,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,92521,ST SPEECH/HEARING EVAL (DELETED),440,310,83.27,26.86% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,74.4,24% of total billed charges,232.5,75% of total billed charges,232.5,75% of total billed charges,248,80% of total billed charges,75.14,24.24% of total billed charges,156.24,50.4% of total billed charges,232.5,75% of total billed charges,75.89,24.48% of total billed charges,83.27,26.86% of total billed charges,74.4,24% of total billed charges,96.72,31.2% of total billed charges,248,80% of total billed charges,74.4,24% of total billed charges,74.4,24% of total billed charges,74.4,248,155
Outpatient Medical Services,THERAPY,92523,ST EVAL SPEECH SOUND LANG COMPREH,440,439,117.92,26.86% of total billed charges,329.25,75% of total billed charges,329.25,75% of total billed charges,105.36,24% of total billed charges,329.25,75% of total billed charges,329.25,75% of total billed charges,351.2,80% of total billed charges,106.41,24.24% of total billed charges,221.26,50.4% of total billed charges,329.25,75% of total billed charges,107.47,24.48% of total billed charges,117.92,26.86% of total billed charges,105.36,24% of total billed charges,136.97,31.2% of total billed charges,351.2,80% of total billed charges,105.36,24% of total billed charges,105.36,24% of total billed charges,105.36,351.2,219.5
Outpatient Medical Services,THERAPY,92526,ST DYSPHAGIA TREATMENT,440,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,39.6,24% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,40,24.24% of total billed charges,83.16,50.4% of total billed charges,123.75,75% of total billed charges,40.39,24.48% of total billed charges,44.32,26.86% of total billed charges,39.6,24% of total billed charges,51.48,31.2% of total billed charges,132,80% of total billed charges,39.6,24% of total billed charges,39.6,24% of total billed charges,39.6,132,82.5
Outpatient Medical Services,THERAPY,92610,ST DYSPHAGIA EVAL,440,247,66.34,26.86% of total billed charges,185.25,75% of total billed charges,185.25,75% of total billed charges,59.28,24% of total billed charges,185.25,75% of total billed charges,185.25,75% of total billed charges,197.6,80% of total billed charges,59.87,24.24% of total billed charges,124.49,50.4% of total billed charges,185.25,75% of total billed charges,60.47,24.48% of total billed charges,66.34,26.86% of total billed charges,59.28,24% of total billed charges,77.06,31.2% of total billed charges,197.6,80% of total billed charges,59.28,24% of total billed charges,59.28,24% of total billed charges,59.28,197.6,123.5
Outpatient Medical Services,THERAPY,97129,ST COGNITIVE SKILLS DEVELOPMENT,440,117.5,31.56,26.86% of total billed charges,88.13,75% of total billed charges,88.13,75% of total billed charges,28.2,24% of total billed charges,88.13,75% of total billed charges,88.13,75% of total billed charges,94,80% of total billed charges,28.48,24.24% of total billed charges,59.22,50.4% of total billed charges,88.13,75% of total billed charges,28.76,24.48% of total billed charges,31.56,26.86% of total billed charges,28.2,24% of total billed charges,36.66,31.2% of total billed charges,94,80% of total billed charges,28.2,24% of total billed charges,28.2,24% of total billed charges,28.2,94,58.75
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8996,.ST SWALLOW CURRENT G8996-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8997,.ST  SWALLOW GOAL G8997-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8998,.ST SWALLOW DC G8998-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G8999,.ST MOTOR SPEECH CURRENT G8999-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9158,.ST MOTOR SPEECH DC  G9158-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9159,.ST  LANG COMP CURRENT  G9159-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9160,.ST  LANG COMP GOAL G9160-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9161,.ST  LANG COMP DC G9161-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9162,.ST  LANG EXPRESS CURRENT G9162-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9163,.ST  LANG EXPRESS GOAL G9163-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9164,.ST LANG EXPRESS DC G9164 -CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9171,.ST  VOICE CURRENT G9171-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9172,.ST VOICE GOAL  G9172-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9173,.ST  VOICE DC G9173-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9174,.ST  SPEECH LANG CURRENT G9174-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9175,.ST  SPEECH LANG GOAL G9175-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9176,.ST  SPEECH LANG DC G9176-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CH,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CI,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CJ,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CK,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CL,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CM,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,G9186,.ST  MOTOR SPEECH GOAL G9186-CN,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,$206.00 ,55.33,26.86% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,49.44,24% of total billed charges,154.5,75% of total billed charges,154.5,75% of total billed charges,164.8,80% of total billed charges,49.93,24.24% of total billed charges,103.82,50.4% of total billed charges,154.5,75% of total billed charges,50.43,24.48% of total billed charges,55.33,26.86% of total billed charges,49.44,24% of total billed charges,64.27,31.2% of total billed charges,164.8,80% of total billed charges,49.44,24% of total billed charges,49.44,24% of total billed charges,49.44,164.8,103
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,,,440,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,THERAPY,92611,ST MOTION SWALLOW/FLUOR,444,415,111.47,26.86% of total billed charges,311.25,75% of total billed charges,311.25,75% of total billed charges,99.6,24% of total billed charges,311.25,75% of total billed charges,311.25,75% of total billed charges,332,80% of total billed charges,100.6,24.24% of total billed charges,209.16,50.4% of total billed charges,311.25,75% of total billed charges,101.59,24.48% of total billed charges,111.47,26.86% of total billed charges,99.6,24% of total billed charges,129.48,31.2% of total billed charges,332,80% of total billed charges,99.6,24% of total billed charges,99.6,24% of total billed charges,99.6,332,207.5
Outpatient Medical Services,THERAPY,96105,ST SPEECH ASSESSMENT,444,247,66.34,26.86% of total billed charges,185.25,75% of total billed charges,185.25,75% of total billed charges,59.28,24% of total billed charges,185.25,75% of total billed charges,185.25,75% of total billed charges,197.6,80% of total billed charges,59.87,24.24% of total billed charges,124.49,50.4% of total billed charges,185.25,75% of total billed charges,60.47,24.48% of total billed charges,66.34,26.86% of total billed charges,59.28,24% of total billed charges,77.06,31.2% of total billed charges,197.6,80% of total billed charges,59.28,24% of total billed charges,59.28,24% of total billed charges,59.28,197.6,123.5
Outpatient Medical Services,THERAPY,96105,ST APHASIA ASSESSMENT,444,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,39.6,24% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,40,24.24% of total billed charges,83.16,50.4% of total billed charges,123.75,75% of total billed charges,40.39,24.48% of total billed charges,44.32,26.86% of total billed charges,39.6,24% of total billed charges,51.48,31.2% of total billed charges,132,80% of total billed charges,39.6,24% of total billed charges,39.6,24% of total billed charges,39.6,132,82.5
Outpatient Medical Services,VISIT CHARGES,99202,NEW PATIENT LEVEL 1 (10 MINS),521,132,35.46,26.86% of total billed charges,99,75% of total billed charges,99,75% of total billed charges,185.51,Case rate,99,75% of total billed charges,99,75% of total billed charges,105.6,80% of total billed charges,187.36,Case rate,66.53,50.4% of total billed charges,99,75% of total billed charges,189.22,Case rate,35.46,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,35.46,241.16,66
Outpatient Medical Services,VISIT CHARGES,99202,NEW PATIENT LEVEL 2 (20 MINS),521,165,44.32,26.86% of total billed charges,123.75,75% of total billed charges,123.75,75% of total billed charges,185.51,Case rate,123.75,75% of total billed charges,123.75,75% of total billed charges,132,80% of total billed charges,187.36,Case rate,83.16,50.4% of total billed charges,123.75,75% of total billed charges,189.22,Case rate,44.32,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,44.32,241.16,82.5
Outpatient Medical Services,VISIT CHARGES,99205,NEW PATIENT LEVEL 5 (60 MINS),521,413,110.93,26.86% of total billed charges,309.75,75% of total billed charges,309.75,75% of total billed charges,185.51,Case rate,309.75,75% of total billed charges,309.75,75% of total billed charges,330.4,80% of total billed charges,187.36,Case rate,208.15,50.4% of total billed charges,309.75,75% of total billed charges,189.22,Case rate,110.93,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,110.93,330.4,206.5
Outpatient Medical Services,VISIT CHARGES,99211,ESTABLISHED PT LEVEL 1 (5 MINS-NURSE VIS,521,65,17.46,26.86% of total billed charges,48.75,75% of total billed charges,48.75,75% of total billed charges,185.51,Case rate,48.75,75% of total billed charges,48.75,75% of total billed charges,52,80% of total billed charges,187.36,Case rate,32.76,50.4% of total billed charges,48.75,75% of total billed charges,189.22,Case rate,17.46,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,17.46,241.16,32.5
Outpatient Medical Services,VISIT CHARGES,99212,ESTABLISHED PT LEVEL 2 (10 MINS),521,91.5,24.58,26.86% of total billed charges,68.63,75% of total billed charges,68.63,75% of total billed charges,185.51,Case rate,68.63,75% of total billed charges,68.63,75% of total billed charges,73.2,80% of total billed charges,187.36,Case rate,46.12,50.4% of total billed charges,68.63,75% of total billed charges,189.22,Case rate,24.58,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,24.58,241.16,45.75
Outpatient Medical Services,VISIT CHARGES,99213,ESTABLISHED PT LEVEL 3 (15 MINS),521,116.5,31.29,26.86% of total billed charges,87.38,75% of total billed charges,87.38,75% of total billed charges,185.51,Case rate,87.38,75% of total billed charges,87.38,75% of total billed charges,93.2,80% of total billed charges,187.36,Case rate,58.72,50.4% of total billed charges,87.38,75% of total billed charges,189.22,Case rate,31.29,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,31.29,241.16,58.25
Outpatient Medical Services,VISIT CHARGES,99215,ESTABLISHED PT LEVEL 5 (40 MINS),521,272,73.06,26.86% of total billed charges,204,75% of total billed charges,204,75% of total billed charges,185.51,Case rate,204,75% of total billed charges,204,75% of total billed charges,217.6,80% of total billed charges,187.36,Case rate,137.09,50.4% of total billed charges,204,75% of total billed charges,189.22,Case rate,73.06,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,73.06,241.16,136
Outpatient Medical Services,VISIT CHARGES,99226,SUBSEQUENT OBSERVATION CARE 35 MINS,521,212,56.94,26.86% of total billed charges,159,75% of total billed charges,159,75% of total billed charges,185.51,Case rate,159,75% of total billed charges,159,75% of total billed charges,169.6,80% of total billed charges,187.36,Case rate,106.85,50.4% of total billed charges,159,75% of total billed charges,189.22,Case rate,56.94,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,56.94,241.16,106
Outpatient Medical Services,VISIT CHARGES,99244,OFFICE CONSULT COMPREHENSIVE-MODERATE,521,408,109.59,26.86% of total billed charges,306,75% of total billed charges,306,75% of total billed charges,185.51,Case rate,306,75% of total billed charges,306,75% of total billed charges,326.4,80% of total billed charges,187.36,Case rate,205.63,50.4% of total billed charges,306,75% of total billed charges,189.22,Case rate,109.59,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,109.59,326.4,204
Outpatient Medical Services,VISIT CHARGES,99245,OFFICE CONSULT COMPREHENSIVE HIGH,521,515,138.33,26.86% of total billed charges,386.25,75% of total billed charges,386.25,75% of total billed charges,185.51,Case rate,386.25,75% of total billed charges,386.25,75% of total billed charges,412,80% of total billed charges,187.36,Case rate,259.56,50.4% of total billed charges,386.25,75% of total billed charges,189.22,Case rate,138.33,26.86% of total billed charges,185.51,Case rate,241.16,Case rate,N/A,Not Separately reimbursable,185.51,Case rate,185.51,Case rate,138.33,412,257.5
Outpatient Medical Services,EMERGENCY ROOM,,,450,N/A,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,710,Case rate,710,Case rate,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,710,710,N/A
Outpatient Medical Services,EMERGENCY ROOM,,,450,$210.00 ,56.41,26.86% of total billed charges,710,Case rate,710,Case rate,50.4,24% of total billed charges,710,Case rate,710,Case rate,168,80% of total billed charges,50.9,24.24% of total billed charges,105.84,50.4% of total billed charges,157.5,75% of total billed charges,51.41,24.48% of total billed charges,56.41,26.86% of total billed charges,50.4,24% of total billed charges,65.52,31.2% of total billed charges,168,80% of total billed charges,50.4,24% of total billed charges,50.4,24% of total billed charges,50.4,710,105
Outpatient Medical Services,EMERGENCY ROOM,,,450,$244.00 ,65.54,26.86% of total billed charges,710,Case rate,710,Case rate,58.56,24% of total billed charges,710,Case rate,710,Case rate,195.2,80% of total billed charges,59.15,24.24% of total billed charges,122.98,50.4% of total billed charges,183,75% of total billed charges,59.73,24.48% of total billed charges,65.54,26.86% of total billed charges,58.56,24% of total billed charges,76.13,31.2% of total billed charges,195.2,80% of total billed charges,58.56,24% of total billed charges,58.56,24% of total billed charges,58.56,710,122
Outpatient Medical Services,EMERGENCY ROOM,,,450,$752.00 ,201.99,26.86% of total billed charges,710,Case rate,710,Case rate,180.48,24% of total billed charges,710,Case rate,710,Case rate,601.6,80% of total billed charges,182.28,24.24% of total billed charges,379.01,50.4% of total billed charges,564,75% of total billed charges,184.09,24.48% of total billed charges,201.99,26.86% of total billed charges,180.48,24% of total billed charges,234.62,31.2% of total billed charges,601.6,80% of total billed charges,180.48,24% of total billed charges,180.48,24% of total billed charges,180.48,710,376
Outpatient Medical Services,EMERGENCY ROOM,,,450,"$1,045.50 ",280.82,26.86% of total billed charges,710,Case rate,710,Case rate,250.92,24% of total billed charges,710,Case rate,710,Case rate,836.4,80% of total billed charges,253.43,24.24% of total billed charges,526.93,50.4% of total billed charges,784.13,75% of total billed charges,255.94,24.48% of total billed charges,280.82,26.86% of total billed charges,250.92,24% of total billed charges,326.2,31.2% of total billed charges,836.4,80% of total billed charges,250.92,24% of total billed charges,250.92,24% of total billed charges,250.92,836.4,522.75
Outpatient Medical Services,LAB,,,300,$10.50 ,2.82,26.86% of total billed charges,7.88,75% of total billed charges,7.88,75% of total billed charges,2.52,24% of total billed charges,7.88,75% of total billed charges,7.88,75% of total billed charges,8.4,80% of total billed charges,2.55,24.24% of total billed charges,5.29,50.4% of total billed charges,7.88,75% of total billed charges,2.57,24.48% of total billed charges,2.82,26.86% of total billed charges,2.52,24% of total billed charges,3.28,31.2% of total billed charges,8.4,80% of total billed charges,2.52,24% of total billed charges,2.52,24% of total billed charges,2.52,8.4,5.25
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,$46.50 ,12.49,26.86% of total billed charges,34.88,75% of total billed charges,34.88,75% of total billed charges,11.16,24% of total billed charges,34.88,75% of total billed charges,34.88,75% of total billed charges,37.2,80% of total billed charges,11.27,24.24% of total billed charges,23.44,50.4% of total billed charges,34.88,75% of total billed charges,11.38,24.48% of total billed charges,12.49,26.86% of total billed charges,11.16,24% of total billed charges,14.51,31.2% of total billed charges,37.2,80% of total billed charges,11.16,24% of total billed charges,11.16,24% of total billed charges,11.16,37.2,23.25
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,300,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,$61.00 ,16.38,26.86% of total billed charges,45.75,75% of total billed charges,45.75,75% of total billed charges,14.64,24% of total billed charges,45.75,75% of total billed charges,45.75,75% of total billed charges,48.8,80% of total billed charges,14.79,24.24% of total billed charges,30.74,50.4% of total billed charges,45.75,75% of total billed charges,14.93,24.48% of total billed charges,16.38,26.86% of total billed charges,14.64,24% of total billed charges,19.03,31.2% of total billed charges,48.8,80% of total billed charges,14.64,24% of total billed charges,14.64,24% of total billed charges,14.64,48.8,30.5
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,301,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,307,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,,,307,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,320,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,320,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,351,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,,,610,N/A,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,Not Separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99204,"New patient office of other outpatient visit, typically 45 min",761,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,76805,"Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus",402,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,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,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,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,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,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,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,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,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,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,SERVICE NOT OFFERED,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,Not Separately reimbursable. Service not offered,N/A,N/A,N/A