hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|LA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Reeves Memorial Medical Center,12/18/2024,2.0.0,Reeves Memorial Medical Center,"409 1st Street Bernice, LA 71222",720685207,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA PLAN,AETNA REIMBURSEMENT METHOD,BCBS ADVANTAGE PLAN,BCBS ADVANTAGE REIMBURSEMENT METHOD,BCBS HMO PLAN,BCBS HMO REIMBURSEMENT METHOD,BCBS PPO PLAN,BCBS PPO REIMBURSEMENT METHOD,BCBS TRADITIONAL PLAN,BCBS TRADITIONAL REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,HUMANA HMO PLAN,HUMANA HMO REIMBURSEMENT METHOD,HUMANA MEDICARE HMO PLAN,HUMANA MEDICARE HMO REIMBURSEMENT METHOD,HUMANA MEDICARE PFFS PLAN,HUMANA MEDICARE PFFS REIMBURSEMENT METHOD,HUMANA MEDICARE PPO PLAN,HUMANA MEDICARE PPO REIMBURSEMENT METHOD,HUMANA POS PLAN,HUMANA POS REIMBURSEMENT METHOD,HUMANA PPO PLAN,HUMANA PPO REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,VANTAGE COMMERCIAL PLAN,VANTAGE COMMERCIAL REIMBURSEMENT METHOD,VANTAGE MEDICARE PLAN,VANTAGE MEDICARE REIMBURSEMENT METHOD,VANTAGE PPO PLAN,VANTAGE PPO REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,MEDICAL SERVICES,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,844,506.4,60% of total billed charges for outpatient setting,405.12,48% of toatl Billed Charges for Outpatient Setting,158.46,100% of BCBS Fee Schedule for Outpatient Setting,158.46,100% of BCBS Fee Schedule for Outpatient Setting,175.89,111% of BCBS Fee Schedule for Outpatient Setting,422,Case rate,590.8,70% of Total Billed charges for Outpatient setting,409.17,48.48% of total Billed Charges for Outpatient Setting,409.17,48.48% of total Billed Charges for Outpatient Setting,409.17,48.48% of total Billed Charges for Outpatient Setting,590.8,70% of Total Billed charges for Outpatient setting,590.8,70% of Total Billed charges for Outpatient setting,405.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,409.17,48.48% of total Billed Charges for Outpatient Setting,759.6,90% of Total Billed charges for Outpatient setting,158.46,759.6,506.4
Outpatient Medical Services,MEDICAL SERVICES,81003,Automated urinalysis test,307,36.25,21.75,60% of total billed charges for outpatient setting,17.4,48% of toatl Billed Charges for Outpatient Setting,6.81,100% of BCBS Fee Schedule for Outpatient Setting,6.81,100% of BCBS Fee Schedule for Outpatient Setting,7.56,111% of BCBS Fee Schedule for Outpatient Setting,18.13,Case rate,25.38,70% of Total Billed charges for Outpatient setting,17.57,48.48% of total Billed Charges for Outpatient Setting,17.57,48.48% of total Billed Charges for Outpatient Setting,17.57,48.48% of total Billed Charges for Outpatient Setting,25.38,70% of Total Billed charges for Outpatient setting,25.38,70% of Total Billed charges for Outpatient setting,17.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,17.57,48.48% of total Billed Charges for Outpatient Setting,32.63,90% of Total Billed charges for Outpatient setting,6.81,32.63,27.19
Outpatient Medical Services,MEDICAL SERVICES,80048,Basic metabolic panel,301,113.75,13,100% of Aetna Fee Schedule for Outpatient Setting,54.6,48% of toatl Billed Charges for Outpatient Setting,25.65,100% of BCBS Fee Schedule for Outpatient Setting,25.65,100% of BCBS Fee Schedule for Outpatient Setting,28.47,111% of BCBS Fee Schedule for Outpatient Setting,56.88,Case rate,79.63,70% of Total Billed charges for Outpatient setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,79.63,70% of Total Billed charges for Outpatient setting,79.63,70% of Total Billed charges for Outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.15,48.48% of total Billed Charges for Outpatient Setting,102.38,90% of Total Billed charges for Outpatient setting,13,102.38,85.31
Outpatient Medical Services,MEDICAL SERVICES,85610,"Blood test, clotting time",305,45,27,60% of total billed charges for outpatient setting,21.6,48% of toatl Billed Charges for Outpatient Setting,11.9,100% of BCBS Fee Schedule for Outpatient Setting,11.9,100% of BCBS Fee Schedule for Outpatient Setting,13.21,111% of BCBS Fee Schedule for Outpatient Setting,22.5,Case rate,31.5,70% of Total Billed charges for Outpatient setting,21.82,48.48% of total Billed Charges for Outpatient Setting,21.82,48.48% of total Billed Charges for Outpatient Setting,21.82,48.48% of total Billed Charges for Outpatient Setting,31.5,70% of Total Billed charges for Outpatient setting,31.5,70% of Total Billed charges for Outpatient setting,21.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,21.82,48.48% of total Billed Charges for Outpatient Setting,40.5,90% of Total Billed charges for Outpatient setting,11.9,40.5,33.75
Outpatient Medical Services,MEDICAL SERVICES,80053,"Blood test, comprehensive group of blood chemicals",301,147.5,15,100% of Aetna Fee Schedule for Outpatient Setting,70.8,48% of toatl Billed Charges for Outpatient Setting,32.02,100% of BCBS Fee Schedule for Outpatient Setting,32.02,100% of BCBS Fee Schedule for Outpatient Setting,35.54,111% of BCBS Fee Schedule for Outpatient Setting,73.75,Case rate,103.25,70% of Total Billed charges for Outpatient setting,71.51,48.48% of total Billed Charges for Outpatient Setting,71.51,48.48% of total Billed Charges for Outpatient Setting,71.51,48.48% of total Billed Charges for Outpatient Setting,103.25,70% of Total Billed charges for Outpatient setting,103.25,70% of Total Billed charges for Outpatient setting,70.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,71.51,48.48% of total Billed Charges for Outpatient Setting,132.75,90% of Total Billed charges for Outpatient setting,15,132.75,110.63
Outpatient Medical Services,MEDICAL SERVICES,80061,"Blood test, lipids (cholesterol and triglycerides)",301,97.5,58.5,60% of total billed charges for outpatient setting,46.8,48% of toatl Billed Charges for Outpatient Setting,36.18,100% of BCBS Fee Schedule for Outpatient Setting,36.18,100% of BCBS Fee Schedule for Outpatient Setting,40.16,111% of BCBS Fee Schedule for Outpatient Setting,48.75,Case rate,68.25,70% of Total Billed charges for Outpatient setting,47.27,48.48% of total Billed Charges for Outpatient Setting,47.27,48.48% of total Billed Charges for Outpatient Setting,47.27,48.48% of total Billed Charges for Outpatient Setting,68.25,70% of Total Billed charges for Outpatient setting,68.25,70% of Total Billed charges for Outpatient setting,46.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,47.27,48.48% of total Billed Charges for Outpatient Setting,87.75,90% of Total Billed charges for Outpatient setting,36.18,87.75,73.13
Outpatient Medical Services,MEDICAL SERVICES,84443,"Blood test, thyroid stimulating hormone (TSH)",300,121.5,72.9,60% of total billed charges for outpatient setting,58.32,48% of toatl Billed Charges for Outpatient Setting,50.88,100% of BCBS Fee Schedule for Outpatient Setting,50.88,100% of BCBS Fee Schedule for Outpatient Setting,56.48,111% of BCBS Fee Schedule for Outpatient Setting,60.75,Case rate,85.05,70% of Total Billed charges for Outpatient setting,58.9,48.48% of total Billed Charges for Outpatient Setting,58.9,48.48% of total Billed Charges for Outpatient Setting,58.9,48.48% of total Billed Charges for Outpatient Setting,85.05,70% of Total Billed charges for Outpatient setting,85.05,70% of Total Billed charges for Outpatient setting,58.32,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,58.9,48.48% of total Billed Charges for Outpatient Setting,109.35,90% of Total Billed charges for Outpatient setting,50.88,109.35,91.13
Outpatient Medical Services,MEDICAL SERVICES,85730,Coagulation assessment blood test,305,50.5,30.3,60% of total billed charges for outpatient setting,24.24,48% of toatl Billed Charges for Outpatient Setting,18.17,100% of BCBS Fee Schedule for Outpatient Setting,18.17,100% of BCBS Fee Schedule for Outpatient Setting,20.17,111% of BCBS Fee Schedule for Outpatient Setting,25.25,Case rate,35.35,70% of Total Billed charges for Outpatient setting,24.48,48.48% of total Billed Charges for Outpatient Setting,24.48,48.48% of total Billed Charges for Outpatient Setting,24.48,48.48% of total Billed Charges for Outpatient Setting,35.35,70% of Total Billed charges for Outpatient setting,35.35,70% of Total Billed charges for Outpatient setting,24.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,24.48,48.48% of total Billed Charges for Outpatient Setting,45.45,90% of Total Billed charges for Outpatient setting,18.17,45.45,37.88
Outpatient Medical Services,MEDICAL SERVICES,85025,"Complete blood cell count, with differential white blood cells, automated",305,75,45,60% of total billed charges for outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,23.54,100% of BCBS Fee Schedule for Outpatient Setting,23.54,100% of BCBS Fee Schedule for Outpatient Setting,26.13,111% of BCBS Fee Schedule for Outpatient Setting,37.5,Case rate,52.5,70% of Total Billed charges for Outpatient setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,52.5,70% of Total Billed charges for Outpatient setting,52.5,70% of Total Billed charges for Outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,36.36,48.48% of total Billed Charges for Outpatient Setting,67.5,90% of Total Billed charges for Outpatient setting,23.54,67.5,56.25
Outpatient Medical Services,MEDICAL SERVICES,85027,"Complete blood count, automated",305,53.75,32.25,60% of total billed charges for outpatient setting,25.8,48% of toatl Billed Charges for Outpatient Setting,19.6,100% of BCBS Fee Schedule for Outpatient Setting,19.6,100% of BCBS Fee Schedule for Outpatient Setting,21.76,111% of BCBS Fee Schedule for Outpatient Setting,26.88,Case rate,37.63,70% of Total Billed charges for Outpatient setting,26.06,48.48% of total Billed Charges for Outpatient Setting,26.06,48.48% of total Billed Charges for Outpatient Setting,26.06,48.48% of total Billed Charges for Outpatient Setting,37.63,70% of Total Billed charges for Outpatient setting,37.63,70% of Total Billed charges for Outpatient setting,25.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,26.06,48.48% of total Billed Charges for Outpatient Setting,48.38,90% of Total Billed charges for Outpatient setting,19.6,48.38,40.31
Outpatient Medical Services,MEDICAL SERVICES,74177,CT scan of abdomen and pelvis with contrast,350,1950,1170,60% of total billed charges for outpatient setting,936,48% of toatl Billed Charges for Outpatient Setting,658.17,100% of BCBS Fee Schedule for Outpatient Setting,658.17,100% of BCBS Fee Schedule for Outpatient Setting,730.57,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1365,70% of Total Billed charges for Outpatient setting,945.36,48.48% of total Billed Charges for Outpatient Setting,945.36,48.48% of total Billed Charges for Outpatient Setting,945.36,48.48% of total Billed Charges for Outpatient Setting,1365,70% of Total Billed charges for Outpatient setting,1365,70% of Total Billed charges for Outpatient setting,936,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,945.36,48.48% of total Billed Charges for Outpatient Setting,1755,90% of Total Billed charges for Outpatient setting,450,1755,1170
Outpatient Medical Services,MEDICAL SERVICES,70450,"CT scan, head or brain, without contrast",350,1560,219,100% of Aetna Fee Schedule for Outpatient Setting,748.8,48% of toatl Billed Charges for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,393.42,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1092,70% of Total Billed charges for Outpatient setting,756.29,48.48% of total Billed Charges for Outpatient Setting,756.29,48.48% of total Billed Charges for Outpatient Setting,756.29,48.48% of total Billed Charges for Outpatient Setting,1092,70% of Total Billed charges for Outpatient setting,1092,70% of Total Billed charges for Outpatient setting,748.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,756.29,48.48% of total Billed Charges for Outpatient Setting,1404,90% of Total Billed charges for Outpatient setting,219,1404,936
Outpatient Medical Services,MEDICAL SERVICES,72193,"CT scan, pelvis, with contrast",350,1818,1090.8,60% of total billed charges for outpatient setting,872.64,48% of toatl Billed Charges for Outpatient Setting,513.42,100% of BCBS Fee Schedule for Outpatient Setting,513.42,100% of BCBS Fee Schedule for Outpatient Setting,569.9,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1272.6,70% of Total Billed charges for Outpatient setting,881.37,48.48% of total Billed Charges for Outpatient Setting,881.37,48.48% of total Billed Charges for Outpatient Setting,881.37,48.48% of total Billed Charges for Outpatient Setting,1272.6,70% of Total Billed charges for Outpatient setting,1272.6,70% of Total Billed charges for Outpatient setting,872.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,881.37,48.48% of total Billed Charges for Outpatient Setting,1636.2,90% of Total Billed charges for Outpatient setting,450,1636.2,1090.8
Outpatient Medical Services,MEDICAL SERVICES,99385,Initial new patient preventive medicine evaluation (18-39 years),521,97,58.2,60% of total billed charges for outpatient setting,46.56,48% of toatl Billed Charges for Outpatient Setting,48.5,50% of total Billed charges for outpatient setting,48.5,50% of total Billed charges for outpatient setting,48.5,50% of total Billed charges for outpatient setting,N/A,Not Applicable.Service not offered,67.9,70% of Total Billed charges for Outpatient setting,47.03,48.48% of total Billed Charges for Outpatient Setting,47.03,48.48% of total Billed Charges for Outpatient Setting,47.03,48.48% of total Billed Charges for Outpatient Setting,67.9,70% of Total Billed charges for Outpatient setting,67.9,70% of Total Billed charges for Outpatient setting,46.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,47.03,48.48% of total Billed Charges for Outpatient Setting,87.3,90% of Total Billed charges for Outpatient setting,46.56,87.3,72.75
Outpatient Medical Services,MEDICAL SERVICES,99386,Initial new patient preventive medicine evaluation (40-64 years),521,177,106.2,60% of total billed charges for outpatient setting,84.96,48% of toatl Billed Charges for Outpatient Setting,88.5,50% of total Billed charges for outpatient setting,88.5,50% of total Billed charges for outpatient setting,88.5,50% of total Billed charges for outpatient setting,N/A,Not Applicable.Service not offered,123.9,70% of Total Billed charges for Outpatient setting,85.81,48.48% of total Billed Charges for Outpatient Setting,85.81,48.48% of total Billed Charges for Outpatient Setting,85.81,48.48% of total Billed Charges for Outpatient Setting,123.9,70% of Total Billed charges for Outpatient setting,123.9,70% of Total Billed charges for Outpatient setting,84.96,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,85.81,48.48% of total Billed Charges for Outpatient Setting,159.3,90% of Total Billed charges for Outpatient setting,84.96,159.3,132.75
Outpatient Medical Services,MEDICAL SERVICES,80069,Kidney function panel test,301,113.75,68.25,60% of total billed charges for outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,26.3,100% of BCBS Fee Schedule for Outpatient Setting,26.3,100% of BCBS Fee Schedule for Outpatient Setting,29.19,111% of BCBS Fee Schedule for Outpatient Setting,56.88,Case rate,79.63,70% of Total Billed charges for Outpatient setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,79.63,70% of Total Billed charges for Outpatient setting,79.63,70% of Total Billed charges for Outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.15,48.48% of total Billed Charges for Outpatient Setting,102.38,90% of Total Billed charges for Outpatient setting,26.3,102.38,85.31
Outpatient Medical Services,MEDICAL SERVICES,80076,Liver function blood test panel,301,113.75,68.25,60% of total billed charges for outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,24.75,100% of BCBS Fee Schedule for Outpatient Setting,24.75,100% of BCBS Fee Schedule for Outpatient Setting,27.47,111% of BCBS Fee Schedule for Outpatient Setting,56.88,Case rate,79.63,70% of Total Billed charges for Outpatient setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,79.63,70% of Total Billed charges for Outpatient setting,79.63,70% of Total Billed charges for Outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.15,48.48% of total Billed Charges for Outpatient Setting,102.38,90% of Total Billed charges for Outpatient setting,24.75,102.38,85.31
Outpatient Medical Services,MEDICAL SERVICES,81001,Manual urinalysis test with examination using microscope,307,68.75,41.25,60% of total billed charges for outpatient setting,33,48% of toatl Billed Charges for Outpatient Setting,9.6,100% of BCBS Fee Schedule for Outpatient Setting,9.6,100% of BCBS Fee Schedule for Outpatient Setting,10.66,111% of BCBS Fee Schedule for Outpatient Setting,34.38,Case rate,48.13,70% of Total Billed charges for Outpatient setting,33.33,48.48% of total Billed Charges for Outpatient Setting,33.33,48.48% of total Billed Charges for Outpatient Setting,33.33,48.48% of total Billed Charges for Outpatient Setting,48.13,70% of Total Billed charges for Outpatient setting,48.13,70% of Total Billed charges for Outpatient setting,33,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,33.33,48.48% of total Billed Charges for Outpatient Setting,61.88,90% of Total Billed charges for Outpatient setting,9.6,61.88,51.56
Outpatient Medical Services,MEDICAL SERVICES,99204,"New patient office of other outpatient visit, typically 45 min - Hospital",981,650.83,N/A,Not Applicable.Service not offered,129.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,126.59,100% of Cigna Fee Schedule for Outpatient Setting,142.97,110% of Physician Fee Schedule for Outpatient setting,131.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,131.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,131.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,142.97,110% of Physician Fee Schedule for Outpatient setting,142.97,110% of Physician Fee Schedule for Outpatient setting,129.97,100% of Physician Fee Schedule for Outpatient Setting,194.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,129.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,194.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,126.59,194.96,390.5
Outpatient Medical Services,MEDICAL SERVICES,99205,"New patient office of other outpatient visit, typically 60 min - Hospital",981,731.25,N/A,Not Applicable.Service not offered,176.33,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,164.93,100% of Cigna Fee Schedule for Outpatient Setting,193.96,110% of Physician Fee Schedule for Outpatient setting,178.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,193.96,110% of Physician Fee Schedule for Outpatient setting,193.96,110% of Physician Fee Schedule for Outpatient setting,176.33,100% of Physician Fee Schedule for Outpatient Setting,264.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,176.33,100% of CMS RBRVS Fee Schedule for Outpatient Setting,264.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,164.93,264.5,438.75
Outpatient Medical Services,MEDICAL SERVICES,99203,"New patient office or other outpatient visit, typically 30 min - Hospital",981,556.12,N/A,Not Applicable.Service not offered,80.99,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,75,100% of Cigna Fee Schedule for Outpatient Setting,89.09,110% of Physician Fee Schedule for Outpatient setting,81.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,81.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,81.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,89.09,110% of Physician Fee Schedule for Outpatient setting,89.09,110% of Physician Fee Schedule for Outpatient setting,80.99,100% of Physician Fee Schedule for Outpatient Setting,121.49,150% of CMS RBRVS Fee Schedule for Outpatient Setting,80.99,100% of CMS RBRVS Fee Schedule for Outpatient Setting,121.49,150% of CMS RBRVS Fee Schedule for Outpatient Setting,75,121.49,333.67
Outpatient Medical Services,MEDICAL SERVICES,97110,"Physical therapy, therapeutic exercise",430,172,103.2,60% of total billed charges for outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,51.9,100% of BCBS Fee Schedule for Outpatient Setting,51.9,100% of BCBS Fee Schedule for Outpatient Setting,57.61,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,120.4,70% of Total Billed charges for Outpatient setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,120.4,70% of Total Billed charges for Outpatient setting,120.4,70% of Total Billed charges for Outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,83.39,48.48% of total Billed Charges for Outpatient Setting,154.8,90% of Total Billed charges for Outpatient setting,51.9,154.8,129
Outpatient Medical Services,MEDICAL SERVICES,84153,PSA (prostate specific antigen),300,125.5,75.3,60% of total billed charges for outpatient setting,60.24,48% of toatl Billed Charges for Outpatient Setting,55.71,100% of BCBS Fee Schedule for Outpatient Setting,55.71,100% of BCBS Fee Schedule for Outpatient Setting,61.84,111% of BCBS Fee Schedule for Outpatient Setting,62.75,Case rate,87.85,70% of Total Billed charges for Outpatient setting,60.84,48.48% of total Billed Charges for Outpatient Setting,60.84,48.48% of total Billed Charges for Outpatient Setting,60.84,48.48% of total Billed Charges for Outpatient Setting,87.85,70% of Total Billed charges for Outpatient setting,87.85,70% of Total Billed charges for Outpatient setting,60.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,60.84,48.48% of total Billed Charges for Outpatient Setting,112.95,90% of Total Billed charges for Outpatient setting,55.71,112.95,94.13
Outpatient Medical Services,MEDICAL SERVICES,76700,Ultrasound of abdomen,402,931,558.6,60% of total billed charges for outpatient setting,446.88,48% of toatl Billed Charges for Outpatient Setting,148.43,100% of BCBS Fee Schedule for Outpatient Setting,148.43,100% of BCBS Fee Schedule for Outpatient Setting,164.76,111% of BCBS Fee Schedule for Outpatient Setting,465.5,Case rate,651.7,70% of Total Billed charges for Outpatient setting,451.35,48.48% of total Billed Charges for Outpatient Setting,451.35,48.48% of total Billed Charges for Outpatient Setting,451.35,48.48% of total Billed Charges for Outpatient Setting,651.7,70% of Total Billed charges for Outpatient setting,651.7,70% of Total Billed charges for Outpatient setting,446.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,451.35,48.48% of total Billed Charges for Outpatient Setting,837.9,90% of Total Billed charges for Outpatient setting,148.43,837.9,558.6
Outpatient Medical Services,MEDICAL SERVICES,76830,Ultrasound pelvis through vagina,972,901.85,N/A,Not Applicable.Service not offered,110.51,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,79.9,100% of Cigna Fee Schedule for Outpatient Setting,121.56,110% of Physician Fee Schedule for Outpatient setting,111.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,111.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,111.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,121.56,110% of Physician Fee Schedule for Outpatient setting,121.56,110% of Physician Fee Schedule for Outpatient setting,110.51,100% of Physician Fee Schedule for Outpatient Setting,165.77,150% of CMS RBRVS Fee Schedule for Outpatient Setting,110.51,100% of CMS RBRVS Fee Schedule for Outpatient Setting,165.77,150% of CMS RBRVS Fee Schedule for Outpatient Setting,79.9,165.77,541.11
Outpatient Medical Services,MEDICAL SERVICES,72110,"X-Ray, lower back, minimum four views",320,633,50,100% of Aetna Fee Schedule for Outpatient Setting,303.84,48% of toatl Billed Charges for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,121.77,111% of BCBS Fee Schedule for Outpatient Setting,316.5,Case rate,443.1,70% of Total Billed charges for Outpatient setting,306.88,48.48% of total Billed Charges for Outpatient Setting,306.88,48.48% of total Billed Charges for Outpatient Setting,306.88,48.48% of total Billed Charges for Outpatient Setting,443.1,70% of Total Billed charges for Outpatient setting,443.1,70% of Total Billed charges for Outpatient setting,303.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,306.88,48.48% of total Billed Charges for Outpatient Setting,569.7,90% of Total Billed charges for Outpatient setting,50,569.7,379.8
Outpatient Medical Services,LAB,36415,36415 Routine venipuncture,300,24.5,14.7,60% of total billed charges for outpatient setting,11.76,48% of toatl Billed Charges for Outpatient Setting,6.6,100% of BCBS Fee Schedule for Outpatient Setting,6.6,100% of BCBS Fee Schedule for Outpatient Setting,7.33,111% of BCBS Fee Schedule for Outpatient Setting,12.25,Case rate,17.15,70% of Total Billed charges for Outpatient setting,11.88,48.48% of total Billed Charges for Outpatient Setting,11.88,48.48% of total Billed Charges for Outpatient Setting,11.88,48.48% of total Billed Charges for Outpatient Setting,17.15,70% of Total Billed charges for Outpatient setting,17.15,70% of Total Billed charges for Outpatient setting,11.76,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,11.88,48.48% of total Billed Charges for Outpatient Setting,22.05,90% of Total Billed charges for Outpatient setting,6.6,22.05,18.38
Outpatient Medical Services,LAB,36416,36416 Capillary blood draw,300,20,12,60% of total billed charges for outpatient setting,9.6,48% of toatl Billed Charges for Outpatient Setting,1.16,100% of BCBS Fee Schedule for Outpatient Setting,1.16,100% of BCBS Fee Schedule for Outpatient Setting,1.29,111% of BCBS Fee Schedule for Outpatient Setting,10,Case rate,14,70% of Total Billed charges for Outpatient setting,9.7,48.48% of total Billed Charges for Outpatient Setting,9.7,48.48% of total Billed Charges for Outpatient Setting,9.7,48.48% of total Billed Charges for Outpatient Setting,14,70% of Total Billed charges for Outpatient setting,14,70% of Total Billed charges for Outpatient setting,9.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,9.7,48.48% of total Billed Charges for Outpatient Setting,18,90% of Total Billed charges for Outpatient setting,1.16,18,15
Outpatient Medical Services,LAB,36430,36430 Blood transfusion service,450,1250,399,100% of Aetna Asc Tier Grouping Fee Schedule,600,48% of toatl Billed Charges for Outpatient Setting,592.29,100% of BCBS Fee Schedule for Outpatient Setting,592.29,100% of BCBS Fee Schedule for Outpatient Setting,657.44,111% of BCBS Fee Schedule for Outpatient Setting,625,50% of total Billed charges for Outpatient setting,875,70% of Total Billed charges for Outpatient setting,606,48.48% of total Billed Charges for Outpatient Setting,606,48.48% of total Billed Charges for Outpatient Setting,606,48.48% of total Billed Charges for Outpatient Setting,875,70% of Total Billed charges for Outpatient setting,875,70% of Total Billed charges for Outpatient setting,600,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,606,48.48% of total Billed Charges for Outpatient Setting,1125,90% of Total Billed charges for Outpatient setting,399,1125,750
Outpatient Medical Services,LAB,36600,36600 Arterial puncture,300,96,57.6,60% of total billed charges for outpatient setting,46.08,48% of toatl Billed Charges for Outpatient Setting,1.16,100% of BCBS Fee Schedule for Outpatient Setting,1.16,100% of BCBS Fee Schedule for Outpatient Setting,1.29,111% of BCBS Fee Schedule for Outpatient Setting,48,Case rate,67.2,70% of Total Billed charges for Outpatient setting,46.54,48.48% of total Billed Charges for Outpatient Setting,46.54,48.48% of total Billed Charges for Outpatient Setting,46.54,48.48% of total Billed Charges for Outpatient Setting,67.2,70% of Total Billed charges for Outpatient setting,67.2,70% of Total Billed charges for Outpatient setting,46.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,46.54,48.48% of total Billed Charges for Outpatient Setting,86.4,90% of Total Billed charges for Outpatient setting,1.16,86.4,72
Outpatient Medical Services,LAB,80047,80047 Metabolic panel ionized ca,300,113.75,68.25,60% of total billed charges for outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,55.83,100% of BCBS Fee Schedule for Outpatient Setting,55.83,100% of BCBS Fee Schedule for Outpatient Setting,61.97,111% of BCBS Fee Schedule for Outpatient Setting,56.88,Case rate,79.63,70% of Total Billed charges for Outpatient setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,79.63,70% of Total Billed charges for Outpatient setting,79.63,70% of Total Billed charges for Outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.15,48.48% of total Billed Charges for Outpatient Setting,102.38,90% of Total Billed charges for Outpatient setting,54.6,102.38,85.31
Outpatient Medical Services,LAB,80051,80051 Electrolyte panel,301,68.75,41.25,60% of total billed charges for outpatient setting,33,48% of toatl Billed Charges for Outpatient Setting,20.89,100% of BCBS Fee Schedule for Outpatient Setting,20.89,100% of BCBS Fee Schedule for Outpatient Setting,23.19,111% of BCBS Fee Schedule for Outpatient Setting,34.38,Case rate,48.13,70% of Total Billed charges for Outpatient setting,33.33,48.48% of total Billed Charges for Outpatient Setting,33.33,48.48% of total Billed Charges for Outpatient Setting,33.33,48.48% of total Billed Charges for Outpatient Setting,48.13,70% of Total Billed charges for Outpatient setting,48.13,70% of Total Billed charges for Outpatient setting,33,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,33.33,48.48% of total Billed Charges for Outpatient Setting,61.88,90% of Total Billed charges for Outpatient setting,20.89,61.88,51.56
Outpatient Medical Services,LAB,80074,80074 Acute Hepatits Panel,300,358.5,215.1,60% of total billed charges for outpatient setting,172.08,48% of toatl Billed Charges for Outpatient Setting,144.25,100% of BCBS Fee Schedule for Outpatient Setting,144.25,100% of BCBS Fee Schedule for Outpatient Setting,160.12,111% of BCBS Fee Schedule for Outpatient Setting,179.25,Case rate,250.95,70% of Total Billed charges for Outpatient setting,173.8,48.48% of total Billed Charges for Outpatient Setting,173.8,48.48% of total Billed Charges for Outpatient Setting,173.8,48.48% of total Billed Charges for Outpatient Setting,250.95,70% of Total Billed charges for Outpatient setting,250.95,70% of Total Billed charges for Outpatient setting,172.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,173.8,48.48% of total Billed Charges for Outpatient Setting,322.65,90% of Total Billed charges for Outpatient setting,144.25,322.65,215.1
Outpatient Medical Services,LAB,80076,80076 Liver Function Blood Panel,301,113.75,68.25,60% of total billed charges for outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,24.75,100% of BCBS Fee Schedule for Outpatient Setting,24.75,100% of BCBS Fee Schedule for Outpatient Setting,27.47,111% of BCBS Fee Schedule for Outpatient Setting,56.88,Case rate,79.63,70% of Total Billed charges for Outpatient setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,55.15,48.48% of total Billed Charges for Outpatient Setting,79.63,70% of Total Billed charges for Outpatient setting,79.63,70% of Total Billed charges for Outpatient setting,54.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.15,48.48% of total Billed Charges for Outpatient Setting,102.38,90% of Total Billed charges for Outpatient setting,24.75,102.38,85.31
Outpatient Medical Services,LAB,80150,80150 Amikacin level,300,128.5,77.1,60% of total billed charges for outpatient setting,61.68,48% of toatl Billed Charges for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,39.12,111% of BCBS Fee Schedule for Outpatient Setting,64.25,Case rate,89.95,70% of Total Billed charges for Outpatient setting,62.3,48.48% of total Billed Charges for Outpatient Setting,62.3,48.48% of total Billed Charges for Outpatient Setting,62.3,48.48% of total Billed Charges for Outpatient Setting,89.95,70% of Total Billed charges for Outpatient setting,89.95,70% of Total Billed charges for Outpatient setting,61.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,62.3,48.48% of total Billed Charges for Outpatient Setting,115.65,90% of Total Billed charges for Outpatient setting,35.24,115.65,96.38
Outpatient Medical Services,LAB,80156,80156 Tegretol (carbamazepine),301,105,63,60% of total billed charges for outpatient setting,50.4,48% of toatl Billed Charges for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,39.12,111% of BCBS Fee Schedule for Outpatient Setting,52.5,Case rate,73.5,70% of Total Billed charges for Outpatient setting,50.9,48.48% of total Billed Charges for Outpatient Setting,50.9,48.48% of total Billed Charges for Outpatient Setting,50.9,48.48% of total Billed Charges for Outpatient Setting,73.5,70% of Total Billed charges for Outpatient setting,73.5,70% of Total Billed charges for Outpatient setting,50.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,50.9,48.48% of total Billed Charges for Outpatient Setting,94.5,90% of Total Billed charges for Outpatient setting,35.24,94.5,78.75
Outpatient Medical Services,LAB,80158,80158 Cyclosporin level,300,196,117.6,60% of total billed charges for outpatient setting,94.08,48% of toatl Billed Charges for Outpatient Setting,54.69,100% of BCBS Fee Schedule for Outpatient Setting,54.69,100% of BCBS Fee Schedule for Outpatient Setting,60.71,111% of BCBS Fee Schedule for Outpatient Setting,98,Case rate,137.2,70% of Total Billed charges for Outpatient setting,95.02,48.48% of total Billed Charges for Outpatient Setting,95.02,48.48% of total Billed Charges for Outpatient Setting,95.02,48.48% of total Billed Charges for Outpatient Setting,137.2,70% of Total Billed charges for Outpatient setting,137.2,70% of Total Billed charges for Outpatient setting,94.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,95.02,48.48% of total Billed Charges for Outpatient Setting,176.4,90% of Total Billed charges for Outpatient setting,54.69,176.4,147
Outpatient Medical Services,LAB,80162,80162 Digoxin (lanoxin) level,301,99,59.4,60% of total billed charges for outpatient setting,47.52,48% of toatl Billed Charges for Outpatient Setting,40.21,100% of BCBS Fee Schedule for Outpatient Setting,40.21,100% of BCBS Fee Schedule for Outpatient Setting,44.63,111% of BCBS Fee Schedule for Outpatient Setting,49.5,Case rate,69.3,70% of Total Billed charges for Outpatient setting,48,48.48% of total Billed Charges for Outpatient Setting,48,48.48% of total Billed Charges for Outpatient Setting,48,48.48% of total Billed Charges for Outpatient Setting,69.3,70% of Total Billed charges for Outpatient setting,69.3,70% of Total Billed charges for Outpatient setting,47.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,48,48.48% of total Billed Charges for Outpatient Setting,89.1,90% of Total Billed charges for Outpatient setting,40.21,89.1,74.25
Outpatient Medical Services,LAB,80164,80164 Valpoic acid quant,300,105.5,63.3,60% of total billed charges for outpatient setting,50.64,48% of toatl Billed Charges for Outpatient Setting,41.04,100% of BCBS Fee Schedule for Outpatient Setting,41.04,100% of BCBS Fee Schedule for Outpatient Setting,45.55,111% of BCBS Fee Schedule for Outpatient Setting,52.75,Case rate,73.85,70% of Total Billed charges for Outpatient setting,51.15,48.48% of total Billed Charges for Outpatient Setting,51.15,48.48% of total Billed Charges for Outpatient Setting,51.15,48.48% of total Billed Charges for Outpatient Setting,73.85,70% of Total Billed charges for Outpatient setting,73.85,70% of Total Billed charges for Outpatient setting,50.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,51.15,48.48% of total Billed Charges for Outpatient Setting,94.95,90% of Total Billed charges for Outpatient setting,41.04,94.95,79.13
Outpatient Medical Services,LAB,80170,80170 Gentamicin level,300,142.5,85.5,60% of total billed charges for outpatient setting,68.4,48% of toatl Billed Charges for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,39.12,111% of BCBS Fee Schedule for Outpatient Setting,71.25,Case rate,99.75,70% of Total Billed charges for Outpatient setting,69.08,48.48% of total Billed Charges for Outpatient Setting,69.08,48.48% of total Billed Charges for Outpatient Setting,69.08,48.48% of total Billed Charges for Outpatient Setting,99.75,70% of Total Billed charges for Outpatient setting,99.75,70% of Total Billed charges for Outpatient setting,68.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,69.08,48.48% of total Billed Charges for Outpatient Setting,128.25,90% of Total Billed charges for Outpatient setting,35.24,128.25,106.88
Outpatient Medical Services,LAB,80175,80175 Lamotrigine level,300,275,165,60% of total billed charges for outpatient setting,132,48% of toatl Billed Charges for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,36.74,111% of BCBS Fee Schedule for Outpatient Setting,137.5,Case rate,192.5,70% of Total Billed charges for Outpatient setting,133.32,48.48% of total Billed Charges for Outpatient Setting,133.32,48.48% of total Billed Charges for Outpatient Setting,133.32,48.48% of total Billed Charges for Outpatient Setting,192.5,70% of Total Billed charges for Outpatient setting,192.5,70% of Total Billed charges for Outpatient setting,132,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,133.32,48.48% of total Billed Charges for Outpatient Setting,247.5,90% of Total Billed charges for Outpatient setting,33.1,247.5,165
Outpatient Medical Services,LAB,80178,80175 Lithuim level,301,46.25,11,100% of Aetna Fee Schedule for Outpatient Setting,22.2,48% of toatl Billed Charges for Outpatient Setting,20.03,100% of BCBS Fee Schedule for Outpatient Setting,20.03,100% of BCBS Fee Schedule for Outpatient Setting,22.23,111% of BCBS Fee Schedule for Outpatient Setting,23.13,Case rate,32.38,70% of Total Billed charges for Outpatient setting,22.42,48.48% of total Billed Charges for Outpatient Setting,22.42,48.48% of total Billed Charges for Outpatient Setting,22.42,48.48% of total Billed Charges for Outpatient Setting,32.38,70% of Total Billed charges for Outpatient setting,32.38,70% of Total Billed charges for Outpatient setting,22.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,22.42,48.48% of total Billed Charges for Outpatient Setting,41.63,90% of Total Billed charges for Outpatient setting,11,41.63,34.69
Outpatient Medical Services,LAB,80177,80177 Levetiracetam level,300,137.5,82.5,60% of total billed charges for outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,36.74,111% of BCBS Fee Schedule for Outpatient Setting,68.75,Case rate,96.25,70% of Total Billed charges for Outpatient setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,96.25,70% of Total Billed charges for Outpatient setting,96.25,70% of Total Billed charges for Outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,66.66,48.48% of total Billed Charges for Outpatient Setting,123.75,90% of Total Billed charges for Outpatient setting,33.1,123.75,103.13
Outpatient Medical Services,LAB,80183,80183 Oxcarbazepine level,300,173.75,104.25,60% of total billed charges for outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,33.1,100% of BCBS Fee Schedule for Outpatient Setting,36.74,111% of BCBS Fee Schedule for Outpatient Setting,86.88,Case rate,121.63,70% of Total Billed charges for Outpatient setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,121.63,70% of Total Billed charges for Outpatient setting,121.63,70% of Total Billed charges for Outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,84.23,48.48% of total Billed Charges for Outpatient Setting,156.38,90% of Total Billed charges for Outpatient setting,33.1,156.38,130.31
Outpatient Medical Services,LAB,80184,80184 Phenobarbital,300,129.5,77.7,60% of total billed charges for outpatient setting,62.16,48% of toatl Billed Charges for Outpatient Setting,34.71,100% of BCBS Fee Schedule for Outpatient Setting,34.71,100% of BCBS Fee Schedule for Outpatient Setting,38.53,111% of BCBS Fee Schedule for Outpatient Setting,64.75,Case rate,90.65,70% of Total Billed charges for Outpatient setting,62.78,48.48% of total Billed Charges for Outpatient Setting,62.78,48.48% of total Billed Charges for Outpatient Setting,62.78,48.48% of total Billed Charges for Outpatient Setting,90.65,70% of Total Billed charges for Outpatient setting,90.65,70% of Total Billed charges for Outpatient setting,62.16,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,62.78,48.48% of total Billed Charges for Outpatient Setting,116.55,90% of Total Billed charges for Outpatient setting,34.71,116.55,97.13
Outpatient Medical Services,LAB,80185,80185 Dilantin,301,112,67.2,60% of total billed charges for outpatient setting,53.76,48% of toatl Billed Charges for Outpatient Setting,40.15,100% of BCBS Fee Schedule for Outpatient Setting,40.15,100% of BCBS Fee Schedule for Outpatient Setting,44.57,111% of BCBS Fee Schedule for Outpatient Setting,56,Case rate,78.4,70% of Total Billed charges for Outpatient setting,54.3,48.48% of total Billed Charges for Outpatient Setting,54.3,48.48% of total Billed Charges for Outpatient Setting,54.3,48.48% of total Billed Charges for Outpatient Setting,78.4,70% of Total Billed charges for Outpatient setting,78.4,70% of Total Billed charges for Outpatient setting,53.76,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,54.3,48.48% of total Billed Charges for Outpatient Setting,100.8,90% of Total Billed charges for Outpatient setting,40.15,100.8,84
Outpatient Medical Services,LAB,80186,80186 Dilantin free,300,106.25,63.75,60% of total billed charges for outpatient setting,51,48% of toatl Billed Charges for Outpatient Setting,41.69,100% of BCBS Fee Schedule for Outpatient Setting,41.69,100% of BCBS Fee Schedule for Outpatient Setting,46.28,111% of BCBS Fee Schedule for Outpatient Setting,53.13,Case rate,74.38,70% of Total Billed charges for Outpatient setting,51.51,48.48% of total Billed Charges for Outpatient Setting,51.51,48.48% of total Billed Charges for Outpatient Setting,51.51,48.48% of total Billed Charges for Outpatient Setting,74.38,70% of Total Billed charges for Outpatient setting,74.38,70% of Total Billed charges for Outpatient setting,51,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,51.51,48.48% of total Billed Charges for Outpatient Setting,95.63,90% of Total Billed charges for Outpatient setting,41.69,95.63,79.69
Outpatient Medical Services,LAB,80195,80195 Sirolimus level,300,183,109.8,60% of total billed charges for outpatient setting,87.84,48% of toatl Billed Charges for Outpatient Setting,35.08,100% of BCBS Fee Schedule for Outpatient Setting,35.08,100% of BCBS Fee Schedule for Outpatient Setting,38.94,111% of BCBS Fee Schedule for Outpatient Setting,91.5,Case rate,128.1,70% of Total Billed charges for Outpatient setting,88.72,48.48% of total Billed Charges for Outpatient Setting,88.72,48.48% of total Billed Charges for Outpatient Setting,88.72,48.48% of total Billed Charges for Outpatient Setting,128.1,70% of Total Billed charges for Outpatient setting,128.1,70% of Total Billed charges for Outpatient setting,87.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,88.72,48.48% of total Billed Charges for Outpatient Setting,164.7,90% of Total Billed charges for Outpatient setting,35.08,164.7,137.25
Outpatient Medical Services,LAB,80197,80197 Assay of tacrolimus,301,200,120,60% of total billed charges for outpatient setting,96,48% of toatl Billed Charges for Outpatient Setting,41.55,100% of BCBS Fee Schedule for Outpatient Setting,41.55,100% of BCBS Fee Schedule for Outpatient Setting,46.12,111% of BCBS Fee Schedule for Outpatient Setting,100,Case rate,140,70% of Total Billed charges for Outpatient setting,96.96,48.48% of total Billed Charges for Outpatient Setting,96.96,48.48% of total Billed Charges for Outpatient Setting,96.96,48.48% of total Billed Charges for Outpatient Setting,140,70% of Total Billed charges for Outpatient setting,140,70% of Total Billed charges for Outpatient setting,96,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,96.96,48.48% of total Billed Charges for Outpatient Setting,180,90% of Total Billed charges for Outpatient setting,41.55,180,120
Outpatient Medical Services,LAB,80200,80200 Tobramycin level,300,137,82.2,60% of total billed charges for outpatient setting,65.76,48% of toatl Billed Charges for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,35.24,100% of BCBS Fee Schedule for Outpatient Setting,39.12,111% of BCBS Fee Schedule for Outpatient Setting,68.5,Case rate,95.9,70% of Total Billed charges for Outpatient setting,66.42,48.48% of total Billed Charges for Outpatient Setting,66.42,48.48% of total Billed Charges for Outpatient Setting,66.42,48.48% of total Billed Charges for Outpatient Setting,95.9,70% of Total Billed charges for Outpatient setting,95.9,70% of Total Billed charges for Outpatient setting,65.76,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,66.42,48.48% of total Billed Charges for Outpatient Setting,123.3,90% of Total Billed charges for Outpatient setting,35.24,123.3,102.75
Outpatient Medical Services,LAB,80202,80202 Assay of vancomycin,300,173.75,104.25,60% of total billed charges for outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,41.04,100% of BCBS Fee Schedule for Outpatient Setting,41.04,100% of BCBS Fee Schedule for Outpatient Setting,45.55,111% of BCBS Fee Schedule for Outpatient Setting,86.88,Case rate,121.63,70% of Total Billed charges for Outpatient setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,121.63,70% of Total Billed charges for Outpatient setting,121.63,70% of Total Billed charges for Outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,84.23,48.48% of total Billed Charges for Outpatient Setting,156.38,90% of Total Billed charges for Outpatient setting,41.04,156.38,130.31
Outpatient Medical Services,LAB,80307,80307 Drug test prsmv chem anlyzr,300,125,75,60% of total billed charges for outpatient setting,60,48% of toatl Billed Charges for Outpatient Setting,145,100% of BCBS Fee Schedule for Outpatient Setting,145,100% of BCBS Fee Schedule for Outpatient Setting,160.95,111% of BCBS Fee Schedule for Outpatient Setting,62.5,Case rate,87.5,70% of Total Billed charges for Outpatient setting,60.6,48.48% of total Billed Charges for Outpatient Setting,60.6,48.48% of total Billed Charges for Outpatient Setting,60.6,48.48% of total Billed Charges for Outpatient Setting,87.5,70% of Total Billed charges for Outpatient setting,87.5,70% of Total Billed charges for Outpatient setting,60,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,60.6,48.48% of total Billed Charges for Outpatient Setting,112.5,90% of Total Billed charges for Outpatient setting,60,160.95,93.75
Outpatient Medical Services,LAB,81025,81025 Urine pregnancy test,307,87.5,52.5,60% of total billed charges for outpatient setting,42,48% of toatl Billed Charges for Outpatient Setting,19.16,100% of BCBS Fee Schedule for Outpatient Setting,19.16,100% of BCBS Fee Schedule for Outpatient Setting,21.27,111% of BCBS Fee Schedule for Outpatient Setting,43.75,Case rate,61.25,70% of Total Billed charges for Outpatient setting,42.42,48.48% of total Billed Charges for Outpatient Setting,42.42,48.48% of total Billed Charges for Outpatient Setting,42.42,48.48% of total Billed Charges for Outpatient Setting,61.25,70% of Total Billed charges for Outpatient setting,61.25,70% of Total Billed charges for Outpatient setting,42,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,42.42,48.48% of total Billed Charges for Outpatient Setting,78.75,90% of Total Billed charges for Outpatient setting,19.16,78.75,65.63
Outpatient Medical Services,LAB,81240,81240 Prothrombin (factor II) 20210G mutation,300,401.5,240.9,60% of total billed charges for outpatient setting,192.72,48% of toatl Billed Charges for Outpatient Setting,120.19,100% of BCBS Fee Schedule for Outpatient Setting,120.19,100% of BCBS Fee Schedule for Outpatient Setting,133.41,111% of BCBS Fee Schedule for Outpatient Setting,200.75,Case rate,281.05,70% of Total Billed charges for Outpatient setting,194.65,48.48% of total Billed Charges for Outpatient Setting,194.65,48.48% of total Billed Charges for Outpatient Setting,194.65,48.48% of total Billed Charges for Outpatient Setting,281.05,70% of Total Billed charges for Outpatient setting,281.05,70% of Total Billed charges for Outpatient setting,192.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,194.65,48.48% of total Billed Charges for Outpatient Setting,361.35,90% of Total Billed charges for Outpatient setting,120.19,361.35,240.9
Outpatient Medical Services,LAB,81241,81241 Factor V leiden mutation,300,401.5,240.9,60% of total billed charges for outpatient setting,192.72,48% of toatl Billed Charges for Outpatient Setting,138.03,100% of BCBS Fee Schedule for Outpatient Setting,138.03,100% of BCBS Fee Schedule for Outpatient Setting,153.21,111% of BCBS Fee Schedule for Outpatient Setting,200.75,Case rate,281.05,70% of Total Billed charges for Outpatient setting,194.65,48.48% of total Billed Charges for Outpatient Setting,194.65,48.48% of total Billed Charges for Outpatient Setting,194.65,48.48% of total Billed Charges for Outpatient Setting,281.05,70% of Total Billed charges for Outpatient setting,281.05,70% of Total Billed charges for Outpatient setting,192.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,194.65,48.48% of total Billed Charges for Outpatient Setting,361.35,90% of Total Billed charges for Outpatient setting,138.03,361.35,240.9
Outpatient Medical Services,LAB,81291,81291 MTHFR gene analysis,300,420,252,60% of total billed charges for outpatient setting,201.6,48% of toatl Billed Charges for Outpatient Setting,119.55,100% of BCBS Fee Schedule for Outpatient Setting,119.55,100% of BCBS Fee Schedule for Outpatient Setting,132.7,111% of BCBS Fee Schedule for Outpatient Setting,210,Case rate,294,70% of Total Billed charges for Outpatient setting,203.62,48.48% of total Billed Charges for Outpatient Setting,203.62,48.48% of total Billed Charges for Outpatient Setting,203.62,48.48% of total Billed Charges for Outpatient Setting,294,70% of Total Billed charges for Outpatient setting,294,70% of Total Billed charges for Outpatient setting,201.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,203.62,48.48% of total Billed Charges for Outpatient Setting,378,90% of Total Billed charges for Outpatient setting,119.55,378,252
Outpatient Medical Services,LAB,81401,81401 Molecular pathology procedure,300,380,228,60% of total billed charges for outpatient setting,182.4,48% of toatl Billed Charges for Outpatient Setting,250.66,100% of BCBS Fee Schedule for Outpatient Setting,250.66,100% of BCBS Fee Schedule for Outpatient Setting,278.23,111% of BCBS Fee Schedule for Outpatient Setting,190,Case rate,266,70% of Total Billed charges for Outpatient setting,184.22,48.48% of total Billed Charges for Outpatient Setting,184.22,48.48% of total Billed Charges for Outpatient Setting,184.22,48.48% of total Billed Charges for Outpatient Setting,266,70% of Total Billed charges for Outpatient setting,266,70% of Total Billed charges for Outpatient setting,182.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,184.22,48.48% of total Billed Charges for Outpatient Setting,342,90% of Total Billed charges for Outpatient setting,182.4,342,228
Outpatient Medical Services,LAB,81599,81599 Fibrosure nash,300,288.75,173.25,60% of total billed charges for outpatient setting,138.6,48% of toatl Billed Charges for Outpatient Setting,144.38,50% of total Billed charges for outpatient setting,144.38,50% of total Billed charges for outpatient setting,144.38,50% of total Billed charges for outpatient setting,144.38,Case rate,202.13,70% of Total Billed charges for Outpatient setting,139.99,48.48% of total Billed Charges for Outpatient Setting,139.99,48.48% of total Billed Charges for Outpatient Setting,139.99,48.48% of total Billed Charges for Outpatient Setting,202.13,70% of Total Billed charges for Outpatient setting,202.13,70% of Total Billed charges for Outpatient setting,138.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,139.99,48.48% of total Billed Charges for Outpatient Setting,259.88,90% of Total Billed charges for Outpatient setting,138.6,259.88,173.25
Outpatient Medical Services,LAB,82024,82024 ACTH,300,269.5,161.7,60% of total billed charges for outpatient setting,129.36,48% of toatl Billed Charges for Outpatient Setting,117,100% of BCBS Fee Schedule for Outpatient Setting,117,100% of BCBS Fee Schedule for Outpatient Setting,129.87,111% of BCBS Fee Schedule for Outpatient Setting,134.75,Case rate,188.65,70% of Total Billed charges for Outpatient setting,130.65,48.48% of total Billed Charges for Outpatient Setting,130.65,48.48% of total Billed Charges for Outpatient Setting,130.65,48.48% of total Billed Charges for Outpatient Setting,188.65,70% of Total Billed charges for Outpatient setting,188.65,70% of Total Billed charges for Outpatient setting,129.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,130.65,48.48% of total Billed Charges for Outpatient Setting,242.55,90% of Total Billed charges for Outpatient setting,117,242.55,161.7
Outpatient Medical Services,LAB,82040,82040 Assay of serum albumin,301,35,21,60% of total billed charges for outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,15,100% of BCBS Fee Schedule for Outpatient Setting,15,100% of BCBS Fee Schedule for Outpatient Setting,16.65,111% of BCBS Fee Schedule for Outpatient Setting,17.5,Case rate,24.5,70% of Total Billed charges for Outpatient setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,24.5,70% of Total Billed charges for Outpatient setting,24.5,70% of Total Billed charges for Outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,16.97,48.48% of total Billed Charges for Outpatient Setting,31.5,90% of Total Billed charges for Outpatient setting,15,31.5,26.25
Outpatient Medical Services,LAB,82044,82044 Microalbumin quant,301,61.25,36.75,60% of total billed charges for outpatient setting,29.4,48% of toatl Billed Charges for Outpatient Setting,9.22,100% of BCBS Fee Schedule for Outpatient Setting,9.22,100% of BCBS Fee Schedule for Outpatient Setting,10.23,111% of BCBS Fee Schedule for Outpatient Setting,30.63,Case rate,42.88,70% of Total Billed charges for Outpatient setting,29.69,48.48% of total Billed Charges for Outpatient Setting,29.69,48.48% of total Billed Charges for Outpatient Setting,29.69,48.48% of total Billed Charges for Outpatient Setting,42.88,70% of Total Billed charges for Outpatient setting,42.88,70% of Total Billed charges for Outpatient setting,29.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,29.69,48.48% of total Billed Charges for Outpatient Setting,55.13,90% of Total Billed charges for Outpatient setting,9.22,55.13,45.94
Outpatient Medical Services,LAB,82085,82085 Aldolase,300,89.5,53.7,60% of total billed charges for outpatient setting,42.96,48% of toatl Billed Charges for Outpatient Setting,29.4,100% of BCBS Fee Schedule for Outpatient Setting,29.4,100% of BCBS Fee Schedule for Outpatient Setting,32.63,111% of BCBS Fee Schedule for Outpatient Setting,44.75,Case rate,62.65,70% of Total Billed charges for Outpatient setting,43.39,48.48% of total Billed Charges for Outpatient Setting,43.39,48.48% of total Billed Charges for Outpatient Setting,43.39,48.48% of total Billed Charges for Outpatient Setting,62.65,70% of Total Billed charges for Outpatient setting,62.65,70% of Total Billed charges for Outpatient setting,42.96,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,43.39,48.48% of total Billed Charges for Outpatient Setting,80.55,90% of Total Billed charges for Outpatient setting,29.4,80.55,67.13
Outpatient Medical Services,LAB,82088,82088 Aldosterone,300,288,172.8,60% of total billed charges for outpatient setting,138.24,48% of toatl Billed Charges for Outpatient Setting,123.43,100% of BCBS Fee Schedule for Outpatient Setting,123.43,100% of BCBS Fee Schedule for Outpatient Setting,137.01,111% of BCBS Fee Schedule for Outpatient Setting,144,Case rate,201.6,70% of Total Billed charges for Outpatient setting,139.62,48.48% of total Billed Charges for Outpatient Setting,139.62,48.48% of total Billed Charges for Outpatient Setting,139.62,48.48% of total Billed Charges for Outpatient Setting,201.6,70% of Total Billed charges for Outpatient setting,201.6,70% of Total Billed charges for Outpatient setting,138.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,139.62,48.48% of total Billed Charges for Outpatient Setting,259.2,90% of Total Billed charges for Outpatient setting,123.43,259.2,172.8
Outpatient Medical Services,LAB,82104,82104 Alpha 1 antitrypsin phenotype,300,69,41.4,60% of total billed charges for outpatient setting,33.12,48% of toatl Billed Charges for Outpatient Setting,43.8,100% of BCBS Fee Schedule for Outpatient Setting,43.8,100% of BCBS Fee Schedule for Outpatient Setting,48.62,111% of BCBS Fee Schedule for Outpatient Setting,34.5,Case rate,48.3,70% of Total Billed charges for Outpatient setting,33.45,48.48% of total Billed Charges for Outpatient Setting,33.45,48.48% of total Billed Charges for Outpatient Setting,33.45,48.48% of total Billed Charges for Outpatient Setting,48.3,70% of Total Billed charges for Outpatient setting,48.3,70% of Total Billed charges for Outpatient setting,33.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,33.45,48.48% of total Billed Charges for Outpatient Setting,62.1,90% of Total Billed charges for Outpatient setting,33.12,62.1,51.75
Outpatient Medical Services,LAB,82105,82105 Alpha fetorotein,300,108.75,65.25,60% of total billed charges for outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,50.81,100% of BCBS Fee Schedule for Outpatient Setting,50.81,100% of BCBS Fee Schedule for Outpatient Setting,56.4,111% of BCBS Fee Schedule for Outpatient Setting,54.38,Case rate,76.13,70% of Total Billed charges for Outpatient setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,76.13,70% of Total Billed charges for Outpatient setting,76.13,70% of Total Billed charges for Outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,52.72,48.48% of total Billed Charges for Outpatient Setting,97.88,90% of Total Billed charges for Outpatient setting,50.81,97.88,81.56
Outpatient Medical Services,LAB,82107,82107 AFP/AFP-L3,300,312.5,187.5,60% of total billed charges for outpatient setting,150,48% of toatl Billed Charges for Outpatient Setting,164.64,100% of BCBS Fee Schedule for Outpatient Setting,164.64,100% of BCBS Fee Schedule for Outpatient Setting,182.75,111% of BCBS Fee Schedule for Outpatient Setting,156.25,Case rate,218.75,70% of Total Billed charges for Outpatient setting,151.5,48.48% of total Billed Charges for Outpatient Setting,151.5,48.48% of total Billed Charges for Outpatient Setting,151.5,48.48% of total Billed Charges for Outpatient Setting,218.75,70% of Total Billed charges for Outpatient setting,218.75,70% of Total Billed charges for Outpatient setting,150,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,151.5,48.48% of total Billed Charges for Outpatient Setting,281.25,90% of Total Billed charges for Outpatient setting,150,281.25,187.5
Outpatient Medical Services,LAB,82140,82140 Assay of ammonia,300,123,73.8,60% of total billed charges for outpatient setting,59.04,48% of toatl Billed Charges for Outpatient Setting,44.14,100% of BCBS Fee Schedule for Outpatient Setting,44.14,100% of BCBS Fee Schedule for Outpatient Setting,49,111% of BCBS Fee Schedule for Outpatient Setting,61.5,Case rate,86.1,70% of Total Billed charges for Outpatient setting,59.63,48.48% of total Billed Charges for Outpatient Setting,59.63,48.48% of total Billed Charges for Outpatient Setting,59.63,48.48% of total Billed Charges for Outpatient Setting,86.1,70% of Total Billed charges for Outpatient setting,86.1,70% of Total Billed charges for Outpatient setting,59.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,59.63,48.48% of total Billed Charges for Outpatient Setting,110.7,90% of Total Billed charges for Outpatient setting,44.14,110.7,92.25
Outpatient Medical Services,LAB,82150,82150 Assay of amylase,301,54.5,32.7,60% of total billed charges for outpatient setting,26.16,48% of toatl Billed Charges for Outpatient Setting,19.65,100% of BCBS Fee Schedule for Outpatient Setting,19.65,100% of BCBS Fee Schedule for Outpatient Setting,21.81,111% of BCBS Fee Schedule for Outpatient Setting,27.25,Case rate,38.15,70% of Total Billed charges for Outpatient setting,26.42,48.48% of total Billed Charges for Outpatient Setting,26.42,48.48% of total Billed Charges for Outpatient Setting,26.42,48.48% of total Billed Charges for Outpatient Setting,38.15,70% of Total Billed charges for Outpatient setting,38.15,70% of Total Billed charges for Outpatient setting,26.16,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,26.42,48.48% of total Billed Charges for Outpatient Setting,49.05,90% of Total Billed charges for Outpatient setting,19.65,49.05,40.88
Outpatient Medical Services,LAB,82164,82164 Angiotensin converting enzyme,300,145,87,60% of total billed charges for outpatient setting,69.6,48% of toatl Billed Charges for Outpatient Setting,44.2,100% of BCBS Fee Schedule for Outpatient Setting,44.2,100% of BCBS Fee Schedule for Outpatient Setting,49.06,111% of BCBS Fee Schedule for Outpatient Setting,72.5,Case rate,101.5,70% of Total Billed charges for Outpatient setting,70.3,48.48% of total Billed Charges for Outpatient Setting,70.3,48.48% of total Billed Charges for Outpatient Setting,70.3,48.48% of total Billed Charges for Outpatient Setting,101.5,70% of Total Billed charges for Outpatient setting,101.5,70% of Total Billed charges for Outpatient setting,69.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,70.3,48.48% of total Billed Charges for Outpatient Setting,130.5,90% of Total Billed charges for Outpatient setting,44.2,130.5,108.75
Outpatient Medical Services,LAB,82172,82172 Apolipoprotein,300,119.5,71.7,60% of total billed charges for outpatient setting,57.36,48% of toatl Billed Charges for Outpatient Setting,46.93,100% of BCBS Fee Schedule for Outpatient Setting,46.93,100% of BCBS Fee Schedule for Outpatient Setting,52.09,111% of BCBS Fee Schedule for Outpatient Setting,59.75,Case rate,83.65,70% of Total Billed charges for Outpatient setting,57.93,48.48% of total Billed Charges for Outpatient Setting,57.93,48.48% of total Billed Charges for Outpatient Setting,57.93,48.48% of total Billed Charges for Outpatient Setting,83.65,70% of Total Billed charges for Outpatient setting,83.65,70% of Total Billed charges for Outpatient setting,57.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,57.93,48.48% of total Billed Charges for Outpatient Setting,107.55,90% of Total Billed charges for Outpatient setting,46.93,107.55,89.63
Outpatient Medical Services,LAB,82232,82232 Beta-2 microglobulin,300,50,30,60% of total billed charges for outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,49.02,100% of BCBS Fee Schedule for Outpatient Setting,49.02,100% of BCBS Fee Schedule for Outpatient Setting,54.41,111% of BCBS Fee Schedule for Outpatient Setting,25,Case rate,35,70% of Total Billed charges for Outpatient setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,35,70% of Total Billed charges for Outpatient setting,35,70% of Total Billed charges for Outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,24.24,48.48% of total Billed Charges for Outpatient Setting,45,90% of Total Billed charges for Outpatient setting,24,54.41,37.5
Outpatient Medical Services,LAB,82247,82247 Bilirubin total,300,37.5,22.5,60% of total billed charges for outpatient setting,18,48% of toatl Billed Charges for Outpatient Setting,10.55,100% of BCBS Fee Schedule for Outpatient Setting,10.55,100% of BCBS Fee Schedule for Outpatient Setting,11.71,111% of BCBS Fee Schedule for Outpatient Setting,18.75,Case rate,26.25,70% of Total Billed charges for Outpatient setting,18.18,48.48% of total Billed Charges for Outpatient Setting,18.18,48.48% of total Billed Charges for Outpatient Setting,18.18,48.48% of total Billed Charges for Outpatient Setting,26.25,70% of Total Billed charges for Outpatient setting,26.25,70% of Total Billed charges for Outpatient setting,18,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,18.18,48.48% of total Billed Charges for Outpatient Setting,33.75,90% of Total Billed charges for Outpatient setting,10.55,33.75,28.13
Outpatient Medical Services,LAB,82248,82248 Bilirubin direct,301,51.25,30.75,60% of total billed charges for outpatient setting,24.6,48% of toatl Billed Charges for Outpatient Setting,10.55,100% of BCBS Fee Schedule for Outpatient Setting,10.55,100% of BCBS Fee Schedule for Outpatient Setting,11.71,111% of BCBS Fee Schedule for Outpatient Setting,25.63,Case rate,35.88,70% of Total Billed charges for Outpatient setting,24.85,48.48% of total Billed Charges for Outpatient Setting,24.85,48.48% of total Billed Charges for Outpatient Setting,24.85,48.48% of total Billed Charges for Outpatient Setting,35.88,70% of Total Billed charges for Outpatient setting,35.88,70% of Total Billed charges for Outpatient setting,24.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,24.85,48.48% of total Billed Charges for Outpatient Setting,46.13,90% of Total Billed charges for Outpatient setting,10.55,46.13,38.44
Outpatient Medical Services,LAB,82271,82271 Gastric occult blood,301,18.75,11.25,60% of total billed charges for outpatient setting,9,48% of toatl Billed Charges for Outpatient Setting,8.3,100% of BCBS Fee Schedule for Outpatient Setting,8.3,100% of BCBS Fee Schedule for Outpatient Setting,9.21,111% of BCBS Fee Schedule for Outpatient Setting,9.38,Case rate,13.13,70% of Total Billed charges for Outpatient setting,9.09,48.48% of total Billed Charges for Outpatient Setting,9.09,48.48% of total Billed Charges for Outpatient Setting,9.09,48.48% of total Billed Charges for Outpatient Setting,13.13,70% of Total Billed charges for Outpatient setting,13.13,70% of Total Billed charges for Outpatient setting,9,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,9.09,48.48% of total Billed Charges for Outpatient Setting,16.88,90% of Total Billed charges for Outpatient setting,8.3,16.88,14.06
Outpatient Medical Services,LAB,82272,82272 Occult blood stool,301,27.5,16.5,60% of total billed charges for outpatient setting,13.2,48% of toatl Billed Charges for Outpatient Setting,8.3,100% of BCBS Fee Schedule for Outpatient Setting,8.3,100% of BCBS Fee Schedule for Outpatient Setting,9.21,111% of BCBS Fee Schedule for Outpatient Setting,13.75,Case rate,19.25,70% of Total Billed charges for Outpatient setting,13.33,48.48% of total Billed Charges for Outpatient Setting,13.33,48.48% of total Billed Charges for Outpatient Setting,13.33,48.48% of total Billed Charges for Outpatient Setting,19.25,70% of Total Billed charges for Outpatient setting,19.25,70% of Total Billed charges for Outpatient setting,13.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,13.33,48.48% of total Billed Charges for Outpatient Setting,24.75,90% of Total Billed charges for Outpatient setting,8.3,24.75,20.63
Outpatient Medical Services,LAB,82306,82306 Vitamin d 25 hydroxy,300,283.5,170.1,60% of total billed charges for outpatient setting,136.08,48% of toatl Billed Charges for Outpatient Setting,89.66,100% of BCBS Fee Schedule for Outpatient Setting,89.66,100% of BCBS Fee Schedule for Outpatient Setting,99.52,111% of BCBS Fee Schedule for Outpatient Setting,141.75,Case rate,198.45,70% of Total Billed charges for Outpatient setting,137.44,48.48% of total Billed Charges for Outpatient Setting,137.44,48.48% of total Billed Charges for Outpatient Setting,137.44,48.48% of total Billed Charges for Outpatient Setting,198.45,70% of Total Billed charges for Outpatient setting,198.45,70% of Total Billed charges for Outpatient setting,136.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,137.44,48.48% of total Billed Charges for Outpatient Setting,255.15,90% of Total Billed charges for Outpatient setting,89.66,255.15,170.1
Outpatient Medical Services,LAB,82308,82308 Calcitonin serum,300,84,50.4,60% of total billed charges for outpatient setting,40.32,48% of toatl Billed Charges for Outpatient Setting,81.09,100% of BCBS Fee Schedule for Outpatient Setting,81.09,100% of BCBS Fee Schedule for Outpatient Setting,90.01,111% of BCBS Fee Schedule for Outpatient Setting,42,Case rate,58.8,70% of Total Billed charges for Outpatient setting,40.72,48.48% of total Billed Charges for Outpatient Setting,40.72,48.48% of total Billed Charges for Outpatient Setting,40.72,48.48% of total Billed Charges for Outpatient Setting,58.8,70% of Total Billed charges for Outpatient setting,58.8,70% of Total Billed charges for Outpatient setting,40.32,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,40.72,48.48% of total Billed Charges for Outpatient Setting,75.6,90% of Total Billed charges for Outpatient setting,40.32,90.01,63
Outpatient Medical Services,LAB,82310,82310 Assay of calcium,301,54.5,32.7,60% of total billed charges for outpatient setting,26.16,48% of toatl Billed Charges for Outpatient Setting,15.61,100% of BCBS Fee Schedule for Outpatient Setting,15.61,100% of BCBS Fee Schedule for Outpatient Setting,17.33,111% of BCBS Fee Schedule for Outpatient Setting,27.25,Case rate,38.15,70% of Total Billed charges for Outpatient setting,26.42,48.48% of total Billed Charges for Outpatient Setting,26.42,48.48% of total Billed Charges for Outpatient Setting,26.42,48.48% of total Billed Charges for Outpatient Setting,38.15,70% of Total Billed charges for Outpatient setting,38.15,70% of Total Billed charges for Outpatient setting,26.16,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,26.42,48.48% of total Billed Charges for Outpatient Setting,49.05,90% of Total Billed charges for Outpatient setting,15.61,49.05,40.88
Outpatient Medical Services,LAB,82330,82330 Assay of calcium,300,122.5,73.5,60% of total billed charges for outpatient setting,58.8,48% of toatl Billed Charges for Outpatient Setting,41.39,100% of BCBS Fee Schedule for Outpatient Setting,41.39,100% of BCBS Fee Schedule for Outpatient Setting,45.94,111% of BCBS Fee Schedule for Outpatient Setting,61.25,Case rate,85.75,70% of Total Billed charges for Outpatient setting,59.39,48.48% of total Billed Charges for Outpatient Setting,59.39,48.48% of total Billed Charges for Outpatient Setting,59.39,48.48% of total Billed Charges for Outpatient Setting,85.75,70% of Total Billed charges for Outpatient setting,85.75,70% of Total Billed charges for Outpatient setting,58.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,59.39,48.48% of total Billed Charges for Outpatient Setting,110.25,90% of Total Billed charges for Outpatient setting,41.39,110.25,91.88
Outpatient Medical Services,LAB,82340,"82340 Calcium, urine timed",300,72.5,43.5,60% of total billed charges for outpatient setting,34.8,48% of toatl Billed Charges for Outpatient Setting,18.27,100% of BCBS Fee Schedule for Outpatient Setting,18.27,100% of BCBS Fee Schedule for Outpatient Setting,20.28,111% of BCBS Fee Schedule for Outpatient Setting,36.25,Case rate,50.75,70% of Total Billed charges for Outpatient setting,35.15,48.48% of total Billed Charges for Outpatient Setting,35.15,48.48% of total Billed Charges for Outpatient Setting,35.15,48.48% of total Billed Charges for Outpatient Setting,50.75,70% of Total Billed charges for Outpatient setting,50.75,70% of Total Billed charges for Outpatient setting,34.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.15,48.48% of total Billed Charges for Outpatient Setting,65.25,90% of Total Billed charges for Outpatient setting,18.27,65.25,54.38
Outpatient Medical Services,LAB,82374,82374 Carbon dioxide,300,29.5,17.7,60% of total billed charges for outpatient setting,14.16,48% of toatl Billed Charges for Outpatient Setting,14.81,100% of BCBS Fee Schedule for Outpatient Setting,14.81,100% of BCBS Fee Schedule for Outpatient Setting,16.44,111% of BCBS Fee Schedule for Outpatient Setting,14.75,Case rate,20.65,70% of Total Billed charges for Outpatient setting,14.3,48.48% of total Billed Charges for Outpatient Setting,14.3,48.48% of total Billed Charges for Outpatient Setting,14.3,48.48% of total Billed Charges for Outpatient Setting,20.65,70% of Total Billed charges for Outpatient setting,20.65,70% of Total Billed charges for Outpatient setting,14.16,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,14.3,48.48% of total Billed Charges for Outpatient Setting,26.55,90% of Total Billed charges for Outpatient setting,14.16,26.55,22.13
Outpatient Medical Services,LAB,82378,82378 Carcinoembryonic antigen,300,108.75,65.25,60% of total billed charges for outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,57.46,100% of BCBS Fee Schedule for Outpatient Setting,57.46,100% of BCBS Fee Schedule for Outpatient Setting,63.78,111% of BCBS Fee Schedule for Outpatient Setting,54.38,Case rate,76.13,70% of Total Billed charges for Outpatient setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,76.13,70% of Total Billed charges for Outpatient setting,76.13,70% of Total Billed charges for Outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,52.72,48.48% of total Billed Charges for Outpatient Setting,97.88,90% of Total Billed charges for Outpatient setting,52.2,97.88,81.56
Outpatient Medical Services,LAB,82384,"82384 Catecholamines, fractionated, 24hrs",300,191,114.6,60% of total billed charges for outpatient setting,91.68,48% of toatl Billed Charges for Outpatient Setting,76.47,100% of BCBS Fee Schedule for Outpatient Setting,76.47,100% of BCBS Fee Schedule for Outpatient Setting,84.88,111% of BCBS Fee Schedule for Outpatient Setting,95.5,Case rate,133.7,70% of Total Billed charges for Outpatient setting,92.6,48.48% of total Billed Charges for Outpatient Setting,92.6,48.48% of total Billed Charges for Outpatient Setting,92.6,48.48% of total Billed Charges for Outpatient Setting,133.7,70% of Total Billed charges for Outpatient setting,133.7,70% of Total Billed charges for Outpatient setting,91.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,92.6,48.48% of total Billed Charges for Outpatient Setting,171.9,90% of Total Billed charges for Outpatient setting,76.47,171.9,143.25
Outpatient Medical Services,LAB,82435,82435 Chloride,301,35,21,60% of total billed charges for outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,13.91,100% of BCBS Fee Schedule for Outpatient Setting,13.91,100% of BCBS Fee Schedule for Outpatient Setting,15.44,111% of BCBS Fee Schedule for Outpatient Setting,17.5,Case rate,24.5,70% of Total Billed charges for Outpatient setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,24.5,70% of Total Billed charges for Outpatient setting,24.5,70% of Total Billed charges for Outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,16.97,48.48% of total Billed Charges for Outpatient Setting,31.5,90% of Total Billed charges for Outpatient setting,13.91,31.5,26.25
Outpatient Medical Services,LAB,82465,82465 Cholestrol bld/serum tot,301,78,46.8,60% of total billed charges for outpatient setting,37.44,48% of toatl Billed Charges for Outpatient Setting,13.19,100% of BCBS Fee Schedule for Outpatient Setting,13.19,100% of BCBS Fee Schedule for Outpatient Setting,14.64,111% of BCBS Fee Schedule for Outpatient Setting,39,Case rate,54.6,70% of Total Billed charges for Outpatient setting,37.81,48.48% of total Billed Charges for Outpatient Setting,37.81,48.48% of total Billed Charges for Outpatient Setting,37.81,48.48% of total Billed Charges for Outpatient Setting,54.6,70% of Total Billed charges for Outpatient setting,54.6,70% of Total Billed charges for Outpatient setting,37.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,37.81,48.48% of total Billed Charges for Outpatient Setting,70.2,90% of Total Billed charges for Outpatient setting,13.19,70.2,58.5
Outpatient Medical Services,LAB,82480,82480 Cholinesterase serum,300,90,54,60% of total billed charges for outpatient setting,43.2,48% of toatl Billed Charges for Outpatient Setting,23.87,100% of BCBS Fee Schedule for Outpatient Setting,23.87,100% of BCBS Fee Schedule for Outpatient Setting,26.5,111% of BCBS Fee Schedule for Outpatient Setting,45,Case rate,63,70% of Total Billed charges for Outpatient setting,43.63,48.48% of total Billed Charges for Outpatient Setting,43.63,48.48% of total Billed Charges for Outpatient Setting,43.63,48.48% of total Billed Charges for Outpatient Setting,63,70% of Total Billed charges for Outpatient setting,63,70% of Total Billed charges for Outpatient setting,43.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,43.63,48.48% of total Billed Charges for Outpatient Setting,81,90% of Total Billed charges for Outpatient setting,23.87,81,67.5
Outpatient Medical Services,LAB,82530,"82530 Cortisol, free",300,156.25,93.75,60% of total billed charges for outpatient setting,75,48% of toatl Billed Charges for Outpatient Setting,50.62,100% of BCBS Fee Schedule for Outpatient Setting,50.62,100% of BCBS Fee Schedule for Outpatient Setting,56.19,111% of BCBS Fee Schedule for Outpatient Setting,78.13,Case rate,109.38,70% of Total Billed charges for Outpatient setting,75.75,48.48% of total Billed Charges for Outpatient Setting,75.75,48.48% of total Billed Charges for Outpatient Setting,75.75,48.48% of total Billed Charges for Outpatient Setting,109.38,70% of Total Billed charges for Outpatient setting,109.38,70% of Total Billed charges for Outpatient setting,75,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,75.75,48.48% of total Billed Charges for Outpatient Setting,140.63,90% of Total Billed charges for Outpatient setting,50.62,140.63,117.19
Outpatient Medical Services,LAB,82533,82533 Total cortisol,300,162.5,97.5,60% of total billed charges for outpatient setting,78,48% of toatl Billed Charges for Outpatient Setting,49.38,100% of BCBS Fee Schedule for Outpatient Setting,49.38,100% of BCBS Fee Schedule for Outpatient Setting,54.81,111% of BCBS Fee Schedule for Outpatient Setting,81.25,Case rate,113.75,70% of Total Billed charges for Outpatient setting,78.78,48.48% of total Billed Charges for Outpatient Setting,78.78,48.48% of total Billed Charges for Outpatient Setting,78.78,48.48% of total Billed Charges for Outpatient Setting,113.75,70% of Total Billed charges for Outpatient setting,113.75,70% of Total Billed charges for Outpatient setting,78,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,78.78,48.48% of total Billed Charges for Outpatient Setting,146.25,90% of Total Billed charges for Outpatient setting,49.38,146.25,121.88
Outpatient Medical Services,LAB,82542,82542 Iodine level,300,141.25,84.75,60% of total billed charges for outpatient setting,67.8,48% of toatl Billed Charges for Outpatient Setting,54.69,100% of BCBS Fee Schedule for Outpatient Setting,54.69,100% of BCBS Fee Schedule for Outpatient Setting,60.71,111% of BCBS Fee Schedule for Outpatient Setting,70.63,Case rate,98.88,70% of Total Billed charges for Outpatient setting,68.48,48.48% of total Billed Charges for Outpatient Setting,68.48,48.48% of total Billed Charges for Outpatient Setting,68.48,48.48% of total Billed Charges for Outpatient Setting,98.88,70% of Total Billed charges for Outpatient setting,98.88,70% of Total Billed charges for Outpatient setting,67.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,68.48,48.48% of total Billed Charges for Outpatient Setting,127.13,90% of Total Billed charges for Outpatient setting,54.69,127.13,105.94
Outpatient Medical Services,LAB,82550,82550 Assay of ck (cpk),301,50,30,60% of total billed charges for outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,19.72,100% of BCBS Fee Schedule for Outpatient Setting,19.72,100% of BCBS Fee Schedule for Outpatient Setting,21.89,111% of BCBS Fee Schedule for Outpatient Setting,25,Case rate,35,70% of Total Billed charges for Outpatient setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,35,70% of Total Billed charges for Outpatient setting,35,70% of Total Billed charges for Outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,24.24,48.48% of total Billed Charges for Outpatient Setting,45,90% of Total Billed charges for Outpatient setting,19.72,45,37.5
Outpatient Medical Services,LAB,82552,82552 CK isoenzymes,300,187.5,112.5,60% of total billed charges for outpatient setting,90,48% of toatl Billed Charges for Outpatient Setting,40.55,100% of BCBS Fee Schedule for Outpatient Setting,40.55,100% of BCBS Fee Schedule for Outpatient Setting,45.01,111% of BCBS Fee Schedule for Outpatient Setting,93.75,Case rate,131.25,70% of Total Billed charges for Outpatient setting,90.9,48.48% of total Billed Charges for Outpatient Setting,90.9,48.48% of total Billed Charges for Outpatient Setting,90.9,48.48% of total Billed Charges for Outpatient Setting,131.25,70% of Total Billed charges for Outpatient setting,131.25,70% of Total Billed charges for Outpatient setting,90,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,90.9,48.48% of total Billed Charges for Outpatient Setting,168.75,90% of Total Billed charges for Outpatient setting,40.55,168.75,140.63
Outpatient Medical Services,LAB,82565,82565 Assay of creatinine,301,33,19.8,60% of total billed charges for outpatient setting,15.84,48% of toatl Billed Charges for Outpatient Setting,15.52,100% of BCBS Fee Schedule for Outpatient Setting,15.52,100% of BCBS Fee Schedule for Outpatient Setting,17.23,111% of BCBS Fee Schedule for Outpatient Setting,16.5,Case rate,23.1,70% of Total Billed charges for Outpatient setting,16,48.48% of total Billed Charges for Outpatient Setting,16,48.48% of total Billed Charges for Outpatient Setting,16,48.48% of total Billed Charges for Outpatient Setting,23.1,70% of Total Billed charges for Outpatient setting,23.1,70% of Total Billed charges for Outpatient setting,15.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,16,48.48% of total Billed Charges for Outpatient Setting,29.7,90% of Total Billed charges for Outpatient setting,15.52,29.7,24.75
Outpatient Medical Services,LAB,82570,82570 Assay of urine creatinine,300,38.75,23.25,60% of total billed charges for outpatient setting,18.6,48% of toatl Billed Charges for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,17.39,111% of BCBS Fee Schedule for Outpatient Setting,19.38,Case rate,27.13,70% of Total Billed charges for Outpatient setting,18.79,48.48% of total Billed Charges for Outpatient Setting,18.79,48.48% of total Billed Charges for Outpatient Setting,18.79,48.48% of total Billed Charges for Outpatient Setting,27.13,70% of Total Billed charges for Outpatient setting,27.13,70% of Total Billed charges for Outpatient setting,18.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,18.79,48.48% of total Billed Charges for Outpatient Setting,34.88,90% of Total Billed charges for Outpatient setting,15.67,34.88,29.06
Outpatient Medical Services,LAB,82607,82607 Vitamin b-12,300,116.5,69.9,60% of total billed charges for outpatient setting,55.92,48% of toatl Billed Charges for Outpatient Setting,45.66,100% of BCBS Fee Schedule for Outpatient Setting,45.66,100% of BCBS Fee Schedule for Outpatient Setting,50.68,111% of BCBS Fee Schedule for Outpatient Setting,58.25,Case rate,81.55,70% of Total Billed charges for Outpatient setting,56.48,48.48% of total Billed Charges for Outpatient Setting,56.48,48.48% of total Billed Charges for Outpatient Setting,56.48,48.48% of total Billed Charges for Outpatient Setting,81.55,70% of Total Billed charges for Outpatient setting,81.55,70% of Total Billed charges for Outpatient setting,55.92,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,56.48,48.48% of total Billed Charges for Outpatient Setting,104.85,90% of Total Billed charges for Outpatient setting,45.66,104.85,87.38
Outpatient Medical Services,LAB,82728,82728 Assay of ferritin,300,93.75,56.25,60% of total billed charges for outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,41.25,100% of BCBS Fee Schedule for Outpatient Setting,41.25,100% of BCBS Fee Schedule for Outpatient Setting,45.79,111% of BCBS Fee Schedule for Outpatient Setting,46.88,Case rate,65.63,70% of Total Billed charges for Outpatient setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,65.63,70% of Total Billed charges for Outpatient setting,65.63,70% of Total Billed charges for Outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,45.45,48.48% of total Billed Charges for Outpatient Setting,84.38,90% of Total Billed charges for Outpatient setting,41.25,84.38,70.31
Outpatient Medical Services,LAB,82746,82746 Assay of folic acid serum,300,114.5,68.7,60% of total billed charges for outpatient setting,54.96,48% of toatl Billed Charges for Outpatient Setting,44.53,100% of BCBS Fee Schedule for Outpatient Setting,44.53,100% of BCBS Fee Schedule for Outpatient Setting,49.43,111% of BCBS Fee Schedule for Outpatient Setting,57.25,Case rate,80.15,70% of Total Billed charges for Outpatient setting,55.51,48.48% of total Billed Charges for Outpatient Setting,55.51,48.48% of total Billed Charges for Outpatient Setting,55.51,48.48% of total Billed Charges for Outpatient Setting,80.15,70% of Total Billed charges for Outpatient setting,80.15,70% of Total Billed charges for Outpatient setting,54.96,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.51,48.48% of total Billed Charges for Outpatient Setting,103.05,90% of Total Billed charges for Outpatient setting,44.53,103.05,85.88
Outpatient Medical Services,LAB,82784,82784 Assay iga/igd/igg/igm each,300,101.25,60.75,60% of total billed charges for outpatient setting,48.6,48% of toatl Billed Charges for Outpatient Setting,28.16,100% of BCBS Fee Schedule for Outpatient Setting,28.16,100% of BCBS Fee Schedule for Outpatient Setting,31.26,111% of BCBS Fee Schedule for Outpatient Setting,50.63,Case rate,70.88,70% of Total Billed charges for Outpatient setting,49.09,48.48% of total Billed Charges for Outpatient Setting,49.09,48.48% of total Billed Charges for Outpatient Setting,49.09,48.48% of total Billed Charges for Outpatient Setting,70.88,70% of Total Billed charges for Outpatient setting,70.88,70% of Total Billed charges for Outpatient setting,48.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,49.09,48.48% of total Billed Charges for Outpatient Setting,91.13,90% of Total Billed charges for Outpatient setting,28.16,91.13,75.94
Outpatient Medical Services,LAB,82803,82803 Blood gases any combination,301,103,61.8,60% of total billed charges for outpatient setting,49.44,48% of toatl Billed Charges for Outpatient Setting,15.77,100% of BCBS Fee Schedule for Outpatient Setting,15.77,100% of BCBS Fee Schedule for Outpatient Setting,17.5,111% of BCBS Fee Schedule for Outpatient Setting,51.5,Case rate,72.1,70% of Total Billed charges for Outpatient setting,49.93,48.48% of total Billed Charges for Outpatient Setting,49.93,48.48% of total Billed Charges for Outpatient Setting,49.93,48.48% of total Billed Charges for Outpatient Setting,72.1,70% of Total Billed charges for Outpatient setting,72.1,70% of Total Billed charges for Outpatient setting,49.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,49.93,48.48% of total Billed Charges for Outpatient Setting,92.7,90% of Total Billed charges for Outpatient setting,15.77,92.7,77.25
Outpatient Medical Services,LAB,82947,82947 Assay glucose blood quant,301,46.25,27.75,60% of total billed charges for outpatient setting,22.2,48% of toatl Billed Charges for Outpatient Setting,11.88,100% of BCBS Fee Schedule for Outpatient Setting,11.88,100% of BCBS Fee Schedule for Outpatient Setting,13.19,111% of BCBS Fee Schedule for Outpatient Setting,23.13,Case rate,32.38,70% of Total Billed charges for Outpatient setting,22.42,48.48% of total Billed Charges for Outpatient Setting,22.42,48.48% of total Billed Charges for Outpatient Setting,22.42,48.48% of total Billed Charges for Outpatient Setting,32.38,70% of Total Billed charges for Outpatient setting,32.38,70% of Total Billed charges for Outpatient setting,22.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,22.42,48.48% of total Billed Charges for Outpatient Setting,41.63,90% of Total Billed charges for Outpatient setting,11.88,41.63,34.69
Outpatient Medical Services,LAB,82948,82948 Reagent strip/blood glucose,301,24,14.4,60% of total billed charges for outpatient setting,11.52,48% of toatl Billed Charges for Outpatient Setting,9.6,100% of BCBS Fee Schedule for Outpatient Setting,9.6,100% of BCBS Fee Schedule for Outpatient Setting,10.66,111% of BCBS Fee Schedule for Outpatient Setting,12,Case rate,16.8,70% of Total Billed charges for Outpatient setting,11.64,48.48% of total Billed Charges for Outpatient Setting,11.64,48.48% of total Billed Charges for Outpatient Setting,11.64,48.48% of total Billed Charges for Outpatient Setting,16.8,70% of Total Billed charges for Outpatient setting,16.8,70% of Total Billed charges for Outpatient setting,11.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,11.64,48.48% of total Billed Charges for Outpatient Setting,21.6,90% of Total Billed charges for Outpatient setting,9.6,21.6,18
Outpatient Medical Services,LAB,83010,83010 Assay of haptoglobin quant,300,127.5,76.5,60% of total billed charges for outpatient setting,61.2,48% of toatl Billed Charges for Outpatient Setting,38.12,100% of BCBS Fee Schedule for Outpatient Setting,38.12,100% of BCBS Fee Schedule for Outpatient Setting,42.31,111% of BCBS Fee Schedule for Outpatient Setting,63.75,Case rate,89.25,70% of Total Billed charges for Outpatient setting,61.81,48.48% of total Billed Charges for Outpatient Setting,61.81,48.48% of total Billed Charges for Outpatient Setting,61.81,48.48% of total Billed Charges for Outpatient Setting,89.25,70% of Total Billed charges for Outpatient setting,89.25,70% of Total Billed charges for Outpatient setting,61.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,61.81,48.48% of total Billed Charges for Outpatient Setting,114.75,90% of Total Billed charges for Outpatient setting,38.12,114.75,95.63
Outpatient Medical Services,LAB,83036,83036 Glycosylated hemoglobin test,300,108.75,65.25,60% of total billed charges for outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,29.4,100% of BCBS Fee Schedule for Outpatient Setting,29.4,100% of BCBS Fee Schedule for Outpatient Setting,32.63,111% of BCBS Fee Schedule for Outpatient Setting,54.38,Case rate,76.13,70% of Total Billed charges for Outpatient setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,52.72,48.48% of total Billed Charges for Outpatient Setting,76.13,70% of Total Billed charges for Outpatient setting,76.13,70% of Total Billed charges for Outpatient setting,52.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,52.72,48.48% of total Billed Charges for Outpatient Setting,97.88,90% of Total Billed charges for Outpatient setting,29.4,97.88,81.56
Outpatient Medical Services,LAB,83498,83498 Assay of progesterone 17-d,300,166,99.6,60% of total billed charges for outpatient setting,79.68,48% of toatl Billed Charges for Outpatient Setting,82.28,100% of BCBS Fee Schedule for Outpatient Setting,82.28,100% of BCBS Fee Schedule for Outpatient Setting,91.33,111% of BCBS Fee Schedule for Outpatient Setting,83,Case rate,116.2,70% of Total Billed charges for Outpatient setting,80.48,48.48% of total Billed Charges for Outpatient Setting,80.48,48.48% of total Billed Charges for Outpatient Setting,80.48,48.48% of total Billed Charges for Outpatient Setting,116.2,70% of Total Billed charges for Outpatient setting,116.2,70% of Total Billed charges for Outpatient setting,79.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,80.48,48.48% of total Billed Charges for Outpatient Setting,149.4,90% of Total Billed charges for Outpatient setting,79.68,149.4,124.5
Outpatient Medical Services,LAB,83540,83540 Assay of iron,300,84,9,100% of Aetna Fee Schedule for Outpatient Setting,40.32,48% of toatl Billed Charges for Outpatient Setting,16.25,100% of BCBS Fee Schedule for Outpatient Setting,16.25,100% of BCBS Fee Schedule for Outpatient Setting,18.04,111% of BCBS Fee Schedule for Outpatient Setting,42,Case rate,58.8,70% of Total Billed charges for Outpatient setting,40.72,48.48% of total Billed Charges for Outpatient Setting,40.72,48.48% of total Billed Charges for Outpatient Setting,40.72,48.48% of total Billed Charges for Outpatient Setting,58.8,70% of Total Billed charges for Outpatient setting,58.8,70% of Total Billed charges for Outpatient setting,40.32,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,40.72,48.48% of total Billed Charges for Outpatient Setting,75.6,90% of Total Billed charges for Outpatient setting,9,75.6,63
Outpatient Medical Services,LAB,83550,83550 Iron binding test,300,97,58.2,60% of total billed charges for outpatient setting,46.56,48% of toatl Billed Charges for Outpatient Setting,26.46,100% of BCBS Fee Schedule for Outpatient Setting,26.46,100% of BCBS Fee Schedule for Outpatient Setting,29.37,111% of BCBS Fee Schedule for Outpatient Setting,48.5,Case rate,67.9,70% of Total Billed charges for Outpatient setting,47.03,48.48% of total Billed Charges for Outpatient Setting,47.03,48.48% of total Billed Charges for Outpatient Setting,47.03,48.48% of total Billed Charges for Outpatient Setting,67.9,70% of Total Billed charges for Outpatient setting,67.9,70% of Total Billed charges for Outpatient setting,46.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,47.03,48.48% of total Billed Charges for Outpatient Setting,87.3,90% of Total Billed charges for Outpatient setting,26.46,87.3,72.75
Outpatient Medical Services,LAB,83605,83605 Assay of lactic acid,300,137.5,82.5,60% of total billed charges for outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,32.33,100% of BCBS Fee Schedule for Outpatient Setting,32.33,100% of BCBS Fee Schedule for Outpatient Setting,35.89,111% of BCBS Fee Schedule for Outpatient Setting,68.75,Case rate,96.25,70% of Total Billed charges for Outpatient setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,96.25,70% of Total Billed charges for Outpatient setting,96.25,70% of Total Billed charges for Outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,66.66,48.48% of total Billed Charges for Outpatient Setting,123.75,90% of Total Billed charges for Outpatient setting,32.33,123.75,103.13
Outpatient Medical Services,LAB,83615,83615 Lactate (ld) (ldh) enzyme,301,74,44.4,60% of total billed charges for outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,18.3,100% of BCBS Fee Schedule for Outpatient Setting,18.3,100% of BCBS Fee Schedule for Outpatient Setting,20.31,111% of BCBS Fee Schedule for Outpatient Setting,37,Case rate,51.8,70% of Total Billed charges for Outpatient setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,51.8,70% of Total Billed charges for Outpatient setting,51.8,70% of Total Billed charges for Outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.88,48.48% of total Billed Charges for Outpatient Setting,66.6,90% of Total Billed charges for Outpatient setting,18.3,66.6,55.5
Outpatient Medical Services,LAB,83690,83690 Assay of lipase,300,90,54,60% of total billed charges for outpatient setting,43.2,48% of toatl Billed Charges for Outpatient Setting,20.86,100% of BCBS Fee Schedule for Outpatient Setting,20.86,100% of BCBS Fee Schedule for Outpatient Setting,23.15,111% of BCBS Fee Schedule for Outpatient Setting,45,Case rate,63,70% of Total Billed charges for Outpatient setting,43.63,48.48% of total Billed Charges for Outpatient Setting,43.63,48.48% of total Billed Charges for Outpatient Setting,43.63,48.48% of total Billed Charges for Outpatient Setting,63,70% of Total Billed charges for Outpatient setting,63,70% of Total Billed charges for Outpatient setting,43.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,43.63,48.48% of total Billed Charges for Outpatient Setting,81,90% of Total Billed charges for Outpatient setting,20.86,81,67.5
Outpatient Medical Services,LAB,83735,83735 Assay of magnesium,301,85,51,60% of total billed charges for outpatient setting,40.8,48% of toatl Billed Charges for Outpatient Setting,20.29,100% of BCBS Fee Schedule for Outpatient Setting,20.29,100% of BCBS Fee Schedule for Outpatient Setting,22.52,111% of BCBS Fee Schedule for Outpatient Setting,42.5,Case rate,59.5,70% of Total Billed charges for Outpatient setting,41.21,48.48% of total Billed Charges for Outpatient Setting,41.21,48.48% of total Billed Charges for Outpatient Setting,41.21,48.48% of total Billed Charges for Outpatient Setting,59.5,70% of Total Billed charges for Outpatient setting,59.5,70% of Total Billed charges for Outpatient setting,40.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,41.21,48.48% of total Billed Charges for Outpatient Setting,76.5,90% of Total Billed charges for Outpatient setting,20.29,76.5,63.75
Outpatient Medical Services,LAB,83880,83880 Assay of natriuretic peptide,300,176.5,105.9,60% of total billed charges for outpatient setting,84.72,48% of toatl Billed Charges for Outpatient Setting,102.82,100% of BCBS Fee Schedule for Outpatient Setting,102.82,100% of BCBS Fee Schedule for Outpatient Setting,114.13,111% of BCBS Fee Schedule for Outpatient Setting,88.25,Case rate,123.55,70% of Total Billed charges for Outpatient setting,85.57,48.48% of total Billed Charges for Outpatient Setting,85.57,48.48% of total Billed Charges for Outpatient Setting,85.57,48.48% of total Billed Charges for Outpatient Setting,123.55,70% of Total Billed charges for Outpatient setting,123.55,70% of Total Billed charges for Outpatient setting,84.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,85.57,48.48% of total Billed Charges for Outpatient Setting,158.85,90% of Total Billed charges for Outpatient setting,84.72,158.85,132.38
Outpatient Medical Services,LAB,83883,83883 Assay nephelometry not spec,300,115.5,69.3,60% of total billed charges for outpatient setting,55.44,48% of toatl Billed Charges for Outpatient Setting,14.08,100% of BCBS Fee Schedule for Outpatient Setting,14.08,100% of BCBS Fee Schedule for Outpatient Setting,15.63,111% of BCBS Fee Schedule for Outpatient Setting,57.75,Case rate,80.85,70% of Total Billed charges for Outpatient setting,55.99,48.48% of total Billed Charges for Outpatient Setting,55.99,48.48% of total Billed Charges for Outpatient Setting,55.99,48.48% of total Billed Charges for Outpatient Setting,80.85,70% of Total Billed charges for Outpatient setting,80.85,70% of Total Billed charges for Outpatient setting,55.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.99,48.48% of total Billed Charges for Outpatient Setting,103.95,90% of Total Billed charges for Outpatient setting,14.08,103.95,86.63
Outpatient Medical Services,LAB,83935,83935 Assay of urine osmolality,300,173.75,104.25,60% of total billed charges for outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,20.64,100% of BCBS Fee Schedule for Outpatient Setting,20.64,100% of BCBS Fee Schedule for Outpatient Setting,22.91,111% of BCBS Fee Schedule for Outpatient Setting,86.88,Case rate,121.63,70% of Total Billed charges for Outpatient setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,84.23,48.48% of total Billed Charges for Outpatient Setting,121.63,70% of Total Billed charges for Outpatient setting,121.63,70% of Total Billed charges for Outpatient setting,83.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,84.23,48.48% of total Billed Charges for Outpatient Setting,156.38,90% of Total Billed charges for Outpatient setting,20.64,156.38,130.31
Outpatient Medical Services,LAB,83970,83970 Assay of parathormone,300,233,139.8,60% of total billed charges for outpatient setting,111.84,48% of toatl Billed Charges for Outpatient Setting,125.01,100% of BCBS Fee Schedule for Outpatient Setting,125.01,100% of BCBS Fee Schedule for Outpatient Setting,138.76,111% of BCBS Fee Schedule for Outpatient Setting,116.5,Case rate,163.1,70% of Total Billed charges for Outpatient setting,112.96,48.48% of total Billed Charges for Outpatient Setting,112.96,48.48% of total Billed Charges for Outpatient Setting,112.96,48.48% of total Billed Charges for Outpatient Setting,163.1,70% of Total Billed charges for Outpatient setting,163.1,70% of Total Billed charges for Outpatient setting,111.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,112.96,48.48% of total Billed Charges for Outpatient Setting,209.7,90% of Total Billed charges for Outpatient setting,111.84,209.7,139.8
Outpatient Medical Services,LAB,84075,84075 Assay alkaline phosphatase,301,68,40.8,60% of total billed charges for outpatient setting,32.64,48% of toatl Billed Charges for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,17.39,111% of BCBS Fee Schedule for Outpatient Setting,34,Case rate,47.6,70% of Total Billed charges for Outpatient setting,32.97,48.48% of total Billed Charges for Outpatient Setting,32.97,48.48% of total Billed Charges for Outpatient Setting,32.97,48.48% of total Billed Charges for Outpatient Setting,47.6,70% of Total Billed charges for Outpatient setting,47.6,70% of Total Billed charges for Outpatient setting,32.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,32.97,48.48% of total Billed Charges for Outpatient Setting,61.2,90% of Total Billed charges for Outpatient setting,15.67,61.2,51
Outpatient Medical Services,LAB,84100,84100 Assay of phosphorus,301,75,45,60% of total billed charges for outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,14.38,100% of BCBS Fee Schedule for Outpatient Setting,14.38,100% of BCBS Fee Schedule for Outpatient Setting,15.96,111% of BCBS Fee Schedule for Outpatient Setting,37.5,Case rate,52.5,70% of Total Billed charges for Outpatient setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,52.5,70% of Total Billed charges for Outpatient setting,52.5,70% of Total Billed charges for Outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,36.36,48.48% of total Billed Charges for Outpatient Setting,67.5,90% of Total Billed charges for Outpatient setting,14.38,67.5,56.25
Outpatient Medical Services,LAB,84132,84132 Assay of serum potassium,301,74,44.4,60% of total billed charges for outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,13.91,100% of BCBS Fee Schedule for Outpatient Setting,13.91,100% of BCBS Fee Schedule for Outpatient Setting,15.44,111% of BCBS Fee Schedule for Outpatient Setting,37,Case rate,51.8,70% of Total Billed charges for Outpatient setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,51.8,70% of Total Billed charges for Outpatient setting,51.8,70% of Total Billed charges for Outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.88,48.48% of total Billed Charges for Outpatient Setting,66.6,90% of Total Billed charges for Outpatient setting,13.91,66.6,55.5
Outpatient Medical Services,LAB,84134,84134 Assay of prealbumin,301,115,69,60% of total billed charges for outpatient setting,55.2,48% of toatl Billed Charges for Outpatient Setting,16.9,100% of BCBS Fee Schedule for Outpatient Setting,16.9,100% of BCBS Fee Schedule for Outpatient Setting,18.76,111% of BCBS Fee Schedule for Outpatient Setting,57.5,Case rate,80.5,70% of Total Billed charges for Outpatient setting,55.75,48.48% of total Billed Charges for Outpatient Setting,55.75,48.48% of total Billed Charges for Outpatient Setting,55.75,48.48% of total Billed Charges for Outpatient Setting,80.5,70% of Total Billed charges for Outpatient setting,80.5,70% of Total Billed charges for Outpatient setting,55.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,55.75,48.48% of total Billed Charges for Outpatient Setting,103.5,90% of Total Billed charges for Outpatient setting,16.9,103.5,86.25
Outpatient Medical Services,LAB,84145,84145 Procalcitonin (pct),300,250,150,60% of total billed charges for outpatient setting,120,48% of toatl Billed Charges for Outpatient Setting,41.79,100% of BCBS Fee Schedule for Outpatient Setting,41.79,100% of BCBS Fee Schedule for Outpatient Setting,46.39,111% of BCBS Fee Schedule for Outpatient Setting,125,Case rate,175,70% of Total Billed charges for Outpatient setting,121.2,48.48% of total Billed Charges for Outpatient Setting,121.2,48.48% of total Billed Charges for Outpatient Setting,121.2,48.48% of total Billed Charges for Outpatient Setting,175,70% of Total Billed charges for Outpatient setting,175,70% of Total Billed charges for Outpatient setting,120,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,121.2,48.48% of total Billed Charges for Outpatient Setting,225,90% of Total Billed charges for Outpatient setting,41.79,225,150
Outpatient Medical Services,LAB,84156,84156 Assay of protein urine,300,110,66,60% of total billed charges for outpatient setting,52.8,48% of toatl Billed Charges for Outpatient Setting,11.09,100% of BCBS Fee Schedule for Outpatient Setting,11.09,100% of BCBS Fee Schedule for Outpatient Setting,12.31,111% of BCBS Fee Schedule for Outpatient Setting,55,Case rate,77,70% of Total Billed charges for Outpatient setting,53.33,48.48% of total Billed Charges for Outpatient Setting,53.33,48.48% of total Billed Charges for Outpatient Setting,53.33,48.48% of total Billed Charges for Outpatient Setting,77,70% of Total Billed charges for Outpatient setting,77,70% of Total Billed charges for Outpatient setting,52.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,53.33,48.48% of total Billed Charges for Outpatient Setting,99,90% of Total Billed charges for Outpatient setting,11.09,99,82.5
Outpatient Medical Services,LAB,84165,84165 Protein e-phoresis serum,300,201.25,120.75,60% of total billed charges for outpatient setting,96.6,48% of toatl Billed Charges for Outpatient Setting,32.53,100% of BCBS Fee Schedule for Outpatient Setting,32.53,100% of BCBS Fee Schedule for Outpatient Setting,36.11,111% of BCBS Fee Schedule for Outpatient Setting,100.63,Case rate,140.88,70% of Total Billed charges for Outpatient setting,97.57,48.48% of total Billed Charges for Outpatient Setting,97.57,48.48% of total Billed Charges for Outpatient Setting,97.57,48.48% of total Billed Charges for Outpatient Setting,140.88,70% of Total Billed charges for Outpatient setting,140.88,70% of Total Billed charges for Outpatient setting,96.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,97.57,48.48% of total Billed Charges for Outpatient Setting,181.13,90% of Total Billed charges for Outpatient setting,32.53,181.13,120.75
Outpatient Medical Services,LAB,84295,84295 Assay of serum sodium,301,68.5,41.1,60% of total billed charges for outpatient setting,32.88,48% of toatl Billed Charges for Outpatient Setting,14.57,100% of BCBS Fee Schedule for Outpatient Setting,14.57,100% of BCBS Fee Schedule for Outpatient Setting,16.17,111% of BCBS Fee Schedule for Outpatient Setting,34.25,Case rate,47.95,70% of Total Billed charges for Outpatient setting,33.21,48.48% of total Billed Charges for Outpatient Setting,33.21,48.48% of total Billed Charges for Outpatient Setting,33.21,48.48% of total Billed Charges for Outpatient Setting,47.95,70% of Total Billed charges for Outpatient setting,47.95,70% of Total Billed charges for Outpatient setting,32.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,33.21,48.48% of total Billed Charges for Outpatient Setting,61.65,90% of Total Billed charges for Outpatient setting,14.57,61.65,51.38
Outpatient Medical Services,LAB,84300,84300 Assay of urine sodium,300,74,44.4,60% of total billed charges for outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,14.72,100% of BCBS Fee Schedule for Outpatient Setting,14.72,100% of BCBS Fee Schedule for Outpatient Setting,16.34,111% of BCBS Fee Schedule for Outpatient Setting,37,Case rate,51.8,70% of Total Billed charges for Outpatient setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,51.8,70% of Total Billed charges for Outpatient setting,51.8,70% of Total Billed charges for Outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.88,48.48% of total Billed Charges for Outpatient Setting,66.6,90% of Total Billed charges for Outpatient setting,14.72,66.6,55.5
Outpatient Medical Services,LAB,84403,84403 Assay of total testosterone,300,175,105,60% of total billed charges for outpatient setting,84,48% of toatl Billed Charges for Outpatient Setting,78.22,100% of BCBS Fee Schedule for Outpatient Setting,78.22,100% of BCBS Fee Schedule for Outpatient Setting,86.82,111% of BCBS Fee Schedule for Outpatient Setting,87.5,Case rate,122.5,70% of Total Billed charges for Outpatient setting,84.84,48.48% of total Billed Charges for Outpatient Setting,84.84,48.48% of total Billed Charges for Outpatient Setting,84.84,48.48% of total Billed Charges for Outpatient Setting,122.5,70% of Total Billed charges for Outpatient setting,122.5,70% of Total Billed charges for Outpatient setting,84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,84.84,48.48% of total Billed Charges for Outpatient Setting,157.5,90% of Total Billed charges for Outpatient setting,78.22,157.5,131.25
Outpatient Medical Services,LAB,84436,84436 Assay of total thyroxine,300,81.5,48.9,60% of total billed charges for outpatient setting,39.12,48% of toatl Billed Charges for Outpatient Setting,14.65,100% of BCBS Fee Schedule for Outpatient Setting,14.65,100% of BCBS Fee Schedule for Outpatient Setting,16.26,111% of BCBS Fee Schedule for Outpatient Setting,40.75,Case rate,57.05,70% of Total Billed charges for Outpatient setting,39.51,48.48% of total Billed Charges for Outpatient Setting,39.51,48.48% of total Billed Charges for Outpatient Setting,39.51,48.48% of total Billed Charges for Outpatient Setting,57.05,70% of Total Billed charges for Outpatient setting,57.05,70% of Total Billed charges for Outpatient setting,39.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,39.51,48.48% of total Billed Charges for Outpatient Setting,73.35,90% of Total Billed charges for Outpatient setting,14.65,73.35,61.13
Outpatient Medical Services,LAB,84439,84439 Assay of free thyroxine,300,127.5,76.5,60% of total billed charges for outpatient setting,61.2,48% of toatl Billed Charges for Outpatient Setting,27.31,100% of BCBS Fee Schedule for Outpatient Setting,27.31,100% of BCBS Fee Schedule for Outpatient Setting,30.31,111% of BCBS Fee Schedule for Outpatient Setting,63.75,Case rate,89.25,70% of Total Billed charges for Outpatient setting,61.81,48.48% of total Billed Charges for Outpatient Setting,61.81,48.48% of total Billed Charges for Outpatient Setting,61.81,48.48% of total Billed Charges for Outpatient Setting,89.25,70% of Total Billed charges for Outpatient setting,89.25,70% of Total Billed charges for Outpatient setting,61.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,61.81,48.48% of total Billed Charges for Outpatient Setting,114.75,90% of Total Billed charges for Outpatient setting,27.31,114.75,95.63
Outpatient Medical Services,LAB,84450,84450 Transferase (ast) (sgot),301,71,42.6,60% of total billed charges for outpatient setting,34.08,48% of toatl Billed Charges for Outpatient Setting,15.66,100% of BCBS Fee Schedule for Outpatient Setting,15.66,100% of BCBS Fee Schedule for Outpatient Setting,17.38,111% of BCBS Fee Schedule for Outpatient Setting,35.5,Case rate,49.7,70% of Total Billed charges for Outpatient setting,34.42,48.48% of total Billed Charges for Outpatient Setting,34.42,48.48% of total Billed Charges for Outpatient Setting,34.42,48.48% of total Billed Charges for Outpatient Setting,49.7,70% of Total Billed charges for Outpatient setting,49.7,70% of Total Billed charges for Outpatient setting,34.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,34.42,48.48% of total Billed Charges for Outpatient Setting,63.9,90% of Total Billed charges for Outpatient setting,15.66,63.9,53.25
Outpatient Medical Services,LAB,84460,84460 Alanine amino (alt) (sgpt),301,73,43.8,60% of total billed charges for outpatient setting,35.04,48% of toatl Billed Charges for Outpatient Setting,16.05,100% of BCBS Fee Schedule for Outpatient Setting,16.05,100% of BCBS Fee Schedule for Outpatient Setting,17.82,111% of BCBS Fee Schedule for Outpatient Setting,36.5,Case rate,51.1,70% of Total Billed charges for Outpatient setting,35.39,48.48% of total Billed Charges for Outpatient Setting,35.39,48.48% of total Billed Charges for Outpatient Setting,35.39,48.48% of total Billed Charges for Outpatient Setting,51.1,70% of Total Billed charges for Outpatient setting,51.1,70% of Total Billed charges for Outpatient setting,35.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.39,48.48% of total Billed Charges for Outpatient Setting,65.7,90% of Total Billed charges for Outpatient setting,16.05,65.7,54.75
Outpatient Medical Services,LAB,84478,84478 Assay of triglycerides,301,74,44.4,60% of total billed charges for outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,17.43,100% of BCBS Fee Schedule for Outpatient Setting,17.43,100% of BCBS Fee Schedule for Outpatient Setting,19.35,111% of BCBS Fee Schedule for Outpatient Setting,37,Case rate,51.8,70% of Total Billed charges for Outpatient setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,35.88,48.48% of total Billed Charges for Outpatient Setting,51.8,70% of Total Billed charges for Outpatient setting,51.8,70% of Total Billed charges for Outpatient setting,35.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.88,48.48% of total Billed Charges for Outpatient Setting,66.6,90% of Total Billed charges for Outpatient setting,17.43,66.6,55.5
Outpatient Medical Services,LAB,84484,84484 Assay of troponin quant,301,106.5,63.9,60% of total billed charges for outpatient setting,51.12,48% of toatl Billed Charges for Outpatient Setting,29.81,100% of BCBS Fee Schedule for Outpatient Setting,29.81,100% of BCBS Fee Schedule for Outpatient Setting,33.09,111% of BCBS Fee Schedule for Outpatient Setting,53.25,Case rate,74.55,70% of Total Billed charges for Outpatient setting,51.63,48.48% of total Billed Charges for Outpatient Setting,51.63,48.48% of total Billed Charges for Outpatient Setting,51.63,48.48% of total Billed Charges for Outpatient Setting,74.55,70% of Total Billed charges for Outpatient setting,74.55,70% of Total Billed charges for Outpatient setting,51.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,51.63,48.48% of total Billed Charges for Outpatient Setting,95.85,90% of Total Billed charges for Outpatient setting,29.81,95.85,79.88
Outpatient Medical Services,LAB,84520,84520 Assay of urea nitrogen,301,68.5,41.1,60% of total billed charges for outpatient setting,32.88,48% of toatl Billed Charges for Outpatient Setting,11.94,100% of BCBS Fee Schedule for Outpatient Setting,11.94,100% of BCBS Fee Schedule for Outpatient Setting,13.25,111% of BCBS Fee Schedule for Outpatient Setting,34.25,Case rate,47.95,70% of Total Billed charges for Outpatient setting,33.21,48.48% of total Billed Charges for Outpatient Setting,33.21,48.48% of total Billed Charges for Outpatient Setting,33.21,48.48% of total Billed Charges for Outpatient Setting,47.95,70% of Total Billed charges for Outpatient setting,47.95,70% of Total Billed charges for Outpatient setting,32.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,33.21,48.48% of total Billed Charges for Outpatient Setting,61.65,90% of Total Billed charges for Outpatient setting,11.94,61.65,51.38
Outpatient Medical Services,LAB,84550,84550 Assay of blood/uric acid,301,73.5,44.1,60% of total billed charges for outpatient setting,35.28,48% of toatl Billed Charges for Outpatient Setting,13.69,100% of BCBS Fee Schedule for Outpatient Setting,13.69,100% of BCBS Fee Schedule for Outpatient Setting,15.2,111% of BCBS Fee Schedule for Outpatient Setting,36.75,Case rate,51.45,70% of Total Billed charges for Outpatient setting,35.63,48.48% of total Billed Charges for Outpatient Setting,35.63,48.48% of total Billed Charges for Outpatient Setting,35.63,48.48% of total Billed Charges for Outpatient Setting,51.45,70% of Total Billed charges for Outpatient setting,51.45,70% of Total Billed charges for Outpatient setting,35.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.63,48.48% of total Billed Charges for Outpatient Setting,66.15,90% of Total Billed charges for Outpatient setting,13.69,66.15,55.13
Outpatient Medical Services,LAB,84702,84702 Chorionic gonadotropin test,300,137.5,82.5,60% of total billed charges for outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,45.58,100% of BCBS Fee Schedule for Outpatient Setting,45.58,100% of BCBS Fee Schedule for Outpatient Setting,50.59,111% of BCBS Fee Schedule for Outpatient Setting,68.75,Case rate,96.25,70% of Total Billed charges for Outpatient setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,66.66,48.48% of total Billed Charges for Outpatient Setting,96.25,70% of Total Billed charges for Outpatient setting,96.25,70% of Total Billed charges for Outpatient setting,66,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,66.66,48.48% of total Billed Charges for Outpatient Setting,123.75,90% of Total Billed charges for Outpatient setting,45.58,123.75,103.13
Outpatient Medical Services,LAB,85014,85014 Hematocrit,305,22.5,13.5,60% of total billed charges for outpatient setting,10.8,48% of toatl Billed Charges for Outpatient Setting,7.18,100% of BCBS Fee Schedule for Outpatient Setting,7.18,100% of BCBS Fee Schedule for Outpatient Setting,7.97,111% of BCBS Fee Schedule for Outpatient Setting,11.25,Case rate,15.75,70% of Total Billed charges for Outpatient setting,10.91,48.48% of total Billed Charges for Outpatient Setting,10.91,48.48% of total Billed Charges for Outpatient Setting,10.91,48.48% of total Billed Charges for Outpatient Setting,15.75,70% of Total Billed charges for Outpatient setting,15.75,70% of Total Billed charges for Outpatient setting,10.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,10.91,48.48% of total Billed Charges for Outpatient Setting,20.25,90% of Total Billed charges for Outpatient setting,7.18,20.25,16.88
Outpatient Medical Services,LAB,85018,85018 Hemoglobin,305,22,13.2,60% of total billed charges for outpatient setting,10.56,48% of toatl Billed Charges for Outpatient Setting,7.18,100% of BCBS Fee Schedule for Outpatient Setting,7.18,100% of BCBS Fee Schedule for Outpatient Setting,7.97,111% of BCBS Fee Schedule for Outpatient Setting,11,Case rate,15.4,70% of Total Billed charges for Outpatient setting,10.67,48.48% of total Billed Charges for Outpatient Setting,10.67,48.48% of total Billed Charges for Outpatient Setting,10.67,48.48% of total Billed Charges for Outpatient Setting,15.4,70% of Total Billed charges for Outpatient setting,15.4,70% of Total Billed charges for Outpatient setting,10.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,10.67,48.48% of total Billed Charges for Outpatient Setting,19.8,90% of Total Billed charges for Outpatient setting,7.18,19.8,16.5
Outpatient Medical Services,LAB,85049,85049 Automated platelet count,300,35,21,60% of total billed charges for outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,12.43,100% of BCBS Fee Schedule for Outpatient Setting,12.43,100% of BCBS Fee Schedule for Outpatient Setting,13.8,111% of BCBS Fee Schedule for Outpatient Setting,17.5,Case rate,24.5,70% of Total Billed charges for Outpatient setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,16.97,48.48% of total Billed Charges for Outpatient Setting,24.5,70% of Total Billed charges for Outpatient setting,24.5,70% of Total Billed charges for Outpatient setting,16.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,16.97,48.48% of total Billed Charges for Outpatient Setting,31.5,90% of Total Billed charges for Outpatient setting,12.43,31.5,26.25
Outpatient Medical Services,LAB,85379,85379 Fibrin degradation quant,305,187.5,112.5,60% of total billed charges for outpatient setting,90,48% of toatl Billed Charges for Outpatient Setting,30.83,100% of BCBS Fee Schedule for Outpatient Setting,30.83,100% of BCBS Fee Schedule for Outpatient Setting,34.22,111% of BCBS Fee Schedule for Outpatient Setting,93.75,Case rate,131.25,70% of Total Billed charges for Outpatient setting,90.9,48.48% of total Billed Charges for Outpatient Setting,90.9,48.48% of total Billed Charges for Outpatient Setting,90.9,48.48% of total Billed Charges for Outpatient Setting,131.25,70% of Total Billed charges for Outpatient setting,131.25,70% of Total Billed charges for Outpatient setting,90,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,90.9,48.48% of total Billed Charges for Outpatient Setting,168.75,90% of Total Billed charges for Outpatient setting,30.83,168.75,140.63
Outpatient Medical Services,LAB,85384,85384 Fibrinogen activity,300,73.75,44.25,60% of total billed charges for outpatient setting,35.4,48% of toatl Billed Charges for Outpatient Setting,25.73,100% of BCBS Fee Schedule for Outpatient Setting,25.73,100% of BCBS Fee Schedule for Outpatient Setting,28.56,111% of BCBS Fee Schedule for Outpatient Setting,36.88,Case rate,51.63,70% of Total Billed charges for Outpatient setting,35.75,48.48% of total Billed Charges for Outpatient Setting,35.75,48.48% of total Billed Charges for Outpatient Setting,35.75,48.48% of total Billed Charges for Outpatient Setting,51.63,70% of Total Billed charges for Outpatient setting,51.63,70% of Total Billed charges for Outpatient setting,35.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,35.75,48.48% of total Billed Charges for Outpatient Setting,66.38,90% of Total Billed charges for Outpatient setting,25.73,66.38,55.31
Outpatient Medical Services,LAB,85651,85651 Rbc sed rate nonautomated,305,30.5,18.3,60% of total billed charges for outpatient setting,14.64,48% of toatl Billed Charges for Outpatient Setting,10.75,100% of BCBS Fee Schedule for Outpatient Setting,10.75,100% of BCBS Fee Schedule for Outpatient Setting,11.93,111% of BCBS Fee Schedule for Outpatient Setting,15.25,Case rate,21.35,70% of Total Billed charges for Outpatient setting,14.79,48.48% of total Billed Charges for Outpatient Setting,14.79,48.48% of total Billed Charges for Outpatient Setting,14.79,48.48% of total Billed Charges for Outpatient Setting,21.35,70% of Total Billed charges for Outpatient setting,21.35,70% of Total Billed charges for Outpatient setting,14.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,14.79,48.48% of total Billed Charges for Outpatient Setting,27.45,90% of Total Billed charges for Outpatient setting,10.75,27.45,22.88
Outpatient Medical Services,LAB,86038,86038 Antinuclear antibodies,302,117.5,70.5,60% of total billed charges for outpatient setting,56.4,48% of toatl Billed Charges for Outpatient Setting,36.62,100% of BCBS Fee Schedule for Outpatient Setting,36.62,100% of BCBS Fee Schedule for Outpatient Setting,40.65,111% of BCBS Fee Schedule for Outpatient Setting,58.75,Case rate,82.25,70% of Total Billed charges for Outpatient setting,56.96,48.48% of total Billed Charges for Outpatient Setting,56.96,48.48% of total Billed Charges for Outpatient Setting,56.96,48.48% of total Billed Charges for Outpatient Setting,82.25,70% of Total Billed charges for Outpatient setting,82.25,70% of Total Billed charges for Outpatient setting,56.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,56.96,48.48% of total Billed Charges for Outpatient Setting,105.75,90% of Total Billed charges for Outpatient setting,36.62,105.75,88.13
Outpatient Medical Services,LAB,86140,86140 C-reactive protein,300,45.5,27.3,60% of total billed charges for outpatient setting,21.84,48% of toatl Billed Charges for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,15.67,100% of BCBS Fee Schedule for Outpatient Setting,17.39,111% of BCBS Fee Schedule for Outpatient Setting,22.75,Case rate,31.85,70% of Total Billed charges for Outpatient setting,22.06,48.48% of total Billed Charges for Outpatient Setting,22.06,48.48% of total Billed Charges for Outpatient Setting,22.06,48.48% of total Billed Charges for Outpatient Setting,31.85,70% of Total Billed charges for Outpatient setting,31.85,70% of Total Billed charges for Outpatient setting,21.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,22.06,48.48% of total Billed Charges for Outpatient Setting,40.95,90% of Total Billed charges for Outpatient setting,15.67,40.95,34.13
Outpatient Medical Services,LAB,86255,86255 Fluorescent antibody screen,300,275,165,60% of total billed charges for outpatient setting,132,48% of toatl Billed Charges for Outpatient Setting,34.38,100% of BCBS Fee Schedule for Outpatient Setting,34.38,100% of BCBS Fee Schedule for Outpatient Setting,38.16,111% of BCBS Fee Schedule for Outpatient Setting,137.5,Case rate,192.5,70% of Total Billed charges for Outpatient setting,133.32,48.48% of total Billed Charges for Outpatient Setting,133.32,48.48% of total Billed Charges for Outpatient Setting,133.32,48.48% of total Billed Charges for Outpatient Setting,192.5,70% of Total Billed charges for Outpatient setting,192.5,70% of Total Billed charges for Outpatient setting,132,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,133.32,48.48% of total Billed Charges for Outpatient Setting,247.5,90% of Total Billed charges for Outpatient setting,34.38,247.5,165
Outpatient Medical Services,LAB,86334,86334 Immunofix e-phoresis serum,300,245.5,147.3,60% of total billed charges for outpatient setting,117.84,48% of toatl Billed Charges for Outpatient Setting,67.65,100% of BCBS Fee Schedule for Outpatient Setting,67.65,100% of BCBS Fee Schedule for Outpatient Setting,75.09,111% of BCBS Fee Schedule for Outpatient Setting,122.75,Case rate,171.85,70% of Total Billed charges for Outpatient setting,119.02,48.48% of total Billed Charges for Outpatient Setting,119.02,48.48% of total Billed Charges for Outpatient Setting,119.02,48.48% of total Billed Charges for Outpatient Setting,171.85,70% of Total Billed charges for Outpatient setting,171.85,70% of Total Billed charges for Outpatient setting,117.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,119.02,48.48% of total Billed Charges for Outpatient Setting,220.95,90% of Total Billed charges for Outpatient setting,67.65,220.95,147.3
Outpatient Medical Services,LAB,86592,86592 Syphilis test non-trep qual,300,43.5,26.1,60% of total billed charges for outpatient setting,20.88,48% of toatl Billed Charges for Outpatient Setting,12.91,100% of BCBS Fee Schedule for Outpatient Setting,12.91,100% of BCBS Fee Schedule for Outpatient Setting,14.33,111% of BCBS Fee Schedule for Outpatient Setting,21.75,Case rate,30.45,70% of Total Billed charges for Outpatient setting,21.09,48.48% of total Billed Charges for Outpatient Setting,21.09,48.48% of total Billed Charges for Outpatient Setting,21.09,48.48% of total Billed Charges for Outpatient Setting,30.45,70% of Total Billed charges for Outpatient setting,30.45,70% of Total Billed charges for Outpatient setting,20.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,21.09,48.48% of total Billed Charges for Outpatient Setting,39.15,90% of Total Billed charges for Outpatient setting,12.91,39.15,32.63
Outpatient Medical Services,LAB,86618,86618 Lyme disease antibody,300,146,87.6,60% of total billed charges for outpatient setting,70.08,48% of toatl Billed Charges for Outpatient Setting,51.59,100% of BCBS Fee Schedule for Outpatient Setting,51.59,100% of BCBS Fee Schedule for Outpatient Setting,57.26,111% of BCBS Fee Schedule for Outpatient Setting,73,Case rate,102.2,70% of Total Billed charges for Outpatient setting,70.78,48.48% of total Billed Charges for Outpatient Setting,70.78,48.48% of total Billed Charges for Outpatient Setting,70.78,48.48% of total Billed Charges for Outpatient Setting,102.2,70% of Total Billed charges for Outpatient setting,102.2,70% of Total Billed charges for Outpatient setting,70.08,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,70.78,48.48% of total Billed Charges for Outpatient Setting,131.4,90% of Total Billed charges for Outpatient setting,51.59,131.4,109.5
Outpatient Medical Services,LAB,86900,86900 Blood typing serologic abo,300,105,63,60% of total billed charges for outpatient setting,50.4,48% of toatl Billed Charges for Outpatient Setting,9.03,100% of BCBS Fee Schedule for Outpatient Setting,9.03,100% of BCBS Fee Schedule for Outpatient Setting,10.02,111% of BCBS Fee Schedule for Outpatient Setting,52.5,Case rate,73.5,70% of Total Billed charges for Outpatient setting,50.9,48.48% of total Billed Charges for Outpatient Setting,50.9,48.48% of total Billed Charges for Outpatient Setting,50.9,48.48% of total Billed Charges for Outpatient Setting,73.5,70% of Total Billed charges for Outpatient setting,73.5,70% of Total Billed charges for Outpatient setting,50.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,50.9,48.48% of total Billed Charges for Outpatient Setting,94.5,90% of Total Billed charges for Outpatient setting,9.03,94.5,78.75
Outpatient Medical Services,LAB,86922,86922 Compatibility test antiglob,300,85,51,60% of total billed charges for outpatient setting,40.8,48% of toatl Billed Charges for Outpatient Setting,13.46,100% of BCBS Fee Schedule for Outpatient Setting,13.46,100% of BCBS Fee Schedule for Outpatient Setting,14.94,111% of BCBS Fee Schedule for Outpatient Setting,42.5,Case rate,59.5,70% of Total Billed charges for Outpatient setting,41.21,48.48% of total Billed Charges for Outpatient Setting,41.21,48.48% of total Billed Charges for Outpatient Setting,41.21,48.48% of total Billed Charges for Outpatient Setting,59.5,70% of Total Billed charges for Outpatient setting,59.5,70% of Total Billed charges for Outpatient setting,40.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,41.21,48.48% of total Billed Charges for Outpatient Setting,76.5,90% of Total Billed charges for Outpatient setting,13.46,76.5,63.75
Outpatient Medical Services,LAB,87040,87040 Blood culture for bacteria,300,85.5,51.3,60% of total billed charges for outpatient setting,41.04,48% of toatl Billed Charges for Outpatient Setting,31.25,100% of BCBS Fee Schedule for Outpatient Setting,31.25,100% of BCBS Fee Schedule for Outpatient Setting,34.69,111% of BCBS Fee Schedule for Outpatient Setting,42.75,Case rate,59.85,70% of Total Billed charges for Outpatient setting,41.45,48.48% of total Billed Charges for Outpatient Setting,41.45,48.48% of total Billed Charges for Outpatient Setting,41.45,48.48% of total Billed Charges for Outpatient Setting,59.85,70% of Total Billed charges for Outpatient setting,59.85,70% of Total Billed charges for Outpatient setting,41.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,41.45,48.48% of total Billed Charges for Outpatient Setting,76.95,90% of Total Billed charges for Outpatient setting,31.25,76.95,64.13
Outpatient Medical Services,LAB,87070,87070 Culture othr specimn aerobic,306,183.75,110.25,60% of total billed charges for outpatient setting,88.2,48% of toatl Billed Charges for Outpatient Setting,26.08,100% of BCBS Fee Schedule for Outpatient Setting,26.08,100% of BCBS Fee Schedule for Outpatient Setting,28.95,111% of BCBS Fee Schedule for Outpatient Setting,91.88,Case rate,128.63,70% of Total Billed charges for Outpatient setting,89.08,48.48% of total Billed Charges for Outpatient Setting,89.08,48.48% of total Billed Charges for Outpatient Setting,89.08,48.48% of total Billed Charges for Outpatient Setting,128.63,70% of Total Billed charges for Outpatient setting,128.63,70% of Total Billed charges for Outpatient setting,88.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,89.08,48.48% of total Billed Charges for Outpatient Setting,165.38,90% of Total Billed charges for Outpatient setting,26.08,165.38,137.81
Outpatient Medical Services,LAB,87077,87077 Culture aerobic identify,300,83.75,50.25,60% of total billed charges for outpatient setting,40.2,48% of toatl Billed Charges for Outpatient Setting,24.48,100% of BCBS Fee Schedule for Outpatient Setting,24.48,100% of BCBS Fee Schedule for Outpatient Setting,27.17,111% of BCBS Fee Schedule for Outpatient Setting,41.88,Case rate,58.63,70% of Total Billed charges for Outpatient setting,40.6,48.48% of total Billed Charges for Outpatient Setting,40.6,48.48% of total Billed Charges for Outpatient Setting,40.6,48.48% of total Billed Charges for Outpatient Setting,58.63,70% of Total Billed charges for Outpatient setting,58.63,70% of Total Billed charges for Outpatient setting,40.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,40.6,48.48% of total Billed Charges for Outpatient Setting,75.38,90% of Total Billed charges for Outpatient setting,24.48,75.38,62.81
Outpatient Medical Services,LAB,87086,87086 Urine culture/colony count,300,75,45,60% of total billed charges for outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,24.45,100% of BCBS Fee Schedule for Outpatient Setting,24.45,100% of BCBS Fee Schedule for Outpatient Setting,27.14,111% of BCBS Fee Schedule for Outpatient Setting,37.5,Case rate,52.5,70% of Total Billed charges for Outpatient setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,36.36,48.48% of total Billed Charges for Outpatient Setting,52.5,70% of Total Billed charges for Outpatient setting,52.5,70% of Total Billed charges for Outpatient setting,36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,36.36,48.48% of total Billed Charges for Outpatient Setting,67.5,90% of Total Billed charges for Outpatient setting,24.45,67.5,56.25
Outpatient Medical Services,LAB,87186,87186 Microbe susceptible mic,300,93.75,56.25,60% of total billed charges for outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,26.19,100% of BCBS Fee Schedule for Outpatient Setting,26.19,100% of BCBS Fee Schedule for Outpatient Setting,29.07,111% of BCBS Fee Schedule for Outpatient Setting,46.88,Case rate,65.63,70% of Total Billed charges for Outpatient setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,65.63,70% of Total Billed charges for Outpatient setting,65.63,70% of Total Billed charges for Outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,45.45,48.48% of total Billed Charges for Outpatient Setting,84.38,90% of Total Billed charges for Outpatient setting,26.19,84.38,70.31
Outpatient Medical Services,LAB,87205,87205 Smear gram stain,306,41.5,24.9,60% of total billed charges for outpatient setting,19.92,48% of toatl Billed Charges for Outpatient Setting,12.91,100% of BCBS Fee Schedule for Outpatient Setting,12.91,100% of BCBS Fee Schedule for Outpatient Setting,14.33,111% of BCBS Fee Schedule for Outpatient Setting,20.75,Case rate,29.05,70% of Total Billed charges for Outpatient setting,20.12,48.48% of total Billed Charges for Outpatient Setting,20.12,48.48% of total Billed Charges for Outpatient Setting,20.12,48.48% of total Billed Charges for Outpatient Setting,29.05,70% of Total Billed charges for Outpatient setting,29.05,70% of Total Billed charges for Outpatient setting,19.92,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,20.12,48.48% of total Billed Charges for Outpatient Setting,37.35,90% of Total Billed charges for Outpatient setting,12.91,37.35,31.13
Outpatient Medical Services,LAB,87340,87340 Hepatitis b surface ag ia,300,75.5,45.3,60% of total billed charges for outpatient setting,36.24,48% of toatl Billed Charges for Outpatient Setting,31.28,100% of BCBS Fee Schedule for Outpatient Setting,31.28,100% of BCBS Fee Schedule for Outpatient Setting,34.72,111% of BCBS Fee Schedule for Outpatient Setting,37.75,Case rate,52.85,70% of Total Billed charges for Outpatient setting,36.6,48.48% of total Billed Charges for Outpatient Setting,36.6,48.48% of total Billed Charges for Outpatient Setting,36.6,48.48% of total Billed Charges for Outpatient Setting,52.85,70% of Total Billed charges for Outpatient setting,52.85,70% of Total Billed charges for Outpatient setting,36.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,36.6,48.48% of total Billed Charges for Outpatient Setting,67.95,90% of Total Billed charges for Outpatient setting,31.28,67.95,56.63
Outpatient Medical Services,LAB,87389,87389 Hiv-1 ag w/hiv-1 & hiv-2 ab,300,260,156,60% of total billed charges for outpatient setting,124.8,48% of toatl Billed Charges for Outpatient Setting,58.26,100% of BCBS Fee Schedule for Outpatient Setting,58.26,100% of BCBS Fee Schedule for Outpatient Setting,64.67,111% of BCBS Fee Schedule for Outpatient Setting,130,Case rate,182,70% of Total Billed charges for Outpatient setting,126.05,48.48% of total Billed Charges for Outpatient Setting,126.05,48.48% of total Billed Charges for Outpatient Setting,126.05,48.48% of total Billed Charges for Outpatient Setting,182,70% of Total Billed charges for Outpatient setting,182,70% of Total Billed charges for Outpatient setting,124.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,126.05,48.48% of total Billed Charges for Outpatient Setting,234,90% of Total Billed charges for Outpatient setting,58.26,234,156
Outpatient Medical Services,LAB,87491,87491 Chylmd trach dna amp probe,306,65,39,60% of total billed charges for outpatient setting,31.2,48% of toatl Billed Charges for Outpatient Setting,106.32,100% of BCBS Fee Schedule for Outpatient Setting,106.32,100% of BCBS Fee Schedule for Outpatient Setting,118.02,111% of BCBS Fee Schedule for Outpatient Setting,32.5,Case rate,45.5,70% of Total Billed charges for Outpatient setting,31.51,48.48% of total Billed Charges for Outpatient Setting,31.51,48.48% of total Billed Charges for Outpatient Setting,31.51,48.48% of total Billed Charges for Outpatient Setting,45.5,70% of Total Billed charges for Outpatient setting,45.5,70% of Total Billed charges for Outpatient setting,31.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,31.51,48.48% of total Billed Charges for Outpatient Setting,58.5,90% of Total Billed charges for Outpatient setting,31.2,118.02,48.75
Outpatient Medical Services,LAB,87493,87493 C diff amplified probe,300,156.5,93.9,60% of total billed charges for outpatient setting,75.12,48% of toatl Billed Charges for Outpatient Setting,75.68,100% of BCBS Fee Schedule for Outpatient Setting,75.68,100% of BCBS Fee Schedule for Outpatient Setting,84,111% of BCBS Fee Schedule for Outpatient Setting,78.25,Case rate,109.55,70% of Total Billed charges for Outpatient setting,75.87,48.48% of total Billed Charges for Outpatient Setting,75.87,48.48% of total Billed Charges for Outpatient Setting,75.87,48.48% of total Billed Charges for Outpatient Setting,109.55,70% of Total Billed charges for Outpatient setting,109.55,70% of Total Billed charges for Outpatient setting,75.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,75.87,48.48% of total Billed Charges for Outpatient Setting,140.85,90% of Total Billed charges for Outpatient setting,75.12,140.85,117.38
Outpatient Medical Services,LAB,87522,87522 Hepatitis c revrs trnscrpj,300,352.5,211.5,60% of total billed charges for outpatient setting,169.2,48% of toatl Billed Charges for Outpatient Setting,129.73,100% of BCBS Fee Schedule for Outpatient Setting,129.73,100% of BCBS Fee Schedule for Outpatient Setting,144,111% of BCBS Fee Schedule for Outpatient Setting,176.25,Case rate,246.75,70% of Total Billed charges for Outpatient setting,170.89,48.48% of total Billed Charges for Outpatient Setting,170.89,48.48% of total Billed Charges for Outpatient Setting,170.89,48.48% of total Billed Charges for Outpatient Setting,246.75,70% of Total Billed charges for Outpatient setting,246.75,70% of Total Billed charges for Outpatient setting,169.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,170.89,48.48% of total Billed Charges for Outpatient Setting,317.25,90% of Total Billed charges for Outpatient setting,129.73,317.25,211.5
Outpatient Medical Services,LAB,87591,87591 N.gonorrhoeae dna amp prob,300,65,39,60% of total billed charges for outpatient setting,31.2,48% of toatl Billed Charges for Outpatient Setting,106.32,100% of BCBS Fee Schedule for Outpatient Setting,106.32,100% of BCBS Fee Schedule for Outpatient Setting,118.02,111% of BCBS Fee Schedule for Outpatient Setting,32.5,Case rate,45.5,70% of Total Billed charges for Outpatient setting,31.51,48.48% of total Billed Charges for Outpatient Setting,31.51,48.48% of total Billed Charges for Outpatient Setting,31.51,48.48% of total Billed Charges for Outpatient Setting,45.5,70% of Total Billed charges for Outpatient setting,45.5,70% of Total Billed charges for Outpatient setting,31.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,31.51,48.48% of total Billed Charges for Outpatient Setting,58.5,90% of Total Billed charges for Outpatient setting,31.2,118.02,48.75
Outpatient Medical Services,LAB,87641,87641 Mr-staph dna amp probe,300,50,30,60% of total billed charges for outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,89.72,100% of BCBS Fee Schedule for Outpatient Setting,89.72,100% of BCBS Fee Schedule for Outpatient Setting,99.59,111% of BCBS Fee Schedule for Outpatient Setting,25,Case rate,35,70% of Total Billed charges for Outpatient setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,24.24,48.48% of total Billed Charges for Outpatient Setting,35,70% of Total Billed charges for Outpatient setting,35,70% of Total Billed charges for Outpatient setting,24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,24.24,48.48% of total Billed Charges for Outpatient Setting,45,90% of Total Billed charges for Outpatient setting,24,99.59,37.5
Outpatient Medical Services,LAB,G0103,G0103 Psa screening,300,125.5,75.3,60% of total billed charges for outpatient setting,60.24,48% of toatl Billed Charges for Outpatient Setting,55.71,100% of BCBS Fee Schedule for Outpatient Setting,55.71,100% of BCBS Fee Schedule for Outpatient Setting,61.84,111% of BCBS Fee Schedule for Outpatient Setting,62.75,Case rate,87.85,70% of Total Billed charges for Outpatient setting,60.84,48.48% of total Billed Charges for Outpatient Setting,60.84,48.48% of total Billed Charges for Outpatient Setting,60.84,48.48% of total Billed Charges for Outpatient Setting,87.85,70% of Total Billed charges for Outpatient setting,87.85,70% of Total Billed charges for Outpatient setting,60.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,60.84,48.48% of total Billed Charges for Outpatient Setting,112.95,90% of Total Billed charges for Outpatient setting,55.71,112.95,94.13
Outpatient Medical Services,RADIOLOGY,74178,"CT, Abdomen and Pelvis 1 or more Regions GLR",350,2328,1396.8,60% of total billed charges for outpatient setting,1117.44,48% of toatl Billed Charges for Outpatient Setting,857.07,100% of BCBS Fee Schedule for Outpatient Setting,857.07,100% of BCBS Fee Schedule for Outpatient Setting,951.35,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1629.6,70% of Total Billed charges for Outpatient setting,1128.61,48.48% of total Billed Charges for Outpatient Setting,1128.61,48.48% of total Billed Charges for Outpatient Setting,1128.61,48.48% of total Billed Charges for Outpatient Setting,1629.6,70% of Total Billed charges for Outpatient setting,1629.6,70% of Total Billed charges for Outpatient setting,1117.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1128.61,48.48% of total Billed Charges for Outpatient Setting,2095.2,90% of Total Billed charges for Outpatient setting,450,2095.2,1396.8
Outpatient Medical Services,RADIOLOGY,74178,"CT, Abdomen and Pelvis 1 or more Regions PFR",972,494,N/A,Not Applicable.Service not offered,325.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,229.12,100% of Cigna Fee Schedule for Outpatient Setting,358.57,110% of Physician Fee Schedule for Outpatient setting,329.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,329.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,329.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,358.57,110% of Physician Fee Schedule for Outpatient setting,358.57,110% of Physician Fee Schedule for Outpatient setting,325.97,100% of Physician Fee Schedule for Outpatient Setting,488.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,325.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,488.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,229.12,488.96,296.4
Outpatient Medical Services,RADIOLOGY,74160,"CT, Abdomen with contrast GLR",350,1743,1045.8,60% of total billed charges for outpatient setting,836.64,48% of toatl Billed Charges for Outpatient Setting,513.42,100% of BCBS Fee Schedule for Outpatient Setting,513.42,100% of BCBS Fee Schedule for Outpatient Setting,569.9,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1220.1,70% of Total Billed charges for Outpatient setting,845.01,48.48% of total Billed Charges for Outpatient Setting,845.01,48.48% of total Billed Charges for Outpatient Setting,845.01,48.48% of total Billed Charges for Outpatient Setting,1220.1,70% of Total Billed charges for Outpatient setting,1220.1,70% of Total Billed charges for Outpatient setting,836.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,845.01,48.48% of total Billed Charges for Outpatient Setting,1568.7,90% of Total Billed charges for Outpatient setting,450,1568.7,1045.8
Outpatient Medical Services,RADIOLOGY,74160,"CT, Abdomen with contrast PFR",972,315,N/A,Not Applicable.Service not offered,223.44,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,149.53,100% of Cigna Fee Schedule for Outpatient Setting,245.78,110% of Physician Fee Schedule for Outpatient setting,225.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,225.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,225.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,245.78,110% of Physician Fee Schedule for Outpatient setting,245.78,110% of Physician Fee Schedule for Outpatient setting,223.44,100% of Physician Fee Schedule for Outpatient Setting,335.16,150% of CMS RBRVS Fee Schedule for Outpatient Setting,223.44,100% of CMS RBRVS Fee Schedule for Outpatient Setting,335.16,150% of CMS RBRVS Fee Schedule for Outpatient Setting,149.53,335.16,189
Outpatient Medical Services,RADIOLOGY,74170,"CT, Abdomen with/without contrast GLR",350,2685,1611,60% of total billed charges for outpatient setting,1288.8,48% of toatl Billed Charges for Outpatient Setting,615.7,100% of BCBS Fee Schedule for Outpatient Setting,615.7,100% of BCBS Fee Schedule for Outpatient Setting,683.43,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1879.5,70% of Total Billed charges for Outpatient setting,1301.69,48.48% of total Billed Charges for Outpatient Setting,1301.69,48.48% of total Billed Charges for Outpatient Setting,1301.69,48.48% of total Billed Charges for Outpatient Setting,1879.5,70% of Total Billed charges for Outpatient setting,1879.5,70% of Total Billed charges for Outpatient setting,1288.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1301.69,48.48% of total Billed Charges for Outpatient Setting,2416.5,90% of Total Billed charges for Outpatient setting,450,2416.5,1611
Outpatient Medical Services,RADIOLOGY,74170,"CT, Abdomen with/without contrast PFR",972,347,N/A,Not Applicable.Service not offered,250.41,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,169.81,100% of Cigna Fee Schedule for Outpatient Setting,275.45,110% of Physician Fee Schedule for Outpatient setting,252.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,252.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,252.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,275.45,110% of Physician Fee Schedule for Outpatient setting,275.45,110% of Physician Fee Schedule for Outpatient setting,250.41,100% of Physician Fee Schedule for Outpatient Setting,375.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,250.41,100% of CMS RBRVS Fee Schedule for Outpatient Setting,375.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,169.81,375.62,208.2
Outpatient Medical Services,RADIOLOGY,74150,"CT, Abdomen without contrast GLR",350,1462,877.2,60% of total billed charges for outpatient setting,701.76,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1023.4,70% of Total Billed charges for Outpatient setting,708.78,48.48% of total Billed Charges for Outpatient Setting,708.78,48.48% of total Billed Charges for Outpatient Setting,708.78,48.48% of total Billed Charges for Outpatient Setting,1023.4,70% of Total Billed charges for Outpatient setting,1023.4,70% of Total Billed charges for Outpatient setting,701.76,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,708.78,48.48% of total Billed Charges for Outpatient Setting,1315.8,90% of Total Billed charges for Outpatient setting,381.19,1315.8,877.2
Outpatient Medical Services,RADIOLOGY,74150,"CT, Abdomen without contrast PFR",972,294,N/A,Not Applicable.Service not offered,131.5,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,98.27,100% of Cigna Fee Schedule for Outpatient Setting,144.65,110% of Physician Fee Schedule for Outpatient setting,132.82,101% of CMS RBRVS Fee Schedule for Outpatient Setting,132.82,101% of CMS RBRVS Fee Schedule for Outpatient Setting,132.82,101% of CMS RBRVS Fee Schedule for Outpatient Setting,144.65,110% of Physician Fee Schedule for Outpatient setting,144.65,110% of Physician Fee Schedule for Outpatient setting,131.5,100% of Physician Fee Schedule for Outpatient Setting,197.25,150% of CMS RBRVS Fee Schedule for Outpatient Setting,131.5,100% of CMS RBRVS Fee Schedule for Outpatient Setting,197.25,150% of CMS RBRVS Fee Schedule for Outpatient Setting,98.27,197.25,176.4
Outpatient Medical Services,RADIOLOGY,70460,"CT, Head/Brain with contrast GLR",350,1387.5,832.5,60% of total billed charges for outpatient setting,666,48% of toatl Billed Charges for Outpatient Setting,425.03,100% of BCBS Fee Schedule for Outpatient Setting,425.03,100% of BCBS Fee Schedule for Outpatient Setting,471.78,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,971.25,70% of Total Billed charges for Outpatient setting,672.66,48.48% of total Billed Charges for Outpatient Setting,672.66,48.48% of total Billed Charges for Outpatient Setting,672.66,48.48% of total Billed Charges for Outpatient Setting,971.25,70% of Total Billed charges for Outpatient setting,971.25,70% of Total Billed charges for Outpatient setting,666,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,672.66,48.48% of total Billed Charges for Outpatient Setting,1248.75,90% of Total Billed charges for Outpatient setting,425.03,1248.75,832.5
Outpatient Medical Services,RADIOLOGY,70460,"CT, Head/Brain with contrast PFR",972,257,N/A,Not Applicable.Service not offered,141.63,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,105.82,100% of Cigna Fee Schedule for Outpatient Setting,155.79,110% of Physician Fee Schedule for Outpatient setting,143.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,143.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,143.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,155.79,110% of Physician Fee Schedule for Outpatient setting,155.79,110% of Physician Fee Schedule for Outpatient setting,141.63,100% of Physician Fee Schedule for Outpatient Setting,212.45,150% of CMS RBRVS Fee Schedule for Outpatient Setting,141.63,100% of CMS RBRVS Fee Schedule for Outpatient Setting,212.45,150% of CMS RBRVS Fee Schedule for Outpatient Setting,105.82,212.45,154.2
Outpatient Medical Services,RADIOLOGY,73701,"CT, Lower Extremity with contrast GLR",350,1275,765,60% of total billed charges for outpatient setting,612,48% of toatl Billed Charges for Outpatient Setting,443.53,100% of BCBS Fee Schedule for Outpatient Setting,443.53,100% of BCBS Fee Schedule for Outpatient Setting,492.32,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,892.5,70% of Total Billed charges for Outpatient setting,618.12,48.48% of total Billed Charges for Outpatient Setting,618.12,48.48% of total Billed Charges for Outpatient Setting,618.12,48.48% of total Billed Charges for Outpatient Setting,892.5,70% of Total Billed charges for Outpatient setting,892.5,70% of Total Billed charges for Outpatient setting,612,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,618.12,48.48% of total Billed Charges for Outpatient Setting,1147.5,90% of Total Billed charges for Outpatient setting,443.53,1147.5,765
Outpatient Medical Services,RADIOLOGY,73701,"CT, Lower Extremity with contrast PFR",972,211,N/A,Not Applicable.Service not offered,159.37,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,146.09,100% of Cigna Fee Schedule for Outpatient Setting,175.31,110% of Physician Fee Schedule for Outpatient setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,175.31,110% of Physician Fee Schedule for Outpatient setting,175.31,110% of Physician Fee Schedule for Outpatient setting,159.37,100% of Physician Fee Schedule for Outpatient Setting,239.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,159.37,100% of CMS RBRVS Fee Schedule for Outpatient Setting,239.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,146.09,239.06,126.6
Outpatient Medical Services,RADIOLOGY,73702,"CT, Lower Extremity with/without contrast",350,2087,1252.2,60% of total billed charges for outpatient setting,1001.76,48% of toatl Billed Charges for Outpatient Setting,556.93,100% of BCBS Fee Schedule for Outpatient Setting,556.93,100% of BCBS Fee Schedule for Outpatient Setting,618.19,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1460.9,70% of Total Billed charges for Outpatient setting,1011.78,48.48% of total Billed Charges for Outpatient Setting,1011.78,48.48% of total Billed Charges for Outpatient Setting,1011.78,48.48% of total Billed Charges for Outpatient Setting,1460.9,70% of Total Billed charges for Outpatient setting,1460.9,70% of Total Billed charges for Outpatient setting,1001.76,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1011.78,48.48% of total Billed Charges for Outpatient Setting,1878.3,90% of Total Billed charges for Outpatient setting,450,1878.3,1252.2
Outpatient Medical Services,RADIOLOGY,73702,"CT, Lower Extremity with/without contrast",972,302,N/A,Not Applicable.Service not offered,186.04,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,176.35,100% of Cigna Fee Schedule for Outpatient Setting,204.64,110% of Physician Fee Schedule for Outpatient setting,187.9,101% of CMS RBRVS Fee Schedule for Outpatient Setting,187.9,101% of CMS RBRVS Fee Schedule for Outpatient Setting,187.9,101% of CMS RBRVS Fee Schedule for Outpatient Setting,204.64,110% of Physician Fee Schedule for Outpatient setting,204.64,110% of Physician Fee Schedule for Outpatient setting,186.04,100% of Physician Fee Schedule for Outpatient Setting,279.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,186.04,100% of CMS RBRVS Fee Schedule for Outpatient Setting,279.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,176.35,279.06,181.2
Outpatient Medical Services,RADIOLOGY,73700,"CT, Lower Extremity without contrast GLR",350,1137.5,682.5,60% of total billed charges for outpatient setting,546,48% of toatl Billed Charges for Outpatient Setting,371.34,100% of BCBS Fee Schedule for Outpatient Setting,371.34,100% of BCBS Fee Schedule for Outpatient Setting,412.19,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,796.25,70% of Total Billed charges for Outpatient setting,551.46,48.48% of total Billed Charges for Outpatient Setting,551.46,48.48% of total Billed Charges for Outpatient Setting,551.46,48.48% of total Billed Charges for Outpatient Setting,796.25,70% of Total Billed charges for Outpatient setting,796.25,70% of Total Billed charges for Outpatient setting,546,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,551.46,48.48% of total Billed Charges for Outpatient Setting,1023.75,90% of Total Billed charges for Outpatient setting,371.34,1023.75,682.5
Outpatient Medical Services,RADIOLOGY,73700,"CT, Lower Extremity without contrast PFR",972,247,N/A,Not Applicable.Service not offered,123.69,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,116.59,100% of Cigna Fee Schedule for Outpatient Setting,136.06,110% of Physician Fee Schedule for Outpatient setting,124.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,124.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,124.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,136.06,110% of Physician Fee Schedule for Outpatient setting,136.06,110% of Physician Fee Schedule for Outpatient setting,123.69,100% of Physician Fee Schedule for Outpatient Setting,185.54,150% of CMS RBRVS Fee Schedule for Outpatient Setting,123.69,100% of CMS RBRVS Fee Schedule for Outpatient Setting,185.54,150% of CMS RBRVS Fee Schedule for Outpatient Setting,116.59,185.54,148.2
Outpatient Medical Services,RADIOLOGY,72131,"CT, Lumbar Spine without contrast GLR",350,1325,795,60% of total billed charges for outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,927.5,70% of Total Billed charges for Outpatient setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,927.5,70% of Total Billed charges for Outpatient setting,927.5,70% of Total Billed charges for Outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,642.36,48.48% of total Billed Charges for Outpatient Setting,1192.5,90% of Total Billed charges for Outpatient setting,381.19,1192.5,795
Outpatient Medical Services,RADIOLOGY,72131,"CT, Lumbar Spine without contrast PFR",972,247,N/A,Not Applicable.Service not offered,123.39,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,116.59,100% of Cigna Fee Schedule for Outpatient Setting,135.73,110% of Physician Fee Schedule for Outpatient setting,124.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,124.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,124.62,101% of CMS RBRVS Fee Schedule for Outpatient Setting,135.73,110% of Physician Fee Schedule for Outpatient setting,135.73,110% of Physician Fee Schedule for Outpatient setting,123.39,100% of Physician Fee Schedule for Outpatient Setting,185.09,150% of CMS RBRVS Fee Schedule for Outpatient Setting,123.39,100% of CMS RBRVS Fee Schedule for Outpatient Setting,185.09,150% of CMS RBRVS Fee Schedule for Outpatient Setting,116.59,185.09,148.2
Outpatient Medical Services,RADIOLOGY,70486,"CT, Maxillofacial without contrast GLR",350,1631,234,100% of Aetna Fee Schedule for Outpatient Setting,782.88,48% of toatl Billed Charges for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,393.42,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1141.7,70% of Total Billed charges for Outpatient setting,790.71,48.48% of total Billed Charges for Outpatient Setting,790.71,48.48% of total Billed Charges for Outpatient Setting,790.71,48.48% of total Billed Charges for Outpatient Setting,1141.7,70% of Total Billed charges for Outpatient setting,1141.7,70% of Total Billed charges for Outpatient setting,782.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,790.71,48.48% of total Billed Charges for Outpatient Setting,1467.9,90% of Total Billed charges for Outpatient setting,234,1467.9,978.6
Outpatient Medical Services,RADIOLOGY,70486,"CT, Maxillofacial without contrast PFR",972,213,N/A,Not Applicable.Service not offered,122.17,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,90.46,100% of Cigna Fee Schedule for Outpatient Setting,134.39,110% of Physician Fee Schedule for Outpatient setting,123.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,123.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,123.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,134.39,110% of Physician Fee Schedule for Outpatient setting,134.39,110% of Physician Fee Schedule for Outpatient setting,122.17,100% of Physician Fee Schedule for Outpatient Setting,183.26,150% of CMS RBRVS Fee Schedule for Outpatient Setting,122.17,100% of CMS RBRVS Fee Schedule for Outpatient Setting,183.26,150% of CMS RBRVS Fee Schedule for Outpatient Setting,90.46,183.26,127.8
Outpatient Medical Services,RADIOLOGY,72125,"CT, Neck Spine without contrast GLR",350,1325,795,60% of total billed charges for outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,927.5,70% of Total Billed charges for Outpatient setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,927.5,70% of Total Billed charges for Outpatient setting,927.5,70% of Total Billed charges for Outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,642.36,48.48% of total Billed Charges for Outpatient Setting,1192.5,90% of Total Billed charges for Outpatient setting,381.19,1192.5,795
Outpatient Medical Services,RADIOLOGY,72125,"CT, Neck Spine without contrast PFR",972,247,N/A,Not Applicable.Service not offered,123.99,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,119.91,100% of Cigna Fee Schedule for Outpatient Setting,136.39,110% of Physician Fee Schedule for Outpatient setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,136.39,110% of Physician Fee Schedule for Outpatient setting,136.39,110% of Physician Fee Schedule for Outpatient setting,123.99,100% of Physician Fee Schedule for Outpatient Setting,185.99,150% of CMS RBRVS Fee Schedule for Outpatient Setting,123.99,100% of CMS RBRVS Fee Schedule for Outpatient Setting,185.99,150% of CMS RBRVS Fee Schedule for Outpatient Setting,119.91,185.99,148.2
Outpatient Medical Services,RADIOLOGY,70480,"CT, Orb/Sel/PF/Ear without contrast GLR",350,1137.5,682.5,60% of total billed charges for outpatient setting,546,48% of toatl Billed Charges for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,393.42,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,796.25,70% of Total Billed charges for Outpatient setting,551.46,48.48% of total Billed Charges for Outpatient Setting,551.46,48.48% of total Billed Charges for Outpatient Setting,551.46,48.48% of total Billed Charges for Outpatient Setting,796.25,70% of Total Billed charges for Outpatient setting,796.25,70% of Total Billed charges for Outpatient setting,546,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,551.46,48.48% of total Billed Charges for Outpatient Setting,1023.75,90% of Total Billed charges for Outpatient setting,354.43,1023.75,682.5
Outpatient Medical Services,RADIOLOGY,70480,"CT, Orb/Sel/PF/Ear without contrast PFR",972,319,N/A,Not Applicable.Service not offered,152.15,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,150.89,100% of Cigna Fee Schedule for Outpatient Setting,167.37,110% of Physician Fee Schedule for Outpatient setting,153.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,153.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,153.67,101% of CMS RBRVS Fee Schedule for Outpatient Setting,167.37,110% of Physician Fee Schedule for Outpatient setting,167.37,110% of Physician Fee Schedule for Outpatient setting,152.15,100% of Physician Fee Schedule for Outpatient Setting,228.23,150% of CMS RBRVS Fee Schedule for Outpatient Setting,152.15,100% of CMS RBRVS Fee Schedule for Outpatient Setting,228.23,150% of CMS RBRVS Fee Schedule for Outpatient Setting,150.89,228.23,191.4
Outpatient Medical Services,RADIOLOGY,72194,"CT, Pelvis with/without contrast GLR",350,2200,1320,60% of total billed charges for outpatient setting,1056,48% of toatl Billed Charges for Outpatient Setting,615.7,100% of BCBS Fee Schedule for Outpatient Setting,615.7,100% of BCBS Fee Schedule for Outpatient Setting,683.43,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1540,70% of Total Billed charges for Outpatient setting,1066.56,48.48% of total Billed Charges for Outpatient Setting,1066.56,48.48% of total Billed Charges for Outpatient Setting,1066.56,48.48% of total Billed Charges for Outpatient Setting,1540,70% of Total Billed charges for Outpatient setting,1540,70% of Total Billed charges for Outpatient setting,1056,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1066.56,48.48% of total Billed Charges for Outpatient Setting,1980,90% of Total Billed charges for Outpatient setting,450,1980,1320
Outpatient Medical Services,RADIOLOGY,72194,"CT, Pelvis with/without contrast PFR",972,315,N/A,Not Applicable.Service not offered,241.25,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,167.66,100% of Cigna Fee Schedule for Outpatient Setting,265.38,110% of Physician Fee Schedule for Outpatient setting,243.66,101% of CMS RBRVS Fee Schedule for Outpatient Setting,243.66,101% of CMS RBRVS Fee Schedule for Outpatient Setting,243.66,101% of CMS RBRVS Fee Schedule for Outpatient Setting,265.38,110% of Physician Fee Schedule for Outpatient setting,265.38,110% of Physician Fee Schedule for Outpatient setting,241.25,100% of Physician Fee Schedule for Outpatient Setting,361.88,150% of CMS RBRVS Fee Schedule for Outpatient Setting,241.25,100% of CMS RBRVS Fee Schedule for Outpatient Setting,361.88,150% of CMS RBRVS Fee Schedule for Outpatient Setting,167.66,361.88,189
Outpatient Medical Services,RADIOLOGY,72192,"CT, Pelvis without contrast GLR",350,1325,795,60% of total billed charges for outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,927.5,70% of Total Billed charges for Outpatient setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,927.5,70% of Total Billed charges for Outpatient setting,927.5,70% of Total Billed charges for Outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,642.36,48.48% of total Billed Charges for Outpatient Setting,1192.5,90% of Total Billed charges for Outpatient setting,381.19,1192.5,795
Outpatient Medical Services,RADIOLOGY,72192,"CT, Pelvis without contrast PFR",972,268,N/A,Not Applicable.Service not offered,127.81,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,95.68,100% of Cigna Fee Schedule for Outpatient Setting,140.59,110% of Physician Fee Schedule for Outpatient setting,129.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,129.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,129.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,140.59,110% of Physician Fee Schedule for Outpatient setting,140.59,110% of Physician Fee Schedule for Outpatient setting,127.81,100% of Physician Fee Schedule for Outpatient Setting,191.72,150% of CMS RBRVS Fee Schedule for Outpatient Setting,127.81,100% of CMS RBRVS Fee Schedule for Outpatient Setting,191.72,150% of CMS RBRVS Fee Schedule for Outpatient Setting,95.68,191.72,160.8
Outpatient Medical Services,RADIOLOGY,70491,"CT, Soft Tissue Neck, with contrast GLR",350,1500,900,60% of total billed charges for outpatient setting,720,48% of toatl Billed Charges for Outpatient Setting,425.03,100% of BCBS Fee Schedule for Outpatient Setting,425.03,100% of BCBS Fee Schedule for Outpatient Setting,471.78,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1050,70% of Total Billed charges for Outpatient setting,727.2,48.48% of total Billed Charges for Outpatient Setting,727.2,48.48% of total Billed Charges for Outpatient Setting,727.2,48.48% of total Billed Charges for Outpatient Setting,1050,70% of Total Billed charges for Outpatient setting,1050,70% of Total Billed charges for Outpatient setting,720,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,727.2,48.48% of total Billed Charges for Outpatient Setting,1350,90% of Total Billed charges for Outpatient setting,425.03,1350,900
Outpatient Medical Services,RADIOLOGY,70491,"CT, Soft Tissue Neck, with contrast PFR",972,367.85,N/A,Not Applicable.Service not offered,177,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,152.81,100% of Cigna Fee Schedule for Outpatient Setting,194.7,110% of Physician Fee Schedule for Outpatient setting,178.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,194.7,110% of Physician Fee Schedule for Outpatient setting,194.7,110% of Physician Fee Schedule for Outpatient setting,177,100% of Physician Fee Schedule for Outpatient Setting,265.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,177,100% of CMS RBRVS Fee Schedule for Outpatient Setting,265.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,152.81,265.5,220.71
Outpatient Medical Services,RADIOLOGY,70490,"CT, Soft Tissue Neck, without contrast GLR",350,1200,720,60% of total billed charges for outpatient setting,576,48% of toatl Billed Charges for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,354.43,100% of BCBS Fee Schedule for Outpatient Setting,393.42,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,840,70% of Total Billed charges for Outpatient setting,581.76,48.48% of total Billed Charges for Outpatient Setting,581.76,48.48% of total Billed Charges for Outpatient Setting,581.76,48.48% of total Billed Charges for Outpatient Setting,840,70% of Total Billed charges for Outpatient setting,840,70% of Total Billed charges for Outpatient setting,576,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,581.76,48.48% of total Billed Charges for Outpatient Setting,1080,90% of Total Billed charges for Outpatient setting,354.43,1080,720
Outpatient Medical Services,RADIOLOGY,70490,"CT, Soft Tissue Neck, without contrast PFR",972,316,N/A,Not Applicable.Service not offered,144.43,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,125.71,100% of Cigna Fee Schedule for Outpatient Setting,158.87,110% of Physician Fee Schedule for Outpatient setting,145.87,101% of CMS RBRVS Fee Schedule for Outpatient Setting,145.87,101% of CMS RBRVS Fee Schedule for Outpatient Setting,145.87,101% of CMS RBRVS Fee Schedule for Outpatient Setting,158.87,110% of Physician Fee Schedule for Outpatient setting,158.87,110% of Physician Fee Schedule for Outpatient setting,144.43,100% of Physician Fee Schedule for Outpatient Setting,216.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,144.43,100% of CMS RBRVS Fee Schedule for Outpatient Setting,216.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,125.71,216.65,189.6
Outpatient Medical Services,RADIOLOGY,72128,"CT, Thoracic Spine without contrast GLR",350,1325,795,60% of total billed charges for outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,927.5,70% of Total Billed charges for Outpatient setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,927.5,70% of Total Billed charges for Outpatient setting,927.5,70% of Total Billed charges for Outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,642.36,48.48% of total Billed Charges for Outpatient Setting,1192.5,90% of Total Billed charges for Outpatient setting,381.19,1192.5,795
Outpatient Medical Services,RADIOLOGY,72128,"CT, Thoracic Spine without contrast PFR",972,256,N/A,Not Applicable.Service not offered,123.99,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,117.04,100% of Cigna Fee Schedule for Outpatient Setting,136.39,110% of Physician Fee Schedule for Outpatient setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.23,101% of CMS RBRVS Fee Schedule for Outpatient Setting,136.39,110% of Physician Fee Schedule for Outpatient setting,136.39,110% of Physician Fee Schedule for Outpatient setting,123.99,100% of Physician Fee Schedule for Outpatient Setting,185.99,150% of CMS RBRVS Fee Schedule for Outpatient Setting,123.99,100% of CMS RBRVS Fee Schedule for Outpatient Setting,185.99,150% of CMS RBRVS Fee Schedule for Outpatient Setting,117.04,185.99,153.6
Outpatient Medical Services,RADIOLOGY,71260,"CT, Thorax with contrast GLR",350,2673,1603.8,60% of total billed charges for outpatient setting,1283.04,48% of toatl Billed Charges for Outpatient Setting,517.63,100% of BCBS Fee Schedule for Outpatient Setting,517.63,100% of BCBS Fee Schedule for Outpatient Setting,574.57,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1871.1,70% of Total Billed charges for Outpatient setting,1295.87,48.48% of total Billed Charges for Outpatient Setting,1295.87,48.48% of total Billed Charges for Outpatient Setting,1295.87,48.48% of total Billed Charges for Outpatient Setting,1871.1,70% of Total Billed charges for Outpatient setting,1871.1,70% of Total Billed charges for Outpatient setting,1283.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1295.87,48.48% of total Billed Charges for Outpatient Setting,2405.7,90% of Total Billed charges for Outpatient setting,450,2405.7,1603.8
Outpatient Medical Services,RADIOLOGY,71260,"CT, Thorax with contrast PFR",972,308,N/A,Not Applicable.Service not offered,159.37,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,148.55,100% of Cigna Fee Schedule for Outpatient Setting,175.31,110% of Physician Fee Schedule for Outpatient setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,160.96,101% of CMS RBRVS Fee Schedule for Outpatient Setting,175.31,110% of Physician Fee Schedule for Outpatient setting,175.31,110% of Physician Fee Schedule for Outpatient setting,159.37,100% of Physician Fee Schedule for Outpatient Setting,239.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,159.37,100% of CMS RBRVS Fee Schedule for Outpatient Setting,239.06,150% of CMS RBRVS Fee Schedule for Outpatient Setting,148.55,239.06,184.8
Outpatient Medical Services,RADIOLOGY,71250,"CT, Thorax without contrast GLR",350,2100,1260,60% of total billed charges for outpatient setting,1008,48% of toatl Billed Charges for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,381.19,100% of BCBS Fee Schedule for Outpatient Setting,423.12,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1470,70% of Total Billed charges for Outpatient setting,1018.08,48.48% of total Billed Charges for Outpatient Setting,1018.08,48.48% of total Billed Charges for Outpatient Setting,1018.08,48.48% of total Billed Charges for Outpatient Setting,1470,70% of Total Billed charges for Outpatient setting,1470,70% of Total Billed charges for Outpatient setting,1008,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1018.08,48.48% of total Billed Charges for Outpatient Setting,1890,90% of Total Billed charges for Outpatient setting,381.19,1890,1260
Outpatient Medical Services,RADIOLOGY,71250,"CT, Thorax without contrast PFR",972,285,N/A,Not Applicable.Service not offered,127.77,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,117.09,100% of Cigna Fee Schedule for Outpatient Setting,140.55,110% of Physician Fee Schedule for Outpatient setting,129.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,129.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,129.05,101% of CMS RBRVS Fee Schedule for Outpatient Setting,140.55,110% of Physician Fee Schedule for Outpatient setting,140.55,110% of Physician Fee Schedule for Outpatient setting,127.77,100% of Physician Fee Schedule for Outpatient Setting,191.66,150% of CMS RBRVS Fee Schedule for Outpatient Setting,127.77,100% of CMS RBRVS Fee Schedule for Outpatient Setting,191.66,150% of CMS RBRVS Fee Schedule for Outpatient Setting,117.09,191.66,171
Outpatient Medical Services,RADIOLOGY,73201,"CT, Upper Extremity with contrast GLR",350,1482.5,889.5,60% of total billed charges for outpatient setting,711.6,48% of toatl Billed Charges for Outpatient Setting,443.53,100% of BCBS Fee Schedule for Outpatient Setting,443.53,100% of BCBS Fee Schedule for Outpatient Setting,492.32,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1037.75,70% of Total Billed charges for Outpatient setting,718.72,48.48% of total Billed Charges for Outpatient Setting,718.72,48.48% of total Billed Charges for Outpatient Setting,718.72,48.48% of total Billed Charges for Outpatient Setting,1037.75,70% of Total Billed charges for Outpatient setting,1037.75,70% of Total Billed charges for Outpatient setting,711.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,718.72,48.48% of total Billed Charges for Outpatient Setting,1334.25,90% of Total Billed charges for Outpatient setting,443.53,1334.25,889.5
Outpatient Medical Services,RADIOLOGY,73201,"CT, Upper Extremity with contrast PFR",972,247,N/A,Not Applicable.Service not offered,192.02,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,143.87,100% of Cigna Fee Schedule for Outpatient Setting,211.22,110% of Physician Fee Schedule for Outpatient setting,193.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,193.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,193.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,211.22,110% of Physician Fee Schedule for Outpatient setting,211.22,110% of Physician Fee Schedule for Outpatient setting,192.02,100% of Physician Fee Schedule for Outpatient Setting,288.03,150% of CMS RBRVS Fee Schedule for Outpatient Setting,192.02,100% of CMS RBRVS Fee Schedule for Outpatient Setting,288.03,150% of CMS RBRVS Fee Schedule for Outpatient Setting,143.87,288.03,148.2
Outpatient Medical Services,RADIOLOGY,73202,"CT, Upper Extremity with/without contrast GLR",350,2083,1249.8,60% of total billed charges for outpatient setting,999.84,48% of toatl Billed Charges for Outpatient Setting,556.93,100% of BCBS Fee Schedule for Outpatient Setting,556.93,100% of BCBS Fee Schedule for Outpatient Setting,618.19,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1458.1,70% of Total Billed charges for Outpatient setting,1009.84,48.48% of total Billed Charges for Outpatient Setting,1009.84,48.48% of total Billed Charges for Outpatient Setting,1009.84,48.48% of total Billed Charges for Outpatient Setting,1458.1,70% of Total Billed charges for Outpatient setting,1458.1,70% of Total Billed charges for Outpatient setting,999.84,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1009.84,48.48% of total Billed Charges for Outpatient Setting,1874.7,90% of Total Billed charges for Outpatient setting,450,1874.7,1249.8
Outpatient Medical Services,RADIOLOGY,73202,"CT, Upper Extremity with/without contrast PFR",972,247,N/A,Not Applicable.Service not offered,237.1,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,178.35,100% of Cigna Fee Schedule for Outpatient Setting,260.81,110% of Physician Fee Schedule for Outpatient setting,239.47,101% of CMS RBRVS Fee Schedule for Outpatient Setting,239.47,101% of CMS RBRVS Fee Schedule for Outpatient Setting,239.47,101% of CMS RBRVS Fee Schedule for Outpatient Setting,260.81,110% of Physician Fee Schedule for Outpatient setting,260.81,110% of Physician Fee Schedule for Outpatient setting,237.1,100% of Physician Fee Schedule for Outpatient Setting,355.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,237.1,100% of CMS RBRVS Fee Schedule for Outpatient Setting,355.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,178.35,355.65,148.2
Outpatient Medical Services,RADIOLOGY,73200,"CT, Upper Extremity without contrast GLR",350,1345,807,60% of total billed charges for outpatient setting,645.6,48% of toatl Billed Charges for Outpatient Setting,371.34,100% of BCBS Fee Schedule for Outpatient Setting,371.34,100% of BCBS Fee Schedule for Outpatient Setting,412.19,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,941.5,70% of Total Billed charges for Outpatient setting,652.06,48.48% of total Billed Charges for Outpatient Setting,652.06,48.48% of total Billed Charges for Outpatient Setting,652.06,48.48% of total Billed Charges for Outpatient Setting,941.5,70% of Total Billed charges for Outpatient setting,941.5,70% of Total Billed charges for Outpatient setting,645.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,652.06,48.48% of total Billed Charges for Outpatient Setting,1210.5,90% of Total Billed charges for Outpatient setting,371.34,1210.5,807
Outpatient Medical Services,RADIOLOGY,73200,"CT, Upper Extremity without contrast PFR",972,256,N/A,Not Applicable.Service not offered,153.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,116.37,100% of Cigna Fee Schedule for Outpatient Setting,169.37,110% of Physician Fee Schedule for Outpatient setting,155.51,101% of CMS RBRVS Fee Schedule for Outpatient Setting,155.51,101% of CMS RBRVS Fee Schedule for Outpatient Setting,155.51,101% of CMS RBRVS Fee Schedule for Outpatient Setting,169.37,110% of Physician Fee Schedule for Outpatient setting,169.37,110% of Physician Fee Schedule for Outpatient setting,153.97,100% of Physician Fee Schedule for Outpatient Setting,230.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,153.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,230.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,116.37,230.96,153.6
Outpatient Medical Services,RADIOLOGY,74176,"CTA, Abdomen and Pelvis without contrast GLR",350,1325,795,60% of total billed charges for outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,484.15,100% of BCBS Fee Schedule for Outpatient Setting,484.15,100% of BCBS Fee Schedule for Outpatient Setting,537.41,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,927.5,70% of Total Billed charges for Outpatient setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,642.36,48.48% of total Billed Charges for Outpatient Setting,927.5,70% of Total Billed charges for Outpatient setting,927.5,70% of Total Billed charges for Outpatient setting,636,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,642.36,48.48% of total Billed Charges for Outpatient Setting,1192.5,90% of Total Billed charges for Outpatient setting,450,1192.5,795
Outpatient Medical Services,RADIOLOGY,74176,"CTA, Abdomen and Pelvis without contrast PFR",972,430,N/A,Not Applicable.Service not offered,177.01,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,132.38,100% of Cigna Fee Schedule for Outpatient Setting,194.71,110% of Physician Fee Schedule for Outpatient setting,178.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,178.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,194.71,110% of Physician Fee Schedule for Outpatient setting,194.71,110% of Physician Fee Schedule for Outpatient setting,177.01,100% of Physician Fee Schedule for Outpatient Setting,265.52,150% of CMS RBRVS Fee Schedule for Outpatient Setting,177.01,100% of CMS RBRVS Fee Schedule for Outpatient Setting,265.52,150% of CMS RBRVS Fee Schedule for Outpatient Setting,132.38,265.52,258
Outpatient Medical Services,RADIOLOGY,76705,"US, Abdomen Limited GLR",402,542,325.2,60% of total billed charges for outpatient setting,260.16,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,271,Case rate,379.4,70% of Total Billed charges for Outpatient setting,262.76,48.48% of total Billed Charges for Outpatient Setting,262.76,48.48% of total Billed Charges for Outpatient Setting,262.76,48.48% of total Billed Charges for Outpatient Setting,379.4,70% of Total Billed charges for Outpatient setting,379.4,70% of Total Billed charges for Outpatient setting,260.16,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,262.76,48.48% of total Billed Charges for Outpatient Setting,487.8,90% of Total Billed charges for Outpatient setting,140.33,487.8,325.2
Outpatient Medical Services,RADIOLOGY,76705,"US, Abdomen Limited PFR",972,145,N/A,Not Applicable.Service not offered,81.59,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,59.93,100% of Cigna Fee Schedule for Outpatient Setting,89.75,110% of Physician Fee Schedule for Outpatient setting,82.41,101% of CMS RBRVS Fee Schedule for Outpatient Setting,82.41,101% of CMS RBRVS Fee Schedule for Outpatient Setting,82.41,101% of CMS RBRVS Fee Schedule for Outpatient Setting,89.75,110% of Physician Fee Schedule for Outpatient setting,89.75,110% of Physician Fee Schedule for Outpatient setting,81.59,100% of Physician Fee Schedule for Outpatient Setting,122.39,150% of CMS RBRVS Fee Schedule for Outpatient Setting,81.59,100% of CMS RBRVS Fee Schedule for Outpatient Setting,122.39,150% of CMS RBRVS Fee Schedule for Outpatient Setting,59.93,122.39,108.75
Outpatient Medical Services,RADIOLOGY,76641,"US, Breast, Complete GLR",402,638,382.8,60% of total billed charges for outpatient setting,306.24,48% of toatl Billed Charges for Outpatient Setting,87.73,100% of BCBS Fee Schedule for Outpatient Setting,87.73,100% of BCBS Fee Schedule for Outpatient Setting,97.38,111% of BCBS Fee Schedule for Outpatient Setting,319,Case rate,446.6,70% of Total Billed charges for Outpatient setting,309.3,48.48% of total Billed Charges for Outpatient Setting,309.3,48.48% of total Billed Charges for Outpatient Setting,309.3,48.48% of total Billed Charges for Outpatient Setting,446.6,70% of Total Billed charges for Outpatient setting,446.6,70% of Total Billed charges for Outpatient setting,306.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,309.3,48.48% of total Billed Charges for Outpatient Setting,574.2,90% of Total Billed charges for Outpatient setting,87.73,574.2,382.8
Outpatient Medical Services,RADIOLOGY,76641,"US, Breast, Complete PFR",972,179,N/A,Not Applicable.Service not offered,95.84,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,70.43,100% of Cigna Fee Schedule for Outpatient Setting,105.42,110% of Physician Fee Schedule for Outpatient setting,96.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,96.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,96.8,101% of CMS RBRVS Fee Schedule for Outpatient Setting,105.42,110% of Physician Fee Schedule for Outpatient setting,105.42,110% of Physician Fee Schedule for Outpatient setting,95.84,100% of Physician Fee Schedule for Outpatient Setting,143.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,95.84,100% of CMS RBRVS Fee Schedule for Outpatient Setting,143.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,70.43,143.76,134.25
Outpatient Medical Services,RADIOLOGY,76642,"US, Breast, Limited, Bilateral GLR",402,525,315,60% of total billed charges for outpatient setting,252,48% of toatl Billed Charges for Outpatient Setting,87.73,100% of BCBS Fee Schedule for Outpatient Setting,87.73,100% of BCBS Fee Schedule for Outpatient Setting,97.38,111% of BCBS Fee Schedule for Outpatient Setting,262.5,Case rate,367.5,70% of Total Billed charges for Outpatient setting,254.52,48.48% of total Billed Charges for Outpatient Setting,254.52,48.48% of total Billed Charges for Outpatient Setting,254.52,48.48% of total Billed Charges for Outpatient Setting,367.5,70% of Total Billed charges for Outpatient setting,367.5,70% of Total Billed charges for Outpatient setting,252,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,254.52,48.48% of total Billed Charges for Outpatient Setting,472.5,90% of Total Billed charges for Outpatient setting,87.73,472.5,315
Outpatient Medical Services,RADIOLOGY,76642,"US, Breast, Limited, Bilateral PFR",972,167,N/A,Not Applicable.Service not offered,79.3,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,58.26,100% of Cigna Fee Schedule for Outpatient Setting,87.23,110% of Physician Fee Schedule for Outpatient setting,80.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,80.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,80.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,87.23,110% of Physician Fee Schedule for Outpatient setting,87.23,110% of Physician Fee Schedule for Outpatient setting,79.3,100% of Physician Fee Schedule for Outpatient Setting,118.95,150% of CMS RBRVS Fee Schedule for Outpatient Setting,79.3,100% of CMS RBRVS Fee Schedule for Outpatient Setting,118.95,150% of CMS RBRVS Fee Schedule for Outpatient Setting,58.26,118.95,125.25
Outpatient Medical Services,RADIOLOGY,76604,"US, Chest GLR",402,523,313.8,60% of total billed charges for outpatient setting,251.04,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,261.5,Case rate,366.1,70% of Total Billed charges for Outpatient setting,253.55,48.48% of total Billed Charges for Outpatient Setting,253.55,48.48% of total Billed Charges for Outpatient Setting,253.55,48.48% of total Billed Charges for Outpatient Setting,366.1,70% of Total Billed charges for Outpatient setting,366.1,70% of Total Billed charges for Outpatient setting,251.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,253.55,48.48% of total Billed Charges for Outpatient Setting,470.7,90% of Total Billed charges for Outpatient setting,140.33,470.7,313.8
Outpatient Medical Services,RADIOLOGY,76604,"US, Chest PFR",972,143,N/A,Not Applicable.Service not offered,53.39,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,57.81,100% of Cigna Fee Schedule for Outpatient Setting,58.73,110% of Physician Fee Schedule for Outpatient setting,53.92,101% of CMS RBRVS Fee Schedule for Outpatient Setting,53.92,101% of CMS RBRVS Fee Schedule for Outpatient Setting,53.92,101% of CMS RBRVS Fee Schedule for Outpatient Setting,58.73,110% of Physician Fee Schedule for Outpatient setting,58.73,110% of Physician Fee Schedule for Outpatient setting,53.39,100% of Physician Fee Schedule for Outpatient Setting,80.09,150% of CMS RBRVS Fee Schedule for Outpatient Setting,53.39,100% of CMS RBRVS Fee Schedule for Outpatient Setting,80.09,150% of CMS RBRVS Fee Schedule for Outpatient Setting,53.39,80.09,107.25
Outpatient Medical Services,RADIOLOGY,76881,"US, Extremity, Non-Vascular, Complete",402,685,411,60% of total billed charges for outpatient setting,328.8,48% of toatl Billed Charges for Outpatient Setting,162.54,100% of BCBS Fee Schedule for Outpatient Setting,162.54,100% of BCBS Fee Schedule for Outpatient Setting,180.42,111% of BCBS Fee Schedule for Outpatient Setting,342.5,Case rate,479.5,70% of Total Billed charges for Outpatient setting,332.09,48.48% of total Billed Charges for Outpatient Setting,332.09,48.48% of total Billed Charges for Outpatient Setting,332.09,48.48% of total Billed Charges for Outpatient Setting,479.5,70% of Total Billed charges for Outpatient setting,479.5,70% of Total Billed charges for Outpatient setting,328.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,332.09,48.48% of total Billed Charges for Outpatient Setting,616.5,90% of Total Billed charges for Outpatient setting,162.54,616.5,411
Outpatient Medical Services,RADIOLOGY,76882,"US, Extremity, Non-Vascular, Limited GLR",402,250,150,60% of total billed charges for outpatient setting,120,48% of toatl Billed Charges for Outpatient Setting,19.08,100% of BCBS Fee Schedule for Outpatient Setting,19.08,100% of BCBS Fee Schedule for Outpatient Setting,21.18,111% of BCBS Fee Schedule for Outpatient Setting,125,Case rate,175,70% of Total Billed charges for Outpatient setting,121.2,48.48% of total Billed Charges for Outpatient Setting,121.2,48.48% of total Billed Charges for Outpatient Setting,121.2,48.48% of total Billed Charges for Outpatient Setting,175,70% of Total Billed charges for Outpatient setting,175,70% of Total Billed charges for Outpatient setting,120,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,121.2,48.48% of total Billed Charges for Outpatient Setting,225,90% of Total Billed charges for Outpatient setting,19.08,225,150
Outpatient Medical Services,RADIOLOGY,76882,"US, Extremity, Non-Vascular, Limited PFR",972,120,N/A,Not Applicable.Service not offered,40.75,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,24.44,100% of Cigna Fee Schedule for Outpatient Setting,44.83,110% of Physician Fee Schedule for Outpatient setting,41.16,101% of CMS RBRVS Fee Schedule for Outpatient Setting,41.16,101% of CMS RBRVS Fee Schedule for Outpatient Setting,41.16,101% of CMS RBRVS Fee Schedule for Outpatient Setting,44.83,110% of Physician Fee Schedule for Outpatient setting,44.83,110% of Physician Fee Schedule for Outpatient setting,40.75,100% of Physician Fee Schedule for Outpatient Setting,61.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,40.75,100% of CMS RBRVS Fee Schedule for Outpatient Setting,61.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,24.44,61.13,90
Outpatient Medical Services,RADIOLOGY,76536,"US, Head and Neck GLR",402,689,413.4,60% of total billed charges for outpatient setting,330.72,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,344.5,Case rate,482.3,70% of Total Billed charges for Outpatient setting,334.03,48.48% of total Billed Charges for Outpatient Setting,334.03,48.48% of total Billed Charges for Outpatient Setting,334.03,48.48% of total Billed Charges for Outpatient Setting,482.3,70% of Total Billed charges for Outpatient setting,482.3,70% of Total Billed charges for Outpatient setting,330.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,334.03,48.48% of total Billed Charges for Outpatient Setting,620.1,90% of Total Billed charges for Outpatient setting,140.33,620.1,413.4
Outpatient Medical Services,RADIOLOGY,76536,"US, Head and Neck PFR",972,139,N/A,Not Applicable.Service not offered,102.25,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,75.66,100% of Cigna Fee Schedule for Outpatient Setting,112.48,110% of Physician Fee Schedule for Outpatient setting,103.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,103.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,103.27,101% of CMS RBRVS Fee Schedule for Outpatient Setting,112.48,110% of Physician Fee Schedule for Outpatient setting,112.48,110% of Physician Fee Schedule for Outpatient setting,102.25,100% of Physician Fee Schedule for Outpatient Setting,153.38,150% of CMS RBRVS Fee Schedule for Outpatient Setting,102.25,100% of CMS RBRVS Fee Schedule for Outpatient Setting,153.38,150% of CMS RBRVS Fee Schedule for Outpatient Setting,75.66,153.38,104.25
Outpatient Medical Services,RADIOLOGY,76856,"US, Pelvic Complete GLR",402,653,391.8,60% of total billed charges for outpatient setting,313.44,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,326.5,Case rate,457.1,70% of Total Billed charges for Outpatient setting,316.57,48.48% of total Billed Charges for Outpatient Setting,316.57,48.48% of total Billed Charges for Outpatient Setting,316.57,48.48% of total Billed Charges for Outpatient Setting,457.1,70% of Total Billed charges for Outpatient setting,457.1,70% of Total Billed charges for Outpatient setting,313.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,316.57,48.48% of total Billed Charges for Outpatient Setting,587.7,90% of Total Billed charges for Outpatient setting,140.33,587.7,391.8
Outpatient Medical Services,RADIOLOGY,76856,"US, Pelvic Complete PFR",972,169,N/A,Not Applicable.Service not offered,97.75,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,72.32,100% of Cigna Fee Schedule for Outpatient Setting,107.53,110% of Physician Fee Schedule for Outpatient setting,98.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,98.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,98.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,107.53,110% of Physician Fee Schedule for Outpatient setting,107.53,110% of Physician Fee Schedule for Outpatient setting,97.75,100% of Physician Fee Schedule for Outpatient Setting,146.63,150% of CMS RBRVS Fee Schedule for Outpatient Setting,97.75,100% of CMS RBRVS Fee Schedule for Outpatient Setting,146.63,150% of CMS RBRVS Fee Schedule for Outpatient Setting,72.32,146.63,126.75
Outpatient Medical Services,RADIOLOGY,76857,"US, Pelvic Limited GLR",402,281,168.6,60% of total billed charges for outpatient setting,134.88,48% of toatl Billed Charges for Outpatient Setting,119.75,100% of BCBS Fee Schedule for Outpatient Setting,119.75,100% of BCBS Fee Schedule for Outpatient Setting,132.92,111% of BCBS Fee Schedule for Outpatient Setting,140.5,Case rate,196.7,70% of Total Billed charges for Outpatient setting,136.23,48.48% of total Billed Charges for Outpatient Setting,136.23,48.48% of total Billed Charges for Outpatient Setting,136.23,48.48% of total Billed Charges for Outpatient Setting,196.7,70% of Total Billed charges for Outpatient setting,196.7,70% of Total Billed charges for Outpatient setting,134.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,136.23,48.48% of total Billed Charges for Outpatient Setting,252.9,90% of Total Billed charges for Outpatient setting,119.75,252.9,168.6
Outpatient Medical Services,RADIOLOGY,76857,"US, Pelvic Limited PFR",972,122,N/A,Not Applicable.Service not offered,45.71,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,32.26,100% of Cigna Fee Schedule for Outpatient Setting,50.28,110% of Physician Fee Schedule for Outpatient setting,46.17,101% of CMS RBRVS Fee Schedule for Outpatient Setting,46.17,101% of CMS RBRVS Fee Schedule for Outpatient Setting,46.17,101% of CMS RBRVS Fee Schedule for Outpatient Setting,50.28,110% of Physician Fee Schedule for Outpatient setting,50.28,110% of Physician Fee Schedule for Outpatient setting,45.71,100% of Physician Fee Schedule for Outpatient Setting,68.57,150% of CMS RBRVS Fee Schedule for Outpatient Setting,45.71,100% of CMS RBRVS Fee Schedule for Outpatient Setting,68.57,150% of CMS RBRVS Fee Schedule for Outpatient Setting,32.26,68.57,91.5
Outpatient Medical Services,RADIOLOGY,76801,"US, Pregnant, 1st Trimest, 1st Gestation GLR",402,735,441,60% of total billed charges for outpatient setting,352.8,48% of toatl Billed Charges for Outpatient Setting,158.46,100% of BCBS Fee Schedule for Outpatient Setting,158.46,100% of BCBS Fee Schedule for Outpatient Setting,175.89,111% of BCBS Fee Schedule for Outpatient Setting,367.5,Case rate,514.5,70% of Total Billed charges for Outpatient setting,356.33,48.48% of total Billed Charges for Outpatient Setting,356.33,48.48% of total Billed Charges for Outpatient Setting,356.33,48.48% of total Billed Charges for Outpatient Setting,514.5,70% of Total Billed charges for Outpatient setting,514.5,70% of Total Billed charges for Outpatient setting,352.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,356.33,48.48% of total Billed Charges for Outpatient Setting,661.5,90% of Total Billed charges for Outpatient setting,158.46,661.5,441
Outpatient Medical Services,RADIOLOGY,76801,"US, Pregnant, 1st Trimest, 1st Gestation PFR",972,277.95,N/A,Not Applicable.Service not offered,109.69,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,81.8,100% of Cigna Fee Schedule for Outpatient Setting,120.66,110% of Physician Fee Schedule for Outpatient setting,110.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,110.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,110.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,120.66,110% of Physician Fee Schedule for Outpatient setting,120.66,110% of Physician Fee Schedule for Outpatient setting,109.69,100% of Physician Fee Schedule for Outpatient Setting,164.54,150% of CMS RBRVS Fee Schedule for Outpatient Setting,109.69,100% of CMS RBRVS Fee Schedule for Outpatient Setting,164.54,150% of CMS RBRVS Fee Schedule for Outpatient Setting,81.8,164.54,166.77
Outpatient Medical Services,RADIOLOGY,76817,"US, Pregnant, Transvaginal GLR",402,580,348,60% of total billed charges for outpatient setting,278.4,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,290,Case rate,406,70% of Total Billed charges for Outpatient setting,281.18,48.48% of total Billed Charges for Outpatient Setting,281.18,48.48% of total Billed Charges for Outpatient Setting,281.18,48.48% of total Billed Charges for Outpatient Setting,406,70% of Total Billed charges for Outpatient setting,406,70% of Total Billed charges for Outpatient setting,278.4,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,281.18,48.48% of total Billed Charges for Outpatient Setting,522,90% of Total Billed charges for Outpatient setting,140.33,522,348
Outpatient Medical Services,RADIOLOGY,76817,"US, Pregnant, Transvaginal PFR",972,208.95,N/A,Not Applicable.Service not offered,86.42,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,64.55,100% of Cigna Fee Schedule for Outpatient Setting,95.06,110% of Physician Fee Schedule for Outpatient setting,87.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,87.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,87.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,95.06,110% of Physician Fee Schedule for Outpatient setting,95.06,110% of Physician Fee Schedule for Outpatient setting,86.42,100% of Physician Fee Schedule for Outpatient Setting,129.63,150% of CMS RBRVS Fee Schedule for Outpatient Setting,86.42,100% of CMS RBRVS Fee Schedule for Outpatient Setting,129.63,150% of CMS RBRVS Fee Schedule for Outpatient Setting,64.55,129.63,125.37
Outpatient Medical Services,RADIOLOGY,76770,"US, Retroperitoneal Complete GLR",402,672,403.2,60% of total billed charges for outpatient setting,322.56,48% of toatl Billed Charges for Outpatient Setting,148.43,100% of BCBS Fee Schedule for Outpatient Setting,148.43,100% of BCBS Fee Schedule for Outpatient Setting,164.76,111% of BCBS Fee Schedule for Outpatient Setting,336,Case rate,470.4,70% of Total Billed charges for Outpatient setting,325.79,48.48% of total Billed Charges for Outpatient Setting,325.79,48.48% of total Billed Charges for Outpatient Setting,325.79,48.48% of total Billed Charges for Outpatient Setting,470.4,70% of Total Billed charges for Outpatient setting,470.4,70% of Total Billed charges for Outpatient setting,322.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,325.79,48.48% of total Billed Charges for Outpatient Setting,604.8,90% of Total Billed charges for Outpatient setting,148.43,604.8,403.2
Outpatient Medical Services,RADIOLOGY,76770,"US, Retroperitoneal Complete PFR",972,181,N/A,Not Applicable.Service not offered,100.63,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,74.25,100% of Cigna Fee Schedule for Outpatient Setting,110.69,110% of Physician Fee Schedule for Outpatient setting,101.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,101.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,101.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,110.69,110% of Physician Fee Schedule for Outpatient setting,110.69,110% of Physician Fee Schedule for Outpatient setting,100.63,100% of Physician Fee Schedule for Outpatient Setting,150.95,150% of CMS RBRVS Fee Schedule for Outpatient Setting,100.63,100% of CMS RBRVS Fee Schedule for Outpatient Setting,150.95,150% of CMS RBRVS Fee Schedule for Outpatient Setting,74.25,150.95,135.75
Outpatient Medical Services,RADIOLOGY,76870,"US, Scrotum and Contents, Limited GLR",402,401,240.6,60% of total billed charges for outpatient setting,192.48,48% of toatl Billed Charges for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,140.33,100% of BCBS Fee Schedule for Outpatient Setting,155.77,111% of BCBS Fee Schedule for Outpatient Setting,200.5,Case rate,280.7,70% of Total Billed charges for Outpatient setting,194.4,48.48% of total Billed Charges for Outpatient Setting,194.4,48.48% of total Billed Charges for Outpatient Setting,194.4,48.48% of total Billed Charges for Outpatient Setting,280.7,70% of Total Billed charges for Outpatient setting,280.7,70% of Total Billed charges for Outpatient setting,192.48,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,194.4,48.48% of total Billed Charges for Outpatient Setting,360.9,90% of Total Billed charges for Outpatient setting,140.33,360.9,240.6
Outpatient Medical Services,RADIOLOGY,76870,"US, Scrotum and Contents, Limited PFR",972,157,N/A,Not Applicable.Service not offered,93.38,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,45.44,100% of Cigna Fee Schedule for Outpatient Setting,102.72,110% of Physician Fee Schedule for Outpatient setting,94.31,101% of CMS RBRVS Fee Schedule for Outpatient Setting,94.31,101% of CMS RBRVS Fee Schedule for Outpatient Setting,94.31,101% of CMS RBRVS Fee Schedule for Outpatient Setting,102.72,110% of Physician Fee Schedule for Outpatient setting,102.72,110% of Physician Fee Schedule for Outpatient setting,93.38,100% of Physician Fee Schedule for Outpatient Setting,140.07,150% of CMS RBRVS Fee Schedule for Outpatient Setting,93.38,100% of CMS RBRVS Fee Schedule for Outpatient Setting,140.07,150% of CMS RBRVS Fee Schedule for Outpatient Setting,45.44,140.07,117.75
Outpatient Medical Services,RADIOLOGY,74018,"XRAY, Abdomen 1 View GLR",320,274,164.4,60% of total billed charges for outpatient setting,131.52,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,137,Case rate,191.8,70% of Total Billed charges for Outpatient setting,132.84,48.48% of total Billed Charges for Outpatient Setting,132.84,48.48% of total Billed Charges for Outpatient Setting,132.84,48.48% of total Billed Charges for Outpatient Setting,191.8,70% of Total Billed charges for Outpatient setting,191.8,70% of Total Billed charges for Outpatient setting,131.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,132.84,48.48% of total Billed Charges for Outpatient Setting,246.6,90% of Total Billed charges for Outpatient setting,64.47,246.6,164.4
Outpatient Medical Services,RADIOLOGY,74018,"XRAY, Abdomen 1 View PFR",972,45,N/A,Not Applicable.Service not offered,27.65,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,17.83,100% of Cigna Fee Schedule for Outpatient Setting,30.42,110% of Physician Fee Schedule for Outpatient setting,27.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.93,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.42,110% of Physician Fee Schedule for Outpatient setting,30.42,110% of Physician Fee Schedule for Outpatient setting,27.65,100% of Physician Fee Schedule for Outpatient Setting,41.48,150% of CMS RBRVS Fee Schedule for Outpatient Setting,27.65,100% of CMS RBRVS Fee Schedule for Outpatient Setting,41.48,150% of CMS RBRVS Fee Schedule for Outpatient Setting,17.83,41.48,33.75
Outpatient Medical Services,RADIOLOGY,74019,"XRAY, Abdomen 2 View GLR",320,432,259.2,60% of total billed charges for outpatient setting,207.36,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,216,Case rate,302.4,70% of Total Billed charges for Outpatient setting,209.43,48.48% of total Billed Charges for Outpatient Setting,209.43,48.48% of total Billed Charges for Outpatient Setting,209.43,48.48% of total Billed Charges for Outpatient Setting,302.4,70% of Total Billed charges for Outpatient setting,302.4,70% of Total Billed charges for Outpatient setting,207.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,209.43,48.48% of total Billed Charges for Outpatient Setting,388.8,90% of Total Billed charges for Outpatient setting,64.47,388.8,259.2
Outpatient Medical Services,RADIOLOGY,74019,"XRAY, Abdomen 2 View PFR",972,58,N/A,Not Applicable.Service not offered,34.09,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,21.76,100% of Cigna Fee Schedule for Outpatient Setting,37.5,110% of Physician Fee Schedule for Outpatient setting,34.43,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.43,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.43,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.5,110% of Physician Fee Schedule for Outpatient setting,37.5,110% of Physician Fee Schedule for Outpatient setting,34.09,100% of Physician Fee Schedule for Outpatient Setting,51.14,150% of CMS RBRVS Fee Schedule for Outpatient Setting,34.09,100% of CMS RBRVS Fee Schedule for Outpatient Setting,51.14,150% of CMS RBRVS Fee Schedule for Outpatient Setting,21.76,51.14,43.5
Outpatient Medical Services,RADIOLOGY,74022,"XRAY, Abdomen Series GLR",320,519,311.4,60% of total billed charges for outpatient setting,249.12,48% of toatl Billed Charges for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,121.77,111% of BCBS Fee Schedule for Outpatient Setting,259.5,Case rate,363.3,70% of Total Billed charges for Outpatient setting,251.61,48.48% of total Billed Charges for Outpatient Setting,251.61,48.48% of total Billed Charges for Outpatient Setting,251.61,48.48% of total Billed Charges for Outpatient Setting,363.3,70% of Total Billed charges for Outpatient setting,363.3,70% of Total Billed charges for Outpatient setting,249.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,251.61,48.48% of total Billed Charges for Outpatient Setting,467.1,90% of Total Billed charges for Outpatient setting,109.7,467.1,311.4
Outpatient Medical Services,RADIOLOGY,74022,"XRAY, Abdomen Series PFR",972,78,N/A,Not Applicable.Service not offered,46.14,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,29.22,100% of Cigna Fee Schedule for Outpatient Setting,50.75,110% of Physician Fee Schedule for Outpatient setting,46.6,101% of CMS RBRVS Fee Schedule for Outpatient Setting,46.6,101% of CMS RBRVS Fee Schedule for Outpatient Setting,46.6,101% of CMS RBRVS Fee Schedule for Outpatient Setting,50.75,110% of Physician Fee Schedule for Outpatient setting,50.75,110% of Physician Fee Schedule for Outpatient setting,46.14,100% of Physician Fee Schedule for Outpatient Setting,69.21,150% of CMS RBRVS Fee Schedule for Outpatient Setting,46.14,100% of CMS RBRVS Fee Schedule for Outpatient Setting,69.21,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.22,69.21,58.5
Outpatient Medical Services,RADIOLOGY,73600,"XRAY, Ankle 2 Views GLR",320,349,209.4,60% of total billed charges for outpatient setting,167.52,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,174.5,Case rate,244.3,70% of Total Billed charges for Outpatient setting,169.2,48.48% of total Billed Charges for Outpatient Setting,169.2,48.48% of total Billed Charges for Outpatient Setting,169.2,48.48% of total Billed Charges for Outpatient Setting,244.3,70% of Total Billed charges for Outpatient setting,244.3,70% of Total Billed charges for Outpatient setting,167.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,169.2,48.48% of total Billed Charges for Outpatient Setting,314.1,90% of Total Billed charges for Outpatient setting,64.47,314.1,209.4
Outpatient Medical Services,RADIOLOGY,73600,"XRAY, Ankle 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,29.94,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,19.33,100% of Cigna Fee Schedule for Outpatient Setting,32.93,110% of Physician Fee Schedule for Outpatient setting,30.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.93,110% of Physician Fee Schedule for Outpatient setting,32.93,110% of Physician Fee Schedule for Outpatient setting,29.94,100% of Physician Fee Schedule for Outpatient Setting,44.91,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.94,100% of CMS RBRVS Fee Schedule for Outpatient Setting,44.91,150% of CMS RBRVS Fee Schedule for Outpatient Setting,19.33,44.91,31.5
Outpatient Medical Services,RADIOLOGY,73610,"XRAY, Ankle, Complete, => 3 Views GLR",320,365,29,100% of Aetna Fee Schedule for Outpatient Setting,175.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,182.5,Case rate,255.5,70% of Total Billed charges for Outpatient setting,176.95,48.48% of total Billed Charges for Outpatient Setting,176.95,48.48% of total Billed Charges for Outpatient Setting,176.95,48.48% of total Billed Charges for Outpatient Setting,255.5,70% of Total Billed charges for Outpatient setting,255.5,70% of Total Billed charges for Outpatient setting,175.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,176.95,48.48% of total Billed Charges for Outpatient Setting,328.5,90% of Total Billed charges for Outpatient setting,29,328.5,219
Outpatient Medical Services,RADIOLOGY,73610,"XRAY, Ankle, Complete, => 3 Views PFR",972,43,N/A,Not Applicable.Service not offered,33.84,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20.47,100% of Cigna Fee Schedule for Outpatient Setting,37.22,110% of Physician Fee Schedule for Outpatient setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.22,110% of Physician Fee Schedule for Outpatient setting,37.22,110% of Physician Fee Schedule for Outpatient setting,33.84,100% of Physician Fee Schedule for Outpatient Setting,50.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,33.84,100% of CMS RBRVS Fee Schedule for Outpatient Setting,50.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.47,50.76,32.25
Outpatient Medical Services,RADIOLOGY,73650,"XRAY, Calcaneous 2 Views GLR",320,315,189,60% of total billed charges for outpatient setting,151.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,157.5,Case rate,220.5,70% of Total Billed charges for Outpatient setting,152.71,48.48% of total Billed Charges for Outpatient Setting,152.71,48.48% of total Billed Charges for Outpatient Setting,152.71,48.48% of total Billed Charges for Outpatient Setting,220.5,70% of Total Billed charges for Outpatient setting,220.5,70% of Total Billed charges for Outpatient setting,151.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,152.71,48.48% of total Billed Charges for Outpatient Setting,283.5,90% of Total Billed charges for Outpatient setting,64.47,283.5,189
Outpatient Medical Services,RADIOLOGY,73650,"XRAY, Calcaneous 2 Views PFR",972,41.5,N/A,Not Applicable.Service not offered,26.38,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,17.55,100% of Cigna Fee Schedule for Outpatient Setting,29.02,110% of Physician Fee Schedule for Outpatient setting,26.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.64,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.02,110% of Physician Fee Schedule for Outpatient setting,29.02,110% of Physician Fee Schedule for Outpatient setting,26.38,100% of Physician Fee Schedule for Outpatient Setting,39.57,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.38,100% of CMS RBRVS Fee Schedule for Outpatient Setting,39.57,150% of CMS RBRVS Fee Schedule for Outpatient Setting,17.55,39.57,31.13
Outpatient Medical Services,RADIOLOGY,71046,"XRAY, Chest 2 Views GLR",324,324,194.4,60% of total billed charges for outpatient setting,155.52,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,162,Case rate,226.8,70% of Total Billed charges for Outpatient setting,157.08,48.48% of total Billed Charges for Outpatient Setting,157.08,48.48% of total Billed Charges for Outpatient Setting,157.08,48.48% of total Billed Charges for Outpatient Setting,226.8,70% of Total Billed charges for Outpatient setting,226.8,70% of Total Billed charges for Outpatient setting,155.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,157.08,48.48% of total Billed Charges for Outpatient Setting,291.6,90% of Total Billed charges for Outpatient setting,64.47,291.6,194.4
Outpatient Medical Services,RADIOLOGY,71046,"XRAY, Chest 2 Views PFR",972,54,N/A,Not Applicable.Service not offered,31.08,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,19.95,100% of Cigna Fee Schedule for Outpatient Setting,34.19,110% of Physician Fee Schedule for Outpatient setting,31.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.19,110% of Physician Fee Schedule for Outpatient setting,34.19,110% of Physician Fee Schedule for Outpatient setting,31.08,100% of Physician Fee Schedule for Outpatient Setting,46.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,31.08,100% of CMS RBRVS Fee Schedule for Outpatient Setting,46.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,19.95,46.62,40.5
Outpatient Medical Services,RADIOLOGY,71045,"XRAY, Chest, Single View, Frontal GLR",324,261,156.6,60% of total billed charges for outpatient setting,125.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,130.5,Case rate,182.7,70% of Total Billed charges for Outpatient setting,126.53,48.48% of total Billed Charges for Outpatient Setting,126.53,48.48% of total Billed Charges for Outpatient Setting,126.53,48.48% of total Billed Charges for Outpatient Setting,182.7,70% of Total Billed charges for Outpatient setting,182.7,70% of Total Billed charges for Outpatient setting,125.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,126.53,48.48% of total Billed Charges for Outpatient Setting,234.9,90% of Total Billed charges for Outpatient setting,64.47,234.9,156.6
Outpatient Medical Services,RADIOLOGY,71045,"XRAY, Chest, Single View, Frontal PFR",972,45,N/A,Not Applicable.Service not offered,24.09,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,13.15,100% of Cigna Fee Schedule for Outpatient Setting,26.5,110% of Physician Fee Schedule for Outpatient setting,24.33,101% of CMS RBRVS Fee Schedule for Outpatient Setting,24.33,101% of CMS RBRVS Fee Schedule for Outpatient Setting,24.33,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.5,110% of Physician Fee Schedule for Outpatient setting,26.5,110% of Physician Fee Schedule for Outpatient setting,24.09,100% of Physician Fee Schedule for Outpatient Setting,36.14,150% of CMS RBRVS Fee Schedule for Outpatient Setting,24.09,100% of CMS RBRVS Fee Schedule for Outpatient Setting,36.14,150% of CMS RBRVS Fee Schedule for Outpatient Setting,13.15,36.14,33.75
Outpatient Medical Services,RADIOLOGY,73000,"XRAY, Clavicle 2 Views GLR",320,320,192,60% of total billed charges for outpatient setting,153.6,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,160,Case rate,224,70% of Total Billed charges for Outpatient setting,155.14,48.48% of total Billed Charges for Outpatient Setting,155.14,48.48% of total Billed Charges for Outpatient Setting,155.14,48.48% of total Billed Charges for Outpatient Setting,224,70% of Total Billed charges for Outpatient setting,224,70% of Total Billed charges for Outpatient setting,153.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,155.14,48.48% of total Billed Charges for Outpatient Setting,288,90% of Total Billed charges for Outpatient setting,64.47,288,192
Outpatient Medical Services,RADIOLOGY,73000,"XRAY, Clavicle 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,29.64,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,17.99,100% of Cigna Fee Schedule for Outpatient Setting,32.6,110% of Physician Fee Schedule for Outpatient setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.6,110% of Physician Fee Schedule for Outpatient setting,32.6,110% of Physician Fee Schedule for Outpatient setting,29.64,100% of Physician Fee Schedule for Outpatient Setting,44.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.64,100% of CMS RBRVS Fee Schedule for Outpatient Setting,44.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,17.99,44.46,31.5
Outpatient Medical Services,RADIOLOGY,73070,"XRAY, Elbow 2 Views GLR",320,320,192,60% of total billed charges for outpatient setting,153.6,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,160,Case rate,224,70% of Total Billed charges for Outpatient setting,155.14,48.48% of total Billed Charges for Outpatient Setting,155.14,48.48% of total Billed Charges for Outpatient Setting,155.14,48.48% of total Billed Charges for Outpatient Setting,224,70% of Total Billed charges for Outpatient setting,224,70% of Total Billed charges for Outpatient setting,153.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,155.14,48.48% of total Billed Charges for Outpatient Setting,288,90% of Total Billed charges for Outpatient setting,64.47,288,192
Outpatient Medical Services,RADIOLOGY,73070,"XRAY, Elbow 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,26.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,17.74,100% of Cigna Fee Schedule for Outpatient Setting,29.67,110% of Physician Fee Schedule for Outpatient setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.67,110% of Physician Fee Schedule for Outpatient setting,29.67,110% of Physician Fee Schedule for Outpatient setting,26.97,100% of Physician Fee Schedule for Outpatient Setting,40.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,40.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,17.74,40.46,31.5
Outpatient Medical Services,RADIOLOGY,73080,"XRAY, Elbow 3 Views GLR",320,361,216.6,60% of total billed charges for outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,180.5,Case rate,252.7,70% of Total Billed charges for Outpatient setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,252.7,70% of Total Billed charges for Outpatient setting,252.7,70% of Total Billed charges for Outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,175.01,48.48% of total Billed Charges for Outpatient Setting,324.9,90% of Total Billed charges for Outpatient setting,64.47,324.9,216.6
Outpatient Medical Services,RADIOLOGY,73080,"XRAY, Elbow 3 Views PFR",972,43,N/A,Not Applicable.Service not offered,29.98,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20.25,100% of Cigna Fee Schedule for Outpatient Setting,32.98,110% of Physician Fee Schedule for Outpatient setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.98,110% of Physician Fee Schedule for Outpatient setting,32.98,110% of Physician Fee Schedule for Outpatient setting,29.98,100% of Physician Fee Schedule for Outpatient Setting,44.97,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.98,100% of CMS RBRVS Fee Schedule for Outpatient Setting,44.97,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.25,44.97,32.25
Outpatient Medical Services,RADIOLOGY,70150,"XRAY, Facial Bones 3 Views GLR",320,481,288.6,60% of total billed charges for outpatient setting,230.88,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,240.5,Case rate,336.7,70% of Total Billed charges for Outpatient setting,233.19,48.48% of total Billed Charges for Outpatient Setting,233.19,48.48% of total Billed Charges for Outpatient Setting,233.19,48.48% of total Billed Charges for Outpatient Setting,336.7,70% of Total Billed charges for Outpatient setting,336.7,70% of Total Billed charges for Outpatient setting,230.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,233.19,48.48% of total Billed Charges for Outpatient Setting,432.9,90% of Total Billed charges for Outpatient setting,64.47,432.9,288.6
Outpatient Medical Services,RADIOLOGY,70150,"XRAY, Facial Bones 3 Views PFR",972,66,N/A,Not Applicable.Service not offered,43.13,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,26.97,100% of Cigna Fee Schedule for Outpatient Setting,47.44,110% of Physician Fee Schedule for Outpatient setting,43.56,101% of CMS RBRVS Fee Schedule for Outpatient Setting,43.56,101% of CMS RBRVS Fee Schedule for Outpatient Setting,43.56,101% of CMS RBRVS Fee Schedule for Outpatient Setting,47.44,110% of Physician Fee Schedule for Outpatient setting,47.44,110% of Physician Fee Schedule for Outpatient setting,43.13,100% of Physician Fee Schedule for Outpatient Setting,64.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,43.13,100% of CMS RBRVS Fee Schedule for Outpatient Setting,64.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.97,64.7,49.5
Outpatient Medical Services,RADIOLOGY,73552,"XRAY, Femur 2 Views GLR",320,378,226.8,60% of total billed charges for outpatient setting,181.44,48% of toatl Billed Charges for Outpatient Setting,36.69,100% of BCBS Fee Schedule for Outpatient Setting,36.69,100% of BCBS Fee Schedule for Outpatient Setting,40.73,111% of BCBS Fee Schedule for Outpatient Setting,189,Case rate,264.6,70% of Total Billed charges for Outpatient setting,183.25,48.48% of total Billed Charges for Outpatient Setting,183.25,48.48% of total Billed Charges for Outpatient Setting,183.25,48.48% of total Billed Charges for Outpatient Setting,264.6,70% of Total Billed charges for Outpatient setting,264.6,70% of Total Billed charges for Outpatient setting,181.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,183.25,48.48% of total Billed Charges for Outpatient Setting,340.2,90% of Total Billed charges for Outpatient setting,36.69,340.2,226.8
Outpatient Medical Services,RADIOLOGY,73552,"XRAY, Femur 2 Views PFR",972,45,N/A,Not Applicable.Service not offered,32.7,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,21.17,100% of Cigna Fee Schedule for Outpatient Setting,35.97,110% of Physician Fee Schedule for Outpatient setting,33.03,101% of CMS RBRVS Fee Schedule for Outpatient Setting,33.03,101% of CMS RBRVS Fee Schedule for Outpatient Setting,33.03,101% of CMS RBRVS Fee Schedule for Outpatient Setting,35.97,110% of Physician Fee Schedule for Outpatient setting,35.97,110% of Physician Fee Schedule for Outpatient setting,32.7,100% of Physician Fee Schedule for Outpatient Setting,49.05,150% of CMS RBRVS Fee Schedule for Outpatient Setting,32.7,100% of CMS RBRVS Fee Schedule for Outpatient Setting,49.05,150% of CMS RBRVS Fee Schedule for Outpatient Setting,21.17,49.05,33.75
Outpatient Medical Services,RADIOLOGY,73140,"XRAY, Fingers GLR",320,365,219,60% of total billed charges for outpatient setting,175.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,182.5,Case rate,255.5,70% of Total Billed charges for Outpatient setting,176.95,48.48% of total Billed Charges for Outpatient Setting,176.95,48.48% of total Billed Charges for Outpatient Setting,176.95,48.48% of total Billed Charges for Outpatient Setting,255.5,70% of Total Billed charges for Outpatient setting,255.5,70% of Total Billed charges for Outpatient setting,175.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,176.95,48.48% of total Billed Charges for Outpatient Setting,328.5,90% of Total Billed charges for Outpatient setting,64.47,328.5,219
Outpatient Medical Services,RADIOLOGY,73140,"XRAY, Fingers PFR",972,35,N/A,Not Applicable.Service not offered,34.56,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20.36,100% of Cigna Fee Schedule for Outpatient Setting,38.02,110% of Physician Fee Schedule for Outpatient setting,34.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.91,101% of CMS RBRVS Fee Schedule for Outpatient Setting,38.02,110% of Physician Fee Schedule for Outpatient setting,38.02,110% of Physician Fee Schedule for Outpatient setting,34.56,100% of Physician Fee Schedule for Outpatient Setting,51.84,150% of CMS RBRVS Fee Schedule for Outpatient Setting,34.56,100% of CMS RBRVS Fee Schedule for Outpatient Setting,51.84,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.36,51.84,26.25
Outpatient Medical Services,RADIOLOGY,73620,"XRAY, Foot 2 Views GLR",320,303,181.8,60% of total billed charges for outpatient setting,145.44,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,151.5,Case rate,212.1,70% of Total Billed charges for Outpatient setting,146.89,48.48% of total Billed Charges for Outpatient Setting,146.89,48.48% of total Billed Charges for Outpatient Setting,146.89,48.48% of total Billed Charges for Outpatient Setting,212.1,70% of Total Billed charges for Outpatient setting,212.1,70% of Total Billed charges for Outpatient setting,145.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,146.89,48.48% of total Billed Charges for Outpatient Setting,272.7,90% of Total Billed charges for Outpatient setting,64.47,272.7,181.8
Outpatient Medical Services,RADIOLOGY,73620,"XRAY, Foot 2 Views PFR",972,39,N/A,Not Applicable.Service not offered,26.08,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,16.88,100% of Cigna Fee Schedule for Outpatient Setting,28.69,110% of Physician Fee Schedule for Outpatient setting,26.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,28.69,110% of Physician Fee Schedule for Outpatient setting,28.69,110% of Physician Fee Schedule for Outpatient setting,26.08,100% of Physician Fee Schedule for Outpatient Setting,39.12,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.08,100% of CMS RBRVS Fee Schedule for Outpatient Setting,39.12,150% of CMS RBRVS Fee Schedule for Outpatient Setting,16.88,39.12,29.25
Outpatient Medical Services,RADIOLOGY,73630,"XRAY, Foot, Complete, => 3 Views GLR",320,340,29,100% of Aetna Fee Schedule for Outpatient Setting,163.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,170,Case rate,238,70% of Total Billed charges for Outpatient setting,164.83,48.48% of total Billed Charges for Outpatient Setting,164.83,48.48% of total Billed Charges for Outpatient Setting,164.83,48.48% of total Billed Charges for Outpatient Setting,238,70% of Total Billed charges for Outpatient setting,238,70% of Total Billed charges for Outpatient setting,163.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,164.83,48.48% of total Billed Charges for Outpatient Setting,306,90% of Total Billed charges for Outpatient setting,29,306,204
Outpatient Medical Services,RADIOLOGY,73630,"XRAY, Foot, Complete, => 3 Views PFR",972,42,N/A,Not Applicable.Service not offered,31.47,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.91,100% of Cigna Fee Schedule for Outpatient Setting,34.62,110% of Physician Fee Schedule for Outpatient setting,31.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.78,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.62,110% of Physician Fee Schedule for Outpatient setting,34.62,110% of Physician Fee Schedule for Outpatient setting,31.47,100% of Physician Fee Schedule for Outpatient Setting,47.21,150% of CMS RBRVS Fee Schedule for Outpatient Setting,31.47,100% of CMS RBRVS Fee Schedule for Outpatient Setting,47.21,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.91,47.21,31.5
Outpatient Medical Services,RADIOLOGY,73090,"XRAY, Forearm 2 Views GLR",320,299,179.4,60% of total billed charges for outpatient setting,143.52,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,149.5,Case rate,209.3,70% of Total Billed charges for Outpatient setting,144.96,48.48% of total Billed Charges for Outpatient Setting,144.96,48.48% of total Billed Charges for Outpatient Setting,144.96,48.48% of total Billed Charges for Outpatient Setting,209.3,70% of Total Billed charges for Outpatient setting,209.3,70% of Total Billed charges for Outpatient setting,143.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,144.96,48.48% of total Billed Charges for Outpatient Setting,269.1,90% of Total Billed charges for Outpatient setting,64.47,269.1,179.4
Outpatient Medical Services,RADIOLOGY,73090,"XRAY, Forearm 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,26.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,16.88,100% of Cigna Fee Schedule for Outpatient Setting,29.67,110% of Physician Fee Schedule for Outpatient setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.24,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.67,110% of Physician Fee Schedule for Outpatient setting,29.67,110% of Physician Fee Schedule for Outpatient setting,26.97,100% of Physician Fee Schedule for Outpatient Setting,40.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,40.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,16.88,40.46,31.5
Outpatient Medical Services,RADIOLOGY,73120,"XRAY, Hand 2 Views GLR",320,303,181.8,60% of total billed charges for outpatient setting,145.44,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,151.5,Case rate,212.1,70% of Total Billed charges for Outpatient setting,146.89,48.48% of total Billed Charges for Outpatient Setting,146.89,48.48% of total Billed Charges for Outpatient Setting,146.89,48.48% of total Billed Charges for Outpatient Setting,212.1,70% of Total Billed charges for Outpatient setting,212.1,70% of Total Billed charges for Outpatient setting,145.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,146.89,48.48% of total Billed Charges for Outpatient Setting,272.7,90% of Total Billed charges for Outpatient setting,64.47,272.7,181.8
Outpatient Medical Services,RADIOLOGY,73120,"XRAY, Hand 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,28.75,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,17.1,100% of Cigna Fee Schedule for Outpatient Setting,31.63,110% of Physician Fee Schedule for Outpatient setting,29.04,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.04,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.04,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.63,110% of Physician Fee Schedule for Outpatient setting,31.63,110% of Physician Fee Schedule for Outpatient setting,28.75,100% of Physician Fee Schedule for Outpatient Setting,43.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,28.75,100% of CMS RBRVS Fee Schedule for Outpatient Setting,43.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,17.1,43.13,31.5
Outpatient Medical Services,RADIOLOGY,73130,"XRAY, Hand 3 Views GLR",320,357,29,100% of Aetna Fee Schedule for Outpatient Setting,171.36,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,178.5,Case rate,249.9,70% of Total Billed charges for Outpatient setting,173.07,48.48% of total Billed Charges for Outpatient Setting,173.07,48.48% of total Billed Charges for Outpatient Setting,173.07,48.48% of total Billed Charges for Outpatient Setting,249.9,70% of Total Billed charges for Outpatient setting,249.9,70% of Total Billed charges for Outpatient setting,171.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,173.07,48.48% of total Billed Charges for Outpatient Setting,321.3,90% of Total Billed charges for Outpatient setting,29,321.3,214.2
Outpatient Medical Services,RADIOLOGY,73130,"XRAY, Hand 3 Views PFR",972,43,N/A,Not Applicable.Service not offered,33.84,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20.03,100% of Cigna Fee Schedule for Outpatient Setting,37.22,110% of Physician Fee Schedule for Outpatient setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.18,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.22,110% of Physician Fee Schedule for Outpatient setting,37.22,110% of Physician Fee Schedule for Outpatient setting,33.84,100% of Physician Fee Schedule for Outpatient Setting,50.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,33.84,100% of CMS RBRVS Fee Schedule for Outpatient Setting,50.76,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.03,50.76,32.25
Outpatient Medical Services,RADIOLOGY,73502,"XRAY, Hip 2 Views GLR",320,481,288.6,60% of total billed charges for outpatient setting,230.88,48% of toatl Billed Charges for Outpatient Setting,48.17,100% of BCBS Fee Schedule for Outpatient Setting,48.17,100% of BCBS Fee Schedule for Outpatient Setting,53.47,111% of BCBS Fee Schedule for Outpatient Setting,240.5,Case rate,336.7,70% of Total Billed charges for Outpatient setting,233.19,48.48% of total Billed Charges for Outpatient Setting,233.19,48.48% of total Billed Charges for Outpatient Setting,233.19,48.48% of total Billed Charges for Outpatient Setting,336.7,70% of Total Billed charges for Outpatient setting,336.7,70% of Total Billed charges for Outpatient setting,230.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,233.19,48.48% of total Billed Charges for Outpatient Setting,432.9,90% of Total Billed charges for Outpatient setting,48.17,432.9,288.6
Outpatient Medical Services,RADIOLOGY,73502,"XRAY, Hip 2 Views PFR",972,56,N/A,Not Applicable.Service not offered,42.96,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,26.85,100% of Cigna Fee Schedule for Outpatient Setting,47.26,110% of Physician Fee Schedule for Outpatient setting,43.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,43.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,43.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,47.26,110% of Physician Fee Schedule for Outpatient setting,47.26,110% of Physician Fee Schedule for Outpatient setting,42.96,100% of Physician Fee Schedule for Outpatient Setting,64.44,150% of CMS RBRVS Fee Schedule for Outpatient Setting,42.96,100% of CMS RBRVS Fee Schedule for Outpatient Setting,64.44,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.85,64.44,42
Outpatient Medical Services,RADIOLOGY,73060,"XRAY, Humerus GLR",320,336,201.6,60% of total billed charges for outpatient setting,161.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,168,Case rate,235.2,70% of Total Billed charges for Outpatient setting,162.89,48.48% of total Billed Charges for Outpatient Setting,162.89,48.48% of total Billed Charges for Outpatient Setting,162.89,48.48% of total Billed Charges for Outpatient Setting,235.2,70% of Total Billed charges for Outpatient setting,235.2,70% of Total Billed charges for Outpatient setting,161.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,162.89,48.48% of total Billed Charges for Outpatient Setting,302.4,90% of Total Billed charges for Outpatient setting,64.47,302.4,201.6
Outpatient Medical Services,RADIOLOGY,73060,"XRAY, Humerus PFR",972,42,N/A,Not Applicable.Service not offered,29.64,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.88,100% of Cigna Fee Schedule for Outpatient Setting,32.6,110% of Physician Fee Schedule for Outpatient setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.94,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.6,110% of Physician Fee Schedule for Outpatient setting,32.6,110% of Physician Fee Schedule for Outpatient setting,29.64,100% of Physician Fee Schedule for Outpatient Setting,44.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.64,100% of CMS RBRVS Fee Schedule for Outpatient Setting,44.46,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.88,44.46,31.5
Outpatient Medical Services,RADIOLOGY,73560,"XRAY, Knee 1 or 2 Views GLR",320,361,216.6,60% of total billed charges for outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,180.5,Case rate,252.7,70% of Total Billed charges for Outpatient setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,252.7,70% of Total Billed charges for Outpatient setting,252.7,70% of Total Billed charges for Outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,175.01,48.48% of total Billed Charges for Outpatient Setting,324.9,90% of Total Billed charges for Outpatient setting,64.47,324.9,216.6
Outpatient Medical Services,RADIOLOGY,73560,"XRAY, Knee 1 or 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,31.42,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20,100% of Cigna Fee Schedule for Outpatient Setting,34.56,110% of Physician Fee Schedule for Outpatient setting,31.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.73,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.56,110% of Physician Fee Schedule for Outpatient setting,34.56,110% of Physician Fee Schedule for Outpatient setting,31.42,100% of Physician Fee Schedule for Outpatient Setting,47.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,31.42,100% of CMS RBRVS Fee Schedule for Outpatient Setting,47.13,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20,47.13,31.5
Outpatient Medical Services,RADIOLOGY,73562,"XRAY, Knee 3 Views GLR",320,415,31,100% of Aetna Fee Schedule for Outpatient Setting,199.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,207.5,Case rate,290.5,70% of Total Billed charges for Outpatient setting,201.19,48.48% of total Billed Charges for Outpatient Setting,201.19,48.48% of total Billed Charges for Outpatient Setting,201.19,48.48% of total Billed Charges for Outpatient Setting,290.5,70% of Total Billed charges for Outpatient setting,290.5,70% of Total Billed charges for Outpatient setting,199.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,201.19,48.48% of total Billed Charges for Outpatient Setting,373.5,90% of Total Billed charges for Outpatient setting,31,373.5,249
Outpatient Medical Services,RADIOLOGY,73562,"XRAY, Knee 3 Views PFR",972,47,N/A,Not Applicable.Service not offered,37.15,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,23.18,100% of Cigna Fee Schedule for Outpatient Setting,40.87,110% of Physician Fee Schedule for Outpatient setting,37.52,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.52,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.52,101% of CMS RBRVS Fee Schedule for Outpatient Setting,40.87,110% of Physician Fee Schedule for Outpatient setting,40.87,110% of Physician Fee Schedule for Outpatient setting,37.15,100% of Physician Fee Schedule for Outpatient Setting,55.73,150% of CMS RBRVS Fee Schedule for Outpatient Setting,37.15,100% of CMS RBRVS Fee Schedule for Outpatient Setting,55.73,150% of CMS RBRVS Fee Schedule for Outpatient Setting,23.18,55.73,35.25
Outpatient Medical Services,RADIOLOGY,73565,"XRAY, Knee Bilateral GLR",320,623,373.8,60% of total billed charges for outpatient setting,299.04,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,311.5,Case rate,436.1,70% of Total Billed charges for Outpatient setting,302.03,48.48% of total Billed Charges for Outpatient Setting,302.03,48.48% of total Billed Charges for Outpatient Setting,302.03,48.48% of total Billed Charges for Outpatient Setting,436.1,70% of Total Billed charges for Outpatient setting,436.1,70% of Total Billed charges for Outpatient setting,299.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,302.03,48.48% of total Billed Charges for Outpatient Setting,560.7,90% of Total Billed charges for Outpatient setting,64.47,560.7,373.8
Outpatient Medical Services,RADIOLOGY,73565,"XRAY, Knee Bilateral PFR",972,45,N/A,Not Applicable.Service not offered,36.47,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,23.12,100% of Cigna Fee Schedule for Outpatient Setting,40.12,110% of Physician Fee Schedule for Outpatient setting,36.83,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.83,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.83,101% of CMS RBRVS Fee Schedule for Outpatient Setting,40.12,110% of Physician Fee Schedule for Outpatient setting,40.12,110% of Physician Fee Schedule for Outpatient setting,36.47,100% of Physician Fee Schedule for Outpatient Setting,54.71,150% of CMS RBRVS Fee Schedule for Outpatient Setting,36.47,100% of CMS RBRVS Fee Schedule for Outpatient Setting,54.71,150% of CMS RBRVS Fee Schedule for Outpatient Setting,23.12,54.71,33.75
Outpatient Medical Services,RADIOLOGY,72100,"XRAY, Lumbar Spine 2-3 Views GLR",320,407,244.2,60% of total billed charges for outpatient setting,195.36,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,203.5,Case rate,284.9,70% of Total Billed charges for Outpatient setting,197.31,48.48% of total Billed Charges for Outpatient Setting,197.31,48.48% of total Billed Charges for Outpatient Setting,197.31,48.48% of total Billed Charges for Outpatient Setting,284.9,70% of Total Billed charges for Outpatient setting,284.9,70% of Total Billed charges for Outpatient setting,195.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,197.31,48.48% of total Billed Charges for Outpatient Setting,366.3,90% of Total Billed charges for Outpatient setting,64.47,366.3,244.2
Outpatient Medical Services,RADIOLOGY,72100,"XRAY, Lumbar Spine 2-3 Views PFR",972,56,N/A,Not Applicable.Service not offered,36.72,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,22.84,100% of Cigna Fee Schedule for Outpatient Setting,40.39,110% of Physician Fee Schedule for Outpatient setting,37.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,40.39,110% of Physician Fee Schedule for Outpatient setting,40.39,110% of Physician Fee Schedule for Outpatient setting,36.72,100% of Physician Fee Schedule for Outpatient Setting,55.08,150% of CMS RBRVS Fee Schedule for Outpatient Setting,36.72,100% of CMS RBRVS Fee Schedule for Outpatient Setting,55.08,150% of CMS RBRVS Fee Schedule for Outpatient Setting,22.84,55.08,42
Outpatient Medical Services,RADIOLOGY,70360,"XRAY, Neck Soft Tissue GLR",320,328,196.8,60% of total billed charges for outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,164,Case rate,229.6,70% of Total Billed charges for Outpatient setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,229.6,70% of Total Billed charges for Outpatient setting,229.6,70% of Total Billed charges for Outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,159.01,48.48% of total Billed Charges for Outpatient Setting,295.2,90% of Total Billed charges for Outpatient setting,64.47,295.2,196.8
Outpatient Medical Services,RADIOLOGY,70360,"XRAY, Neck Soft Tissue PFR",972,45,N/A,Not Applicable.Service not offered,29.13,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.24,100% of Cigna Fee Schedule for Outpatient Setting,32.04,110% of Physician Fee Schedule for Outpatient setting,29.42,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.42,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.42,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.04,110% of Physician Fee Schedule for Outpatient setting,32.04,110% of Physician Fee Schedule for Outpatient setting,29.13,100% of Physician Fee Schedule for Outpatient Setting,43.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.13,100% of CMS RBRVS Fee Schedule for Outpatient Setting,43.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.24,43.7,33.75
Outpatient Medical Services,RADIOLOGY,72040,"XRAY, Neck Spine 2-3 Views GLR",320,386,231.6,60% of total billed charges for outpatient setting,185.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,193,Case rate,270.2,70% of Total Billed charges for Outpatient setting,187.13,48.48% of total Billed Charges for Outpatient Setting,187.13,48.48% of total Billed Charges for Outpatient Setting,187.13,48.48% of total Billed Charges for Outpatient Setting,270.2,70% of Total Billed charges for Outpatient setting,270.2,70% of Total Billed charges for Outpatient setting,185.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,187.13,48.48% of total Billed Charges for Outpatient Setting,347.4,90% of Total Billed charges for Outpatient setting,64.47,347.4,231.6
Outpatient Medical Services,RADIOLOGY,72040,"XRAY, Neck Spine 2-3 Views PFR",972,56,N/A,Not Applicable.Service not offered,36.43,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,21.51,100% of Cigna Fee Schedule for Outpatient Setting,40.07,110% of Physician Fee Schedule for Outpatient setting,36.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,40.07,110% of Physician Fee Schedule for Outpatient setting,40.07,110% of Physician Fee Schedule for Outpatient setting,36.43,100% of Physician Fee Schedule for Outpatient Setting,54.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,36.43,100% of CMS RBRVS Fee Schedule for Outpatient Setting,54.65,150% of CMS RBRVS Fee Schedule for Outpatient Setting,21.51,54.65,42
Outpatient Medical Services,RADIOLOGY,72050,"XRAY, Neck Spine 4-5 Views GLR",320,523,313.8,60% of total billed charges for outpatient setting,251.04,48% of toatl Billed Charges for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,121.77,111% of BCBS Fee Schedule for Outpatient Setting,261.5,Case rate,366.1,70% of Total Billed charges for Outpatient setting,253.55,48.48% of total Billed Charges for Outpatient Setting,253.55,48.48% of total Billed Charges for Outpatient Setting,253.55,48.48% of total Billed Charges for Outpatient Setting,366.1,70% of Total Billed charges for Outpatient setting,366.1,70% of Total Billed charges for Outpatient setting,251.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,253.55,48.48% of total Billed Charges for Outpatient Setting,470.7,90% of Total Billed charges for Outpatient setting,109.7,470.7,313.8
Outpatient Medical Services,RADIOLOGY,72050,"XRAY, Neck Spine 4-5 Views PFR",972,68,N/A,Not Applicable.Service not offered,48.81,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,29.64,100% of Cigna Fee Schedule for Outpatient Setting,53.69,110% of Physician Fee Schedule for Outpatient setting,49.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,49.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,49.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,53.69,110% of Physician Fee Schedule for Outpatient setting,53.69,110% of Physician Fee Schedule for Outpatient setting,48.81,100% of Physician Fee Schedule for Outpatient Setting,73.22,150% of CMS RBRVS Fee Schedule for Outpatient Setting,48.81,100% of CMS RBRVS Fee Schedule for Outpatient Setting,73.22,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.64,73.22,51
Outpatient Medical Services,RADIOLOGY,72052,"XRAY, Neck Spine 6 Views",320,656,393.6,60% of total billed charges for outpatient setting,314.88,48% of toatl Billed Charges for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,109.7,100% of BCBS Fee Schedule for Outpatient Setting,121.77,111% of BCBS Fee Schedule for Outpatient Setting,328,Case rate,459.2,70% of Total Billed charges for Outpatient setting,318.03,48.48% of total Billed Charges for Outpatient Setting,318.03,48.48% of total Billed Charges for Outpatient Setting,318.03,48.48% of total Billed Charges for Outpatient Setting,459.2,70% of Total Billed charges for Outpatient setting,459.2,70% of Total Billed charges for Outpatient setting,314.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,318.03,48.48% of total Billed Charges for Outpatient Setting,590.4,90% of Total Billed charges for Outpatient setting,109.7,590.4,393.6
Outpatient Medical Services,RADIOLOGY,72170,"XRAY, Pelvis GLR",320,369,221.4,60% of total billed charges for outpatient setting,177.12,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,184.5,Case rate,258.3,70% of Total Billed charges for Outpatient setting,178.89,48.48% of total Billed Charges for Outpatient Setting,178.89,48.48% of total Billed Charges for Outpatient Setting,178.89,48.48% of total Billed Charges for Outpatient Setting,258.3,70% of Total Billed charges for Outpatient setting,258.3,70% of Total Billed charges for Outpatient setting,177.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,178.89,48.48% of total Billed Charges for Outpatient Setting,332.1,90% of Total Billed charges for Outpatient setting,64.47,332.1,221.4
Outpatient Medical Services,RADIOLOGY,72170,"XRAY, Pelvis PFR",972,43,N/A,Not Applicable.Service not offered,25.83,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,20.7,100% of Cigna Fee Schedule for Outpatient Setting,28.41,110% of Physician Fee Schedule for Outpatient setting,26.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,26.09,101% of CMS RBRVS Fee Schedule for Outpatient Setting,28.41,110% of Physician Fee Schedule for Outpatient setting,28.41,110% of Physician Fee Schedule for Outpatient setting,25.83,100% of Physician Fee Schedule for Outpatient Setting,38.75,150% of CMS RBRVS Fee Schedule for Outpatient Setting,25.83,100% of CMS RBRVS Fee Schedule for Outpatient Setting,38.75,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.7,38.75,32.25
Outpatient Medical Services,RADIOLOGY,71100,"XRAY, Ribs 2 Views GLR",320,382,229.2,60% of total billed charges for outpatient setting,183.36,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,191,Case rate,267.4,70% of Total Billed charges for Outpatient setting,185.19,48.48% of total Billed Charges for Outpatient Setting,185.19,48.48% of total Billed Charges for Outpatient Setting,185.19,48.48% of total Billed Charges for Outpatient Setting,267.4,70% of Total Billed charges for Outpatient setting,267.4,70% of Total Billed charges for Outpatient setting,183.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,185.19,48.48% of total Billed Charges for Outpatient Setting,343.8,90% of Total Billed charges for Outpatient setting,64.47,343.8,229.2
Outpatient Medical Services,RADIOLOGY,71100,"XRAY, Ribs 2 Views PFR",972,56,N/A,Not Applicable.Service not offered,34.05,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,21.51,100% of Cigna Fee Schedule for Outpatient Setting,37.46,110% of Physician Fee Schedule for Outpatient setting,34.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.39,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.46,110% of Physician Fee Schedule for Outpatient setting,37.46,110% of Physician Fee Schedule for Outpatient setting,34.05,100% of Physician Fee Schedule for Outpatient Setting,51.08,150% of CMS RBRVS Fee Schedule for Outpatient Setting,34.05,100% of CMS RBRVS Fee Schedule for Outpatient Setting,51.08,150% of CMS RBRVS Fee Schedule for Outpatient Setting,21.51,51.08,42
Outpatient Medical Services,RADIOLOGY,72220,"XRAY, Sacrum/Coccyx 2 Views GLR",320,328,196.8,60% of total billed charges for outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,164,Case rate,229.6,70% of Total Billed charges for Outpatient setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,229.6,70% of Total Billed charges for Outpatient setting,229.6,70% of Total Billed charges for Outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,159.01,48.48% of total Billed Charges for Outpatient Setting,295.2,90% of Total Billed charges for Outpatient setting,64.47,295.2,196.8
Outpatient Medical Services,RADIOLOGY,72220,"XRAY, Sacrum/Coccyx 2 Views PFR",972,43,N/A,Not Applicable.Service not offered,29.98,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.24,100% of Cigna Fee Schedule for Outpatient Setting,32.98,110% of Physician Fee Schedule for Outpatient setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.28,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.98,110% of Physician Fee Schedule for Outpatient setting,32.98,110% of Physician Fee Schedule for Outpatient setting,29.98,100% of Physician Fee Schedule for Outpatient Setting,44.97,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.98,100% of CMS RBRVS Fee Schedule for Outpatient Setting,44.97,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.24,44.97,32.25
Outpatient Medical Services,RADIOLOGY,73010,"XRAY, Scapula GLR",320,349,209.4,60% of total billed charges for outpatient setting,167.52,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,174.5,Case rate,244.3,70% of Total Billed charges for Outpatient setting,169.2,48.48% of total Billed Charges for Outpatient Setting,169.2,48.48% of total Billed Charges for Outpatient Setting,169.2,48.48% of total Billed Charges for Outpatient Setting,244.3,70% of Total Billed charges for Outpatient setting,244.3,70% of Total Billed charges for Outpatient setting,167.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,169.2,48.48% of total Billed Charges for Outpatient Setting,314.1,90% of Total Billed charges for Outpatient setting,64.47,314.1,209.4
Outpatient Medical Services,RADIOLOGY,73010,"XRAY, Scapula PFR",972,47,N/A,Not Applicable.Service not offered,21.97,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,19.58,100% of Cigna Fee Schedule for Outpatient Setting,24.17,110% of Physician Fee Schedule for Outpatient setting,22.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,22.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,22.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,24.17,110% of Physician Fee Schedule for Outpatient setting,24.17,110% of Physician Fee Schedule for Outpatient setting,21.97,100% of Physician Fee Schedule for Outpatient Setting,32.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,21.97,100% of CMS RBRVS Fee Schedule for Outpatient Setting,32.96,150% of CMS RBRVS Fee Schedule for Outpatient Setting,19.58,32.96,35.25
Outpatient Medical Services,RADIOLOGY,73020,"XRAY, Shoulder 1 View GLR",320,266,159.6,60% of total billed charges for outpatient setting,127.68,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,133,Case rate,186.2,70% of Total Billed charges for Outpatient setting,128.96,48.48% of total Billed Charges for Outpatient Setting,128.96,48.48% of total Billed Charges for Outpatient Setting,128.96,48.48% of total Billed Charges for Outpatient Setting,186.2,70% of Total Billed charges for Outpatient setting,186.2,70% of Total Billed charges for Outpatient setting,127.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,128.96,48.48% of total Billed Charges for Outpatient Setting,239.4,90% of Total Billed charges for Outpatient setting,64.47,239.4,159.6
Outpatient Medical Services,RADIOLOGY,73020,"XRAY, Shoulder 1 View PFR",972,38,N/A,Not Applicable.Service not offered,20.1,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,15.07,100% of Cigna Fee Schedule for Outpatient Setting,22.11,110% of Physician Fee Schedule for Outpatient setting,20.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,20.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,20.3,101% of CMS RBRVS Fee Schedule for Outpatient Setting,22.11,110% of Physician Fee Schedule for Outpatient setting,22.11,110% of Physician Fee Schedule for Outpatient setting,20.1,100% of Physician Fee Schedule for Outpatient Setting,30.15,150% of CMS RBRVS Fee Schedule for Outpatient Setting,20.1,100% of CMS RBRVS Fee Schedule for Outpatient Setting,30.15,150% of CMS RBRVS Fee Schedule for Outpatient Setting,15.07,30.15,28.5
Outpatient Medical Services,RADIOLOGY,73030,"XRAY, Shoulder 2 Views GLR",320,336,31,100% of Aetna Fee Schedule for Outpatient Setting,161.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,168,Case rate,235.2,70% of Total Billed charges for Outpatient setting,162.89,48.48% of total Billed Charges for Outpatient Setting,162.89,48.48% of total Billed Charges for Outpatient Setting,162.89,48.48% of total Billed Charges for Outpatient Setting,235.2,70% of Total Billed charges for Outpatient setting,235.2,70% of Total Billed charges for Outpatient setting,161.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,162.89,48.48% of total Billed Charges for Outpatient Setting,302.4,90% of Total Billed charges for Outpatient setting,31,302.4,201.6
Outpatient Medical Services,RADIOLOGY,73030,"XRAY, Shoulder 2 Views PFR",972,47,N/A,Not Applicable.Service not offered,31.81,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.94,100% of Cigna Fee Schedule for Outpatient Setting,34.99,110% of Physician Fee Schedule for Outpatient setting,32.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,32.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.99,110% of Physician Fee Schedule for Outpatient setting,34.99,110% of Physician Fee Schedule for Outpatient setting,31.81,100% of Physician Fee Schedule for Outpatient Setting,47.72,150% of CMS RBRVS Fee Schedule for Outpatient Setting,31.81,100% of CMS RBRVS Fee Schedule for Outpatient Setting,47.72,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.94,47.72,35.25
Outpatient Medical Services,RADIOLOGY,70220,"XRAY, Sinus 3 Views GLR",320,436,43,100% of Aetna Fee Schedule for Outpatient Setting,209.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,218,Case rate,305.2,70% of Total Billed charges for Outpatient setting,211.37,48.48% of total Billed Charges for Outpatient Setting,211.37,48.48% of total Billed Charges for Outpatient Setting,211.37,48.48% of total Billed Charges for Outpatient Setting,305.2,70% of Total Billed charges for Outpatient setting,305.2,70% of Total Billed charges for Outpatient setting,209.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,211.37,48.48% of total Billed Charges for Outpatient Setting,392.4,90% of Total Billed charges for Outpatient setting,43,392.4,261.6
Outpatient Medical Services,RADIOLOGY,70220,"XRAY, Sinus 3 Views PFR",972,56,N/A,Not Applicable.Service not offered,34.65,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,24.49,100% of Cigna Fee Schedule for Outpatient Setting,38.12,110% of Physician Fee Schedule for Outpatient setting,35,101% of CMS RBRVS Fee Schedule for Outpatient Setting,35,101% of CMS RBRVS Fee Schedule for Outpatient Setting,35,101% of CMS RBRVS Fee Schedule for Outpatient Setting,38.12,110% of Physician Fee Schedule for Outpatient setting,38.12,110% of Physician Fee Schedule for Outpatient setting,34.65,100% of Physician Fee Schedule for Outpatient Setting,51.98,150% of CMS RBRVS Fee Schedule for Outpatient Setting,34.65,100% of CMS RBRVS Fee Schedule for Outpatient Setting,51.98,150% of CMS RBRVS Fee Schedule for Outpatient Setting,24.49,51.98,42
Outpatient Medical Services,RADIOLOGY,70250,"XRAY, Skull 4 Views GLR",320,419,251.4,60% of total billed charges for outpatient setting,201.12,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,209.5,Case rate,293.3,70% of Total Billed charges for Outpatient setting,203.13,48.48% of total Billed Charges for Outpatient Setting,203.13,48.48% of total Billed Charges for Outpatient Setting,203.13,48.48% of total Billed Charges for Outpatient Setting,293.3,70% of Total Billed charges for Outpatient setting,293.3,70% of Total Billed charges for Outpatient setting,201.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,203.13,48.48% of total Billed Charges for Outpatient Setting,377.1,90% of Total Billed charges for Outpatient setting,64.47,377.1,251.4
Outpatient Medical Services,RADIOLOGY,70250,"XRAY, Skull 4 Views PFR",972,50,N/A,Not Applicable.Service not offered,32.99,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,23.57,100% of Cigna Fee Schedule for Outpatient Setting,36.29,110% of Physician Fee Schedule for Outpatient setting,33.32,101% of CMS RBRVS Fee Schedule for Outpatient Setting,33.32,101% of CMS RBRVS Fee Schedule for Outpatient Setting,33.32,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.29,110% of Physician Fee Schedule for Outpatient setting,36.29,110% of Physician Fee Schedule for Outpatient setting,32.99,100% of Physician Fee Schedule for Outpatient Setting,49.49,150% of CMS RBRVS Fee Schedule for Outpatient Setting,32.99,100% of CMS RBRVS Fee Schedule for Outpatient Setting,49.49,150% of CMS RBRVS Fee Schedule for Outpatient Setting,23.57,49.49,37.5
Outpatient Medical Services,RADIOLOGY,72070,"XRAY, Thoracic Spine 2 Views GLR",320,394,236.4,60% of total billed charges for outpatient setting,189.12,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,197,Case rate,275.8,70% of Total Billed charges for Outpatient setting,191.01,48.48% of total Billed Charges for Outpatient Setting,191.01,48.48% of total Billed Charges for Outpatient Setting,191.01,48.48% of total Billed Charges for Outpatient Setting,275.8,70% of Total Billed charges for Outpatient setting,275.8,70% of Total Billed charges for Outpatient setting,189.12,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,191.01,48.48% of total Billed Charges for Outpatient Setting,354.6,90% of Total Billed charges for Outpatient setting,64.47,354.6,236.4
Outpatient Medical Services,RADIOLOGY,72070,"XRAY, Thoracic Spine 2 Views PFR",972,50,N/A,Not Applicable.Service not offered,30.41,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,22.17,100% of Cigna Fee Schedule for Outpatient Setting,33.45,110% of Physician Fee Schedule for Outpatient setting,30.71,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.71,101% of CMS RBRVS Fee Schedule for Outpatient Setting,30.71,101% of CMS RBRVS Fee Schedule for Outpatient Setting,33.45,110% of Physician Fee Schedule for Outpatient setting,33.45,110% of Physician Fee Schedule for Outpatient setting,30.41,100% of Physician Fee Schedule for Outpatient Setting,45.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,30.41,100% of CMS RBRVS Fee Schedule for Outpatient Setting,45.62,150% of CMS RBRVS Fee Schedule for Outpatient Setting,22.17,45.62,37.5
Outpatient Medical Services,RADIOLOGY,72072,"XRAY, Thoracic Spine 3 Views GLR",320,450,270,60% of total billed charges for outpatient setting,216,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,225,Case rate,315,70% of Total Billed charges for Outpatient setting,218.16,48.48% of total Billed Charges for Outpatient Setting,218.16,48.48% of total Billed Charges for Outpatient Setting,218.16,48.48% of total Billed Charges for Outpatient Setting,315,70% of Total Billed charges for Outpatient setting,315,70% of Total Billed charges for Outpatient setting,216,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,218.16,48.48% of total Billed Charges for Outpatient Setting,405,90% of Total Billed charges for Outpatient setting,64.47,405,270
Outpatient Medical Services,RADIOLOGY,72072,"XRAY, Thoracic Spine 3 Views PFR",972,66,N/A,Not Applicable.Service not offered,36.17,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,22.4,100% of Cigna Fee Schedule for Outpatient Setting,39.79,110% of Physician Fee Schedule for Outpatient setting,36.53,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.53,101% of CMS RBRVS Fee Schedule for Outpatient Setting,36.53,101% of CMS RBRVS Fee Schedule for Outpatient Setting,39.79,110% of Physician Fee Schedule for Outpatient setting,39.79,110% of Physician Fee Schedule for Outpatient setting,36.17,100% of Physician Fee Schedule for Outpatient Setting,54.26,150% of CMS RBRVS Fee Schedule for Outpatient Setting,36.17,100% of CMS RBRVS Fee Schedule for Outpatient Setting,54.26,150% of CMS RBRVS Fee Schedule for Outpatient Setting,22.4,54.26,49.5
Outpatient Medical Services,RADIOLOGY,73590,"XRAY, Tibia Fibula 2 Views GLR",320,332,199.2,60% of total billed charges for outpatient setting,159.36,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,166,Case rate,232.4,70% of Total Billed charges for Outpatient setting,160.95,48.48% of total Billed Charges for Outpatient Setting,160.95,48.48% of total Billed Charges for Outpatient Setting,160.95,48.48% of total Billed Charges for Outpatient Setting,232.4,70% of Total Billed charges for Outpatient setting,232.4,70% of Total Billed charges for Outpatient setting,159.36,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,160.95,48.48% of total Billed Charges for Outpatient Setting,298.8,90% of Total Billed charges for Outpatient setting,64.47,298.8,199.2
Outpatient Medical Services,RADIOLOGY,73590,"XRAY, Tibia Fibula 2 Views PFR",972,40,N/A,Not Applicable.Service not offered,29.05,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.66,100% of Cigna Fee Schedule for Outpatient Setting,31.96,110% of Physician Fee Schedule for Outpatient setting,29.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.34,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.96,110% of Physician Fee Schedule for Outpatient setting,31.96,110% of Physician Fee Schedule for Outpatient setting,29.05,100% of Physician Fee Schedule for Outpatient Setting,43.58,150% of CMS RBRVS Fee Schedule for Outpatient Setting,29.05,100% of CMS RBRVS Fee Schedule for Outpatient Setting,43.58,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.66,43.58,30
Outpatient Medical Services,RADIOLOGY,73660,"XRAY, Toes 2 Views GLR",320,328,196.8,60% of total billed charges for outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,164,Case rate,229.6,70% of Total Billed charges for Outpatient setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,159.01,48.48% of total Billed Charges for Outpatient Setting,229.6,70% of Total Billed charges for Outpatient setting,229.6,70% of Total Billed charges for Outpatient setting,157.44,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,159.01,48.48% of total Billed Charges for Outpatient Setting,295.2,90% of Total Billed charges for Outpatient setting,64.47,295.2,196.8
Outpatient Medical Services,RADIOLOGY,73660,"XRAY, Toes 2 Views PFR",972,33,N/A,Not Applicable.Service not offered,26.85,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.13,100% of Cigna Fee Schedule for Outpatient Setting,29.54,110% of Physician Fee Schedule for Outpatient setting,27.12,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.12,101% of CMS RBRVS Fee Schedule for Outpatient Setting,27.12,101% of CMS RBRVS Fee Schedule for Outpatient Setting,29.54,110% of Physician Fee Schedule for Outpatient setting,29.54,110% of Physician Fee Schedule for Outpatient setting,26.85,100% of Physician Fee Schedule for Outpatient Setting,40.28,150% of CMS RBRVS Fee Schedule for Outpatient Setting,26.85,100% of CMS RBRVS Fee Schedule for Outpatient Setting,40.28,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.13,40.28,24.75
Outpatient Medical Services,RADIOLOGY,73100,"XRAY, Wrist 2 Views GLR",320,340,204,60% of total billed charges for outpatient setting,163.2,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,170,Case rate,238,70% of Total Billed charges for Outpatient setting,164.83,48.48% of total Billed Charges for Outpatient Setting,164.83,48.48% of total Billed Charges for Outpatient Setting,164.83,48.48% of total Billed Charges for Outpatient Setting,238,70% of Total Billed charges for Outpatient setting,238,70% of Total Billed charges for Outpatient setting,163.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,164.83,48.48% of total Billed Charges for Outpatient Setting,306,90% of Total Billed charges for Outpatient setting,64.47,306,204
Outpatient Medical Services,RADIOLOGY,73100,"XRAY, Wrist 2 Views PFR",972,42,N/A,Not Applicable.Service not offered,31.13,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,18.88,100% of Cigna Fee Schedule for Outpatient Setting,34.24,110% of Physician Fee Schedule for Outpatient setting,31.44,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.44,101% of CMS RBRVS Fee Schedule for Outpatient Setting,31.44,101% of CMS RBRVS Fee Schedule for Outpatient Setting,34.24,110% of Physician Fee Schedule for Outpatient setting,34.24,110% of Physician Fee Schedule for Outpatient setting,31.13,100% of Physician Fee Schedule for Outpatient Setting,46.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,31.13,100% of CMS RBRVS Fee Schedule for Outpatient Setting,46.7,150% of CMS RBRVS Fee Schedule for Outpatient Setting,18.88,46.7,31.5
Outpatient Medical Services,RADIOLOGY,73110,"XRAY, Wrist 3 Views GLR",320,411,29,100% of Aetna Fee Schedule for Outpatient Setting,197.28,48% of toatl Billed Charges for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,64.47,100% of BCBS Fee Schedule for Outpatient Setting,71.56,111% of BCBS Fee Schedule for Outpatient Setting,205.5,Case rate,287.7,70% of Total Billed charges for Outpatient setting,199.25,48.48% of total Billed Charges for Outpatient Setting,199.25,48.48% of total Billed Charges for Outpatient Setting,199.25,48.48% of total Billed Charges for Outpatient Setting,287.7,70% of Total Billed charges for Outpatient setting,287.7,70% of Total Billed charges for Outpatient setting,197.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,199.25,48.48% of total Billed Charges for Outpatient Setting,369.9,90% of Total Billed charges for Outpatient setting,29,369.9,246.6
Outpatient Medical Services,RADIOLOGY,73110,"XRAY, Wrist 3 Views PFR",972,43,N/A,Not Applicable.Service not offered,37.4,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,22.92,100% of Cigna Fee Schedule for Outpatient Setting,41.14,110% of Physician Fee Schedule for Outpatient setting,37.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,37.77,101% of CMS RBRVS Fee Schedule for Outpatient Setting,41.14,110% of Physician Fee Schedule for Outpatient setting,41.14,110% of Physician Fee Schedule for Outpatient setting,37.4,100% of Physician Fee Schedule for Outpatient Setting,56.1,150% of CMS RBRVS Fee Schedule for Outpatient Setting,37.4,100% of CMS RBRVS Fee Schedule for Outpatient Setting,56.1,150% of CMS RBRVS Fee Schedule for Outpatient Setting,22.92,56.1,32.25
Outpatient Medical Services,RADIOLOGY,77067,"Mammography, screening, bilateral",403,260,156,60% of total billed charges for outpatient setting,124.8,48% of toatl Billed Charges for Outpatient Setting,123.27,100% of BCBS Fee Schedule for Outpatient Setting,123.27,100% of BCBS Fee Schedule for Outpatient Setting,136.83,111% of BCBS Fee Schedule for Outpatient Setting,130,Case rate,182,70% of Total Billed charges for Outpatient setting,126.05,48.48% of total Billed Charges for Outpatient Setting,126.05,48.48% of total Billed Charges for Outpatient Setting,126.05,48.48% of total Billed Charges for Outpatient Setting,182,70% of Total Billed charges for Outpatient setting,182,70% of Total Billed charges for Outpatient setting,124.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,126.05,48.48% of total Billed Charges for Outpatient Setting,234,90% of Total Billed charges for Outpatient setting,123.27,234,156
Outpatient Medical Services,RESPIRATORY,94060,Evaluation of wheezing,460,361,216.6,60% of total billed charges for outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,125.28,100% of BCBS Fee Schedule for Outpatient Setting,125.28,100% of BCBS Fee Schedule for Outpatient Setting,139.06,111% of BCBS Fee Schedule for Outpatient Setting,180.5,50% of total Billed charges for Outpatient setting,252.7,70% of Total Billed charges for Outpatient setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,252.7,70% of Total Billed charges for Outpatient setting,252.7,70% of Total Billed charges for Outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,175.01,48.48% of total Billed Charges for Outpatient Setting,324.9,90% of Total Billed charges for Outpatient setting,125.28,324.9,216.6
Outpatient Medical Services,CARDIAC,93926,Art Flow Lower Extremity GLR,921,529,317.4,60% of total billed charges for outpatient setting,253.92,48% of toatl Billed Charges for Outpatient Setting,207.97,100% of BCBS Fee Schedule for Outpatient Setting,207.97,100% of BCBS Fee Schedule for Outpatient Setting,230.85,111% of BCBS Fee Schedule for Outpatient Setting,264.5,50% of total Billed charges for Outpatient setting,370.3,70% of Total Billed charges for Outpatient setting,256.46,48.48% of total Billed Charges for Outpatient Setting,256.46,48.48% of total Billed Charges for Outpatient Setting,256.46,48.48% of total Billed Charges for Outpatient Setting,370.3,70% of Total Billed charges for Outpatient setting,370.3,70% of Total Billed charges for Outpatient setting,253.92,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,256.46,48.48% of total Billed Charges for Outpatient Setting,476.1,90% of Total Billed charges for Outpatient setting,207.97,476.1,317.4
Outpatient Medical Services,CARDIAC,93926,Art Flow Lower Extremity PFR,972,124.5,N/A,Not Applicable.Service not offered,124.5,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,142.5,100% of Cigna Fee Schedule for Outpatient Setting,136.95,110% of Physician Fee Schedule for Outpatient setting,125.75,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.75,101% of CMS RBRVS Fee Schedule for Outpatient Setting,125.75,101% of CMS RBRVS Fee Schedule for Outpatient Setting,136.95,110% of Physician Fee Schedule for Outpatient setting,136.95,110% of Physician Fee Schedule for Outpatient setting,124.5,100% of Physician Fee Schedule for Outpatient Setting,186.75,150% of CMS RBRVS Fee Schedule for Outpatient Setting,124.5,100% of CMS RBRVS Fee Schedule for Outpatient Setting,186.75,150% of CMS RBRVS Fee Schedule for Outpatient Setting,124.5,186.75,93.38
Outpatient Medical Services,CARDIAC,93923,Art Flow Lwr Ext ABI GLR,921,823,493.8,60% of total billed charges for outpatient setting,395.04,48% of toatl Billed Charges for Outpatient Setting,209.77,100% of BCBS Fee Schedule for Outpatient Setting,209.77,100% of BCBS Fee Schedule for Outpatient Setting,232.84,111% of BCBS Fee Schedule for Outpatient Setting,411.5,50% of total Billed charges for Outpatient setting,576.1,70% of Total Billed charges for Outpatient setting,398.99,48.48% of total Billed Charges for Outpatient Setting,398.99,48.48% of total Billed Charges for Outpatient Setting,398.99,48.48% of total Billed Charges for Outpatient Setting,576.1,70% of Total Billed charges for Outpatient setting,576.1,70% of Total Billed charges for Outpatient setting,395.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,398.99,48.48% of total Billed Charges for Outpatient Setting,740.7,90% of Total Billed charges for Outpatient setting,209.77,740.7,493.8
Outpatient Medical Services,CARDIAC,93923,Art Flow Lwr Ext ABI PFR,972,113,N/A,Not Applicable.Service not offered,113,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,129.3,100% of Cigna Fee Schedule for Outpatient Setting,124.3,110% of Physician Fee Schedule for Outpatient setting,114.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,114.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,114.13,101% of CMS RBRVS Fee Schedule for Outpatient Setting,124.3,110% of Physician Fee Schedule for Outpatient setting,124.3,110% of Physician Fee Schedule for Outpatient setting,113,100% of Physician Fee Schedule for Outpatient Setting,169.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,113,100% of CMS RBRVS Fee Schedule for Outpatient Setting,169.5,150% of CMS RBRVS Fee Schedule for Outpatient Setting,113,169.5,84.75
Outpatient Medical Services,CARDIAC,93005,EKG,730,93.75,56.25,60% of total billed charges for outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,49.35,100% of BCBS Fee Schedule for Outpatient Setting,49.35,100% of BCBS Fee Schedule for Outpatient Setting,54.78,111% of BCBS Fee Schedule for Outpatient Setting,46.88,50% of total Billed charges for Outpatient setting,65.63,70% of Total Billed charges for Outpatient setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,45.45,48.48% of total Billed Charges for Outpatient Setting,65.63,70% of Total Billed charges for Outpatient setting,65.63,70% of Total Billed charges for Outpatient setting,45,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,45.45,48.48% of total Billed Charges for Outpatient Setting,84.38,90% of Total Billed charges for Outpatient setting,45,84.38,70.31
Outpatient Medical Services,CARDIAC,93880,Extracranial bilat study GLR,921,1156,693.6,60% of total billed charges for outpatient setting,554.88,48% of toatl Billed Charges for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,371.24,111% of BCBS Fee Schedule for Outpatient Setting,578,50% of total Billed charges for Outpatient setting,809.2,70% of Total Billed charges for Outpatient setting,560.43,48.48% of total Billed Charges for Outpatient Setting,560.43,48.48% of total Billed Charges for Outpatient Setting,560.43,48.48% of total Billed Charges for Outpatient Setting,809.2,70% of Total Billed charges for Outpatient setting,809.2,70% of Total Billed charges for Outpatient setting,554.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,560.43,48.48% of total Billed Charges for Outpatient Setting,1040.4,90% of Total Billed charges for Outpatient setting,334.45,1040.4,693.6
Outpatient Medical Services,CARDIAC,93880,Extracranial bilat study PFR,972,201,N/A,Not Applicable.Service not offered,174.45,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,190.4,100% of Cigna Fee Schedule for Outpatient Setting,191.9,110% of Physician Fee Schedule for Outpatient setting,176.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,176.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,176.19,101% of CMS RBRVS Fee Schedule for Outpatient Setting,191.9,110% of Physician Fee Schedule for Outpatient setting,191.9,110% of Physician Fee Schedule for Outpatient setting,174.45,100% of Physician Fee Schedule for Outpatient Setting,261.68,150% of CMS RBRVS Fee Schedule for Outpatient Setting,174.45,100% of CMS RBRVS Fee Schedule for Outpatient Setting,261.68,150% of CMS RBRVS Fee Schedule for Outpatient Setting,174.45,261.68,120.6
Outpatient Medical Services,CARDIAC,93970,Extremity study GLR,921,1074,644.4,60% of total billed charges for outpatient setting,515.52,48% of toatl Billed Charges for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,371.24,111% of BCBS Fee Schedule for Outpatient Setting,537,50% of total Billed charges for Outpatient setting,751.8,70% of Total Billed charges for Outpatient setting,520.68,48.48% of total Billed Charges for Outpatient Setting,520.68,48.48% of total Billed Charges for Outpatient Setting,520.68,48.48% of total Billed Charges for Outpatient Setting,751.8,70% of Total Billed charges for Outpatient setting,751.8,70% of Total Billed charges for Outpatient setting,515.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,520.68,48.48% of total Billed Charges for Outpatient Setting,966.6,90% of Total Billed charges for Outpatient setting,334.45,966.6,644.4
Outpatient Medical Services,CARDIAC,93971,Extremity study GLR,921,716,429.6,60% of total billed charges for outpatient setting,343.68,48% of toatl Billed Charges for Outpatient Setting,207.97,100% of BCBS Fee Schedule for Outpatient Setting,207.97,100% of BCBS Fee Schedule for Outpatient Setting,230.85,111% of BCBS Fee Schedule for Outpatient Setting,358,50% of total Billed charges for Outpatient setting,501.2,70% of Total Billed charges for Outpatient setting,347.12,48.48% of total Billed Charges for Outpatient Setting,347.12,48.48% of total Billed Charges for Outpatient Setting,347.12,48.48% of total Billed Charges for Outpatient Setting,501.2,70% of Total Billed charges for Outpatient setting,501.2,70% of Total Billed charges for Outpatient setting,343.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,347.12,48.48% of total Billed Charges for Outpatient Setting,644.4,90% of Total Billed charges for Outpatient setting,207.97,644.4,429.6
Outpatient Medical Services,CARDIAC,93970,Extremity study PFR,972,175,N/A,Not Applicable.Service not offered,171.57,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,185,100% of Cigna Fee Schedule for Outpatient Setting,188.73,110% of Physician Fee Schedule for Outpatient setting,173.29,101% of CMS RBRVS Fee Schedule for Outpatient Setting,173.29,101% of CMS RBRVS Fee Schedule for Outpatient Setting,173.29,101% of CMS RBRVS Fee Schedule for Outpatient Setting,188.73,110% of Physician Fee Schedule for Outpatient setting,188.73,110% of Physician Fee Schedule for Outpatient setting,171.57,100% of Physician Fee Schedule for Outpatient Setting,257.36,150% of CMS RBRVS Fee Schedule for Outpatient Setting,171.57,100% of CMS RBRVS Fee Schedule for Outpatient Setting,257.36,150% of CMS RBRVS Fee Schedule for Outpatient Setting,171.57,257.36,131.25
Outpatient Medical Services,CARDIAC,93971,Extremity study PFR,972,112,N/A,Not Applicable.Service not offered,108.7,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,112.72,100% of Cigna Fee Schedule for Outpatient Setting,119.57,110% of Physician Fee Schedule for Outpatient setting,109.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,109.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,109.79,101% of CMS RBRVS Fee Schedule for Outpatient Setting,119.57,110% of Physician Fee Schedule for Outpatient setting,119.57,110% of Physician Fee Schedule for Outpatient setting,108.7,100% of Physician Fee Schedule for Outpatient Setting,163.05,150% of CMS RBRVS Fee Schedule for Outpatient Setting,108.7,100% of CMS RBRVS Fee Schedule for Outpatient Setting,163.05,150% of CMS RBRVS Fee Schedule for Outpatient Setting,108.7,163.05,84
Outpatient Medical Services,CARDIAC,93225,Holter Monitor 24 Hr,731,200,120,60% of total billed charges for outpatient setting,96,48% of toatl Billed Charges for Outpatient Setting,133.7,100% of BCBS Fee Schedule for Outpatient Setting,133.7,100% of BCBS Fee Schedule for Outpatient Setting,148.41,111% of BCBS Fee Schedule for Outpatient Setting,100,50% of total Billed charges for Outpatient setting,140,70% of Total Billed charges for Outpatient setting,96.96,48.48% of total Billed Charges for Outpatient Setting,96.96,48.48% of total Billed Charges for Outpatient Setting,96.96,48.48% of total Billed Charges for Outpatient Setting,140,70% of Total Billed charges for Outpatient setting,140,70% of Total Billed charges for Outpatient setting,96,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,96.96,48.48% of total Billed Charges for Outpatient Setting,180,90% of Total Billed charges for Outpatient setting,96,180,120
Outpatient Medical Services,CARDIAC,93226,Holter Monitor Report,731,213,127.8,60% of total billed charges for outpatient setting,102.24,48% of toatl Billed Charges for Outpatient Setting,133.7,100% of BCBS Fee Schedule for Outpatient Setting,133.7,100% of BCBS Fee Schedule for Outpatient Setting,148.41,111% of BCBS Fee Schedule for Outpatient Setting,106.5,50% of total Billed charges for Outpatient setting,149.1,70% of Total Billed charges for Outpatient setting,103.26,48.48% of total Billed Charges for Outpatient Setting,103.26,48.48% of total Billed Charges for Outpatient Setting,103.26,48.48% of total Billed Charges for Outpatient Setting,149.1,70% of Total Billed charges for Outpatient setting,149.1,70% of Total Billed charges for Outpatient setting,102.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,103.26,48.48% of total Billed Charges for Outpatient Setting,191.7,90% of Total Billed charges for Outpatient setting,102.24,191.7,127.8
Outpatient Medical Services,CARDIAC,93925,Lower Extremity Study GLR,921,675,405,60% of total billed charges for outpatient setting,324,48% of toatl Billed Charges for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,334.45,100% of BCBS Fee Schedule for Outpatient Setting,371.24,111% of BCBS Fee Schedule for Outpatient Setting,337.5,50% of total Billed charges for Outpatient setting,472.5,70% of Total Billed charges for Outpatient setting,327.24,48.48% of total Billed Charges for Outpatient Setting,327.24,48.48% of total Billed Charges for Outpatient Setting,327.24,48.48% of total Billed Charges for Outpatient Setting,472.5,70% of Total Billed charges for Outpatient setting,472.5,70% of Total Billed charges for Outpatient setting,324,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,327.24,48.48% of total Billed Charges for Outpatient Setting,607.5,90% of Total Billed charges for Outpatient setting,324,607.5,405
Outpatient Medical Services,CARDIAC,93925,Lower Extremity Study PFR,972,198,N/A,Not Applicable.Service not offered,198,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,242.24,100% of Cigna Fee Schedule for Outpatient Setting,217.8,110% of Physician Fee Schedule for Outpatient setting,199.98,101% of CMS RBRVS Fee Schedule for Outpatient Setting,199.98,101% of CMS RBRVS Fee Schedule for Outpatient Setting,199.98,101% of CMS RBRVS Fee Schedule for Outpatient Setting,217.8,110% of Physician Fee Schedule for Outpatient setting,217.8,110% of Physician Fee Schedule for Outpatient setting,198,100% of Physician Fee Schedule for Outpatient Setting,297,150% of CMS RBRVS Fee Schedule for Outpatient Setting,198,100% of CMS RBRVS Fee Schedule for Outpatient Setting,297,150% of CMS RBRVS Fee Schedule for Outpatient Setting,198,297,148.5
Outpatient Medical Services,CARDIAC,93306,Tte w/doppler complete,483,5074.42,3044.65,60% of total billed charges for outpatient setting,2435.72,48% of toatl Billed Charges for Outpatient Setting,949.1,100% of BCBS Fee Schedule for Outpatient Setting,949.1,100% of BCBS Fee Schedule for Outpatient Setting,1053.5,111% of BCBS Fee Schedule for Outpatient Setting,2537.21,50% of total Billed charges for Outpatient setting,3552.09,70% of Total Billed charges for Outpatient setting,2460.08,48.48% of total Billed Charges for Outpatient Setting,2460.08,48.48% of total Billed Charges for Outpatient Setting,2460.08,48.48% of total Billed Charges for Outpatient Setting,3552.09,70% of Total Billed charges for Outpatient setting,3552.09,70% of Total Billed charges for Outpatient setting,2435.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,2460.08,48.48% of total Billed Charges for Outpatient Setting,4566.98,90% of Total Billed charges for Outpatient setting,949.1,4566.98,3044.65
Outpatient Medical Services,CARDIAC,93922,Upr/l xtremity art 2 levels GLR,921,664,398.4,60% of total billed charges for outpatient setting,318.72,48% of toatl Billed Charges for Outpatient Setting,209.77,100% of BCBS Fee Schedule for Outpatient Setting,209.77,100% of BCBS Fee Schedule for Outpatient Setting,232.84,111% of BCBS Fee Schedule for Outpatient Setting,332,50% of total Billed charges for Outpatient setting,464.8,70% of Total Billed charges for Outpatient setting,321.91,48.48% of total Billed Charges for Outpatient Setting,321.91,48.48% of total Billed Charges for Outpatient Setting,321.91,48.48% of total Billed Charges for Outpatient Setting,464.8,70% of Total Billed charges for Outpatient setting,464.8,70% of Total Billed charges for Outpatient setting,318.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,321.91,48.48% of total Billed Charges for Outpatient Setting,597.6,90% of Total Billed charges for Outpatient setting,209.77,597.6,398.4
Outpatient Medical Services,CARDIAC,93922,Upr/l xtremity art 2 levels PFR,972,120,N/A,Not Applicable.Service not offered,74.62,100% of Physician Fee Schedule for Outpatient Setting,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,N/A,Not Applicable.Service not offered,82.99,100% of Cigna Fee Schedule for Outpatient Setting,82.08,110% of Physician Fee Schedule for Outpatient setting,75.37,101% of CMS RBRVS Fee Schedule for Outpatient Setting,75.37,101% of CMS RBRVS Fee Schedule for Outpatient Setting,75.37,101% of CMS RBRVS Fee Schedule for Outpatient Setting,82.08,110% of Physician Fee Schedule for Outpatient setting,82.08,110% of Physician Fee Schedule for Outpatient setting,74.62,100% of Physician Fee Schedule for Outpatient Setting,111.93,150% of CMS RBRVS Fee Schedule for Outpatient Setting,74.62,100% of CMS RBRVS Fee Schedule for Outpatient Setting,111.93,150% of CMS RBRVS Fee Schedule for Outpatient Setting,74.62,111.93,90
Outpatient Medical Services,THERAPY,97129,Cogn Skills Development ST,440,131,78.6,60% of total billed charges for outpatient setting,62.88,48% of toatl Billed Charges for Outpatient Setting,0.01,100% of BCBS Fee Schedule for Outpatient Setting,0.01,100% of BCBS Fee Schedule for Outpatient Setting,0.01,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,91.7,70% of Total Billed charges for Outpatient setting,63.51,48.48% of total Billed Charges for Outpatient Setting,63.51,48.48% of total Billed Charges for Outpatient Setting,63.51,48.48% of total Billed Charges for Outpatient Setting,91.7,70% of Total Billed charges for Outpatient setting,91.7,70% of Total Billed charges for Outpatient setting,62.88,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,63.51,48.48% of total Billed Charges for Outpatient Setting,117.9,90% of Total Billed charges for Outpatient setting,0.01,117.9,98.25
Outpatient Medical Services,THERAPY,97129,Cogn Skills Development OT,430,55.59,33.35,60% of total billed charges for outpatient setting,26.68,48% of toatl Billed Charges for Outpatient Setting,0.01,100% of BCBS Fee Schedule for Outpatient Setting,0.01,100% of BCBS Fee Schedule for Outpatient Setting,0.01,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,38.91,70% of Total Billed charges for Outpatient setting,26.95,48.48% of total Billed Charges for Outpatient Setting,26.95,48.48% of total Billed Charges for Outpatient Setting,26.95,48.48% of total Billed Charges for Outpatient Setting,38.91,70% of Total Billed charges for Outpatient setting,38.91,70% of Total Billed charges for Outpatient setting,26.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,26.95,48.48% of total Billed Charges for Outpatient Setting,50.03,90% of Total Billed charges for Outpatient setting,0.01,80,41.69
Outpatient Medical Services,THERAPY,97032,Elec stim manual PT,420,95,57,60% of total billed charges for outpatient setting,45.6,48% of toatl Billed Charges for Outpatient Setting,29.38,100% of BCBS Fee Schedule for Outpatient Setting,29.38,100% of BCBS Fee Schedule for Outpatient Setting,32.61,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,66.5,70% of Total Billed charges for Outpatient setting,46.06,48.48% of total Billed Charges for Outpatient Setting,46.06,48.48% of total Billed Charges for Outpatient Setting,46.06,48.48% of total Billed Charges for Outpatient Setting,66.5,70% of Total Billed charges for Outpatient setting,66.5,70% of Total Billed charges for Outpatient setting,45.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,46.06,48.48% of total Billed Charges for Outpatient Setting,85.5,90% of Total Billed charges for Outpatient setting,29.38,85.5,71.25
Outpatient Medical Services,THERAPY,97032,Elec stim manual OT,430,79,47.4,60% of total billed charges for outpatient setting,37.92,48% of toatl Billed Charges for Outpatient Setting,29.38,100% of BCBS Fee Schedule for Outpatient Setting,29.38,100% of BCBS Fee Schedule for Outpatient Setting,32.61,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,55.3,70% of Total Billed charges for Outpatient setting,38.3,48.48% of total Billed Charges for Outpatient Setting,38.3,48.48% of total Billed Charges for Outpatient Setting,38.3,48.48% of total Billed Charges for Outpatient Setting,55.3,70% of Total Billed charges for Outpatient setting,55.3,70% of Total Billed charges for Outpatient setting,37.92,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,38.3,48.48% of total Billed Charges for Outpatient Setting,71.1,90% of Total Billed charges for Outpatient setting,29.38,80,59.25
Outpatient Medical Services,THERAPY,92610,Evaluate swallowing function,444,361,216.6,60% of total billed charges for outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,256.61,100% of BCBS Fee Schedule for Outpatient Setting,256.61,100% of BCBS Fee Schedule for Outpatient Setting,284.84,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,252.7,70% of Total Billed charges for Outpatient setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,175.01,48.48% of total Billed Charges for Outpatient Setting,252.7,70% of Total Billed charges for Outpatient setting,252.7,70% of Total Billed charges for Outpatient setting,173.28,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,175.01,48.48% of total Billed Charges for Outpatient Setting,324.9,90% of Total Billed charges for Outpatient setting,80,324.9,216.6
Outpatient Medical Services,THERAPY,97116,Gait training therapy,420,140,84,60% of total billed charges for outpatient setting,67.2,48% of toatl Billed Charges for Outpatient Setting,45.53,100% of BCBS Fee Schedule for Outpatient Setting,45.53,100% of BCBS Fee Schedule for Outpatient Setting,50.54,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,98,70% of Total Billed charges for Outpatient setting,67.87,48.48% of total Billed Charges for Outpatient Setting,67.87,48.48% of total Billed Charges for Outpatient Setting,67.87,48.48% of total Billed Charges for Outpatient Setting,98,70% of Total Billed charges for Outpatient setting,98,70% of Total Billed charges for Outpatient setting,67.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,67.87,48.48% of total Billed Charges for Outpatient Setting,126,90% of Total Billed charges for Outpatient setting,45.53,126,105
Outpatient Medical Services,THERAPY,97140,Manual Therapy,430,147,88.2,60% of total billed charges for outpatient setting,70.56,48% of toatl Billed Charges for Outpatient Setting,48.38,100% of BCBS Fee Schedule for Outpatient Setting,48.38,100% of BCBS Fee Schedule for Outpatient Setting,53.7,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,102.9,70% of Total Billed charges for Outpatient setting,71.27,48.48% of total Billed Charges for Outpatient Setting,71.27,48.48% of total Billed Charges for Outpatient Setting,71.27,48.48% of total Billed Charges for Outpatient Setting,102.9,70% of Total Billed charges for Outpatient setting,102.9,70% of Total Billed charges for Outpatient setting,70.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,71.27,48.48% of total Billed Charges for Outpatient Setting,132.3,90% of Total Billed charges for Outpatient setting,48.38,132.3,110.25
Outpatient Medical Services,THERAPY,97012,Mechanical Traction,430,79,47.4,60% of total billed charges for outpatient setting,37.92,48% of toatl Billed Charges for Outpatient Setting,27.48,100% of BCBS Fee Schedule for Outpatient Setting,27.48,100% of BCBS Fee Schedule for Outpatient Setting,30.5,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,55.3,70% of Total Billed charges for Outpatient setting,38.3,48.48% of total Billed Charges for Outpatient Setting,38.3,48.48% of total Billed Charges for Outpatient Setting,38.3,48.48% of total Billed Charges for Outpatient Setting,55.3,70% of Total Billed charges for Outpatient setting,55.3,70% of Total Billed charges for Outpatient setting,37.92,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,38.3,48.48% of total Billed Charges for Outpatient Setting,71.1,90% of Total Billed charges for Outpatient setting,27.48,80,59.25
Outpatient Medical Services,THERAPY,97112,Neuromuscular Re-Education,430,166,99.6,60% of total billed charges for outpatient setting,79.68,48% of toatl Billed Charges for Outpatient Setting,53.63,100% of BCBS Fee Schedule for Outpatient Setting,53.63,100% of BCBS Fee Schedule for Outpatient Setting,59.53,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,116.2,70% of Total Billed charges for Outpatient setting,80.48,48.48% of total Billed Charges for Outpatient Setting,80.48,48.48% of total Billed Charges for Outpatient Setting,80.48,48.48% of total Billed Charges for Outpatient Setting,116.2,70% of Total Billed charges for Outpatient setting,116.2,70% of Total Billed charges for Outpatient setting,79.68,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,80.48,48.48% of total Billed Charges for Outpatient Setting,149.4,90% of Total Billed charges for Outpatient setting,53.63,149.4,124.5
Outpatient Medical Services,THERAPY,92526,Oral function therapy,440,220,132,60% of total billed charges for outpatient setting,105.6,48% of toatl Billed Charges for Outpatient Setting,256.74,100% of BCBS Fee Schedule for Outpatient Setting,256.74,100% of BCBS Fee Schedule for Outpatient Setting,284.98,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,154,70% of Total Billed charges for Outpatient setting,106.66,48.48% of total Billed Charges for Outpatient Setting,106.66,48.48% of total Billed Charges for Outpatient Setting,106.66,48.48% of total Billed Charges for Outpatient Setting,154,70% of Total Billed charges for Outpatient setting,154,70% of Total Billed charges for Outpatient setting,105.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,106.66,48.48% of total Billed Charges for Outpatient Setting,198,90% of Total Billed charges for Outpatient setting,80,284.98,132
Outpatient Medical Services,THERAPY,97167,Ot eval high complex,434,386.75,232.05,60% of total billed charges for outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,165.33,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,270.73,70% of Total Billed charges for Outpatient setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,270.73,70% of Total Billed charges for Outpatient setting,270.73,70% of Total Billed charges for Outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,187.5,48.48% of total Billed Charges for Outpatient Setting,348.08,90% of Total Billed charges for Outpatient setting,80,348.08,232.05
Outpatient Medical Services,THERAPY,97165,Ot eval low complex 30 min,434,386.75,232.05,60% of total billed charges for outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,165.33,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,270.73,70% of Total Billed charges for Outpatient setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,270.73,70% of Total Billed charges for Outpatient setting,270.73,70% of Total Billed charges for Outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,187.5,48.48% of total Billed Charges for Outpatient Setting,348.08,90% of Total Billed charges for Outpatient setting,80,348.08,232.05
Outpatient Medical Services,THERAPY,97166,Ot eval mod complex 45 min,434,386.75,232.05,60% of total billed charges for outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,148.95,100% of BCBS Fee Schedule for Outpatient Setting,165.33,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,270.73,70% of Total Billed charges for Outpatient setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,187.5,48.48% of total Billed Charges for Outpatient Setting,270.73,70% of Total Billed charges for Outpatient setting,270.73,70% of Total Billed charges for Outpatient setting,185.64,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,187.5,48.48% of total Billed Charges for Outpatient Setting,348.08,90% of Total Billed charges for Outpatient setting,80,348.08,232.05
Outpatient Medical Services,THERAPY,97163,Pt eval high complex,424,399,239.4,60% of total billed charges for outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,155.43,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,279.3,70% of Total Billed charges for Outpatient setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,279.3,70% of Total Billed charges for Outpatient setting,279.3,70% of Total Billed charges for Outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,193.44,48.48% of total Billed Charges for Outpatient Setting,359.1,90% of Total Billed charges for Outpatient setting,80,359.1,239.4
Outpatient Medical Services,THERAPY,97161,Pt eval low complex 20 min,424,399,239.4,60% of total billed charges for outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,155.43,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,279.3,70% of Total Billed charges for Outpatient setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,279.3,70% of Total Billed charges for Outpatient setting,279.3,70% of Total Billed charges for Outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,193.44,48.48% of total Billed Charges for Outpatient Setting,359.1,90% of Total Billed charges for Outpatient setting,80,359.1,239.4
Outpatient Medical Services,THERAPY,97162,Pt eval mod complex 30 min,424,399,239.4,60% of total billed charges for outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,140.03,100% of BCBS Fee Schedule for Outpatient Setting,155.43,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,279.3,70% of Total Billed charges for Outpatient setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,193.44,48.48% of total Billed Charges for Outpatient Setting,279.3,70% of Total Billed charges for Outpatient setting,279.3,70% of Total Billed charges for Outpatient setting,191.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,193.44,48.48% of total Billed Charges for Outpatient Setting,359.1,90% of Total Billed charges for Outpatient setting,80,359.1,239.4
Outpatient Medical Services,THERAPY,97535,Self care mngment training,430,173,103.8,60% of total billed charges for outpatient setting,83.04,48% of toatl Billed Charges for Outpatient Setting,54.88,100% of BCBS Fee Schedule for Outpatient Setting,54.88,100% of BCBS Fee Schedule for Outpatient Setting,60.92,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,121.1,70% of Total Billed charges for Outpatient setting,83.87,48.48% of total Billed Charges for Outpatient Setting,83.87,48.48% of total Billed Charges for Outpatient Setting,83.87,48.48% of total Billed Charges for Outpatient Setting,121.1,70% of Total Billed charges for Outpatient setting,121.1,70% of Total Billed charges for Outpatient setting,83.04,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,83.87,48.48% of total Billed Charges for Outpatient Setting,155.7,90% of Total Billed charges for Outpatient setting,54.88,155.7,129.75
Outpatient Medical Services,THERAPY,92523,Speech sound lang comprehen,444,374,224.4,60% of total billed charges for outpatient setting,179.52,48% of toatl Billed Charges for Outpatient Setting,256.69,100% of BCBS Fee Schedule for Outpatient Setting,256.69,100% of BCBS Fee Schedule for Outpatient Setting,284.93,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,261.8,70% of Total Billed charges for Outpatient setting,181.32,48.48% of total Billed Charges for Outpatient Setting,181.32,48.48% of total Billed Charges for Outpatient Setting,181.32,48.48% of total Billed Charges for Outpatient Setting,261.8,70% of Total Billed charges for Outpatient setting,261.8,70% of Total Billed charges for Outpatient setting,179.52,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,181.32,48.48% of total Billed Charges for Outpatient Setting,336.6,90% of Total Billed charges for Outpatient setting,80,336.6,224.4
Outpatient Medical Services,THERAPY,92507,Speech/hearing therapy,440,139,83.4,60% of total billed charges for outpatient setting,66.72,48% of toatl Billed Charges for Outpatient Setting,188.05,100% of BCBS Fee Schedule for Outpatient Setting,188.05,100% of BCBS Fee Schedule for Outpatient Setting,208.74,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,97.3,70% of Total Billed charges for Outpatient setting,67.39,48.48% of total Billed Charges for Outpatient Setting,67.39,48.48% of total Billed Charges for Outpatient Setting,67.39,48.48% of total Billed Charges for Outpatient Setting,97.3,70% of Total Billed charges for Outpatient setting,97.3,70% of Total Billed charges for Outpatient setting,66.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,67.39,48.48% of total Billed Charges for Outpatient Setting,125.1,90% of Total Billed charges for Outpatient setting,66.72,208.74,104.25
Outpatient Medical Services,THERAPY,97530,Therapeutic activities,430,172,103.2,60% of total billed charges for outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,53.52,100% of BCBS Fee Schedule for Outpatient Setting,53.52,100% of BCBS Fee Schedule for Outpatient Setting,59.41,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,120.4,70% of Total Billed charges for Outpatient setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,120.4,70% of Total Billed charges for Outpatient setting,120.4,70% of Total Billed charges for Outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,83.39,48.48% of total Billed Charges for Outpatient Setting,154.8,90% of Total Billed charges for Outpatient setting,53.52,154.8,129
Outpatient Medical Services,THERAPY,97110,Therapeutic exercises,430,172,103.2,60% of total billed charges for outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,51.9,100% of BCBS Fee Schedule for Outpatient Setting,51.9,100% of BCBS Fee Schedule for Outpatient Setting,57.61,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,120.4,70% of Total Billed charges for Outpatient setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,83.39,48.48% of total Billed Charges for Outpatient Setting,120.4,70% of Total Billed charges for Outpatient setting,120.4,70% of Total Billed charges for Outpatient setting,82.56,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,83.39,48.48% of total Billed Charges for Outpatient Setting,154.8,90% of Total Billed charges for Outpatient setting,51.9,154.8,129
Outpatient Medical Services,THERAPY,97035,Ultrasound Therapy,430,87.5,52.5,60% of total billed charges for outpatient setting,42,48% of toatl Billed Charges for Outpatient Setting,22.64,100% of BCBS Fee Schedule for Outpatient Setting,22.64,100% of BCBS Fee Schedule for Outpatient Setting,25.13,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,61.25,70% of Total Billed charges for Outpatient setting,42.42,48.48% of total Billed Charges for Outpatient Setting,42.42,48.48% of total Billed Charges for Outpatient Setting,42.42,48.48% of total Billed Charges for Outpatient Setting,61.25,70% of Total Billed charges for Outpatient setting,61.25,70% of Total Billed charges for Outpatient setting,42,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,42.42,48.48% of total Billed Charges for Outpatient Setting,78.75,90% of Total Billed charges for Outpatient setting,22.64,80,65.63
Outpatient Medical Services,THERAPY,97016,Vasopneumatic device therapy,430,95,57,60% of total billed charges for outpatient setting,45.6,48% of toatl Billed Charges for Outpatient Setting,25.43,100% of BCBS Fee Schedule for Outpatient Setting,25.43,100% of BCBS Fee Schedule for Outpatient Setting,28.23,111% of BCBS Fee Schedule for Outpatient Setting,80,Case rate,66.5,70% of Total Billed charges for Outpatient setting,46.06,48.48% of total Billed Charges for Outpatient Setting,46.06,48.48% of total Billed Charges for Outpatient Setting,46.06,48.48% of total Billed Charges for Outpatient Setting,66.5,70% of Total Billed charges for Outpatient setting,66.5,70% of Total Billed charges for Outpatient setting,45.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,46.06,48.48% of total Billed Charges for Outpatient Setting,85.5,90% of Total Billed charges for Outpatient setting,25.43,85.5,71.25
Outpatient Medical Services,EMERGENCY ROOM,99291,Critical care first hour-Emergency Services,450,1741.25,870.63,60% of total billed charges for outpatient setting,835.8,48% of toatl Billed Charges for Outpatient Setting,1051.11,100% of BCBS Fee Schedule for Outpatient Setting,1051.11,100% of BCBS Fee Schedule for Outpatient Setting,1166.73,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,1218.88,70% of Total Billed charges for Outpatient setting,844.16,48.48% of total Billed Charges for Outpatient Setting,844.16,48.48% of total Billed Charges for Outpatient Setting,844.16,48.48% of total Billed Charges for Outpatient Setting,1218.88,70% of Total Billed charges for Outpatient setting,1218.88,70% of Total Billed charges for Outpatient setting,835.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,844.16,48.48% of total Billed Charges for Outpatient Setting,1567.13,90% of Total Billed charges for Outpatient setting,450,1567.13,1044.75
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency dept visit Level 1,450,228.75,114.38,60% of total billed charges for outpatient setting,109.8,48% of toatl Billed Charges for Outpatient Setting,162.35,100% of BCBS Fee Schedule for Outpatient Setting,162.35,100% of BCBS Fee Schedule for Outpatient Setting,180.21,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,160.13,70% of Total Billed charges for Outpatient setting,110.9,48.48% of total Billed Charges for Outpatient Setting,110.9,48.48% of total Billed Charges for Outpatient Setting,110.9,48.48% of total Billed Charges for Outpatient Setting,160.13,70% of Total Billed charges for Outpatient setting,160.13,70% of Total Billed charges for Outpatient setting,109.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,110.9,48.48% of total Billed Charges for Outpatient Setting,205.88,90% of Total Billed charges for Outpatient setting,109.8,450,137.25
Outpatient Medical Services,EMERGENCY ROOM,99282,Emergency dept visit Level 2,450,256.25,128.13,60% of total billed charges for outpatient setting,123,48% of toatl Billed Charges for Outpatient Setting,162.35,100% of BCBS Fee Schedule for Outpatient Setting,162.35,100% of BCBS Fee Schedule for Outpatient Setting,180.21,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,179.38,70% of Total Billed charges for Outpatient setting,124.23,48.48% of total Billed Charges for Outpatient Setting,124.23,48.48% of total Billed Charges for Outpatient Setting,124.23,48.48% of total Billed Charges for Outpatient Setting,179.38,70% of Total Billed charges for Outpatient setting,179.38,70% of Total Billed charges for Outpatient setting,123,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,124.23,48.48% of total Billed Charges for Outpatient Setting,230.63,90% of Total Billed charges for Outpatient setting,123,450,153.75
Outpatient Medical Services,EMERGENCY ROOM,99283,Emergency dept visit Level 3,450,366.25,183.13,60% of total billed charges for outpatient setting,175.8,48% of toatl Billed Charges for Outpatient Setting,284.22,100% of BCBS Fee Schedule for Outpatient Setting,284.22,100% of BCBS Fee Schedule for Outpatient Setting,315.48,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,256.38,70% of Total Billed charges for Outpatient setting,177.56,48.48% of total Billed Charges for Outpatient Setting,177.56,48.48% of total Billed Charges for Outpatient Setting,177.56,48.48% of total Billed Charges for Outpatient Setting,256.38,70% of Total Billed charges for Outpatient setting,256.38,70% of Total Billed charges for Outpatient setting,175.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,177.56,48.48% of total Billed Charges for Outpatient Setting,329.63,90% of Total Billed charges for Outpatient setting,175.8,450,219.75
Outpatient Medical Services,EMERGENCY ROOM,99284,Emergency dept visit Level 4,450,565,282.5,60% of total billed charges for outpatient setting,271.2,48% of toatl Billed Charges for Outpatient Setting,494.56,100% of BCBS Fee Schedule for Outpatient Setting,494.56,100% of BCBS Fee Schedule for Outpatient Setting,548.96,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,395.5,70% of Total Billed charges for Outpatient setting,273.91,48.48% of total Billed Charges for Outpatient Setting,273.91,48.48% of total Billed Charges for Outpatient Setting,273.91,48.48% of total Billed Charges for Outpatient Setting,395.5,70% of Total Billed charges for Outpatient setting,395.5,70% of Total Billed charges for Outpatient setting,271.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,273.91,48.48% of total Billed Charges for Outpatient Setting,508.5,90% of Total Billed charges for Outpatient setting,271.2,548.96,339
Outpatient Medical Services,EMERGENCY ROOM,99285,Emergency dept visit Level 5,450,1121.25,560.63,60% of total billed charges for outpatient setting,538.2,48% of toatl Billed Charges for Outpatient Setting,494.56,100% of BCBS Fee Schedule for Outpatient Setting,494.56,100% of BCBS Fee Schedule for Outpatient Setting,548.96,111% of BCBS Fee Schedule for Outpatient Setting,450,Case rate,784.88,70% of Total Billed charges for Outpatient setting,543.58,48.48% of total Billed Charges for Outpatient Setting,543.58,48.48% of total Billed Charges for Outpatient Setting,543.58,48.48% of total Billed Charges for Outpatient Setting,784.88,70% of Total Billed charges for Outpatient setting,784.88,70% of Total Billed charges for Outpatient setting,538.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,543.58,48.48% of total Billed Charges for Outpatient Setting,1009.13,90% of Total Billed charges for Outpatient setting,450,1009.13,672.75
Outpatient Medical Services,OUTPATIENT,11730,Avulsion Nail Plate,761,328.53,399,100% of Aetna Asc Tier Grouping Fee Schedule,157.69,48% of toatl Billed Charges for Outpatient Setting,172.44,100% of BCBS Fee Schedule for Outpatient Setting,172.44,100% of BCBS Fee Schedule for Outpatient Setting,191.41,111% of BCBS Fee Schedule for Outpatient Setting,164.27,50% of total Billed charges for Outpatient setting,229.97,70% of Total Billed charges for Outpatient setting,159.27,48.48% of total Billed Charges for Outpatient Setting,159.27,48.48% of total Billed Charges for Outpatient Setting,159.27,48.48% of total Billed Charges for Outpatient Setting,229.97,70% of Total Billed charges for Outpatient setting,229.97,70% of Total Billed charges for Outpatient setting,157.69,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,159.27,48.48% of total Billed Charges for Outpatient Setting,295.68,90% of Total Billed charges for Outpatient setting,157.69,399,197.12
Outpatient Medical Services,OUTPATIENT,11732,Avulsion Nail Plate Add-on,761,265.31,399,100% of Aetna Asc Tier Grouping Fee Schedule,127.35,48% of toatl Billed Charges for Outpatient Setting,137.87,100% of BCBS Fee Schedule for Outpatient Setting,137.87,100% of BCBS Fee Schedule for Outpatient Setting,153.04,111% of BCBS Fee Schedule for Outpatient Setting,132.66,50% of total Billed charges for Outpatient setting,185.72,70% of Total Billed charges for Outpatient setting,128.62,48.48% of total Billed Charges for Outpatient Setting,128.62,48.48% of total Billed Charges for Outpatient Setting,128.62,48.48% of total Billed Charges for Outpatient Setting,185.72,70% of Total Billed charges for Outpatient setting,185.72,70% of Total Billed charges for Outpatient setting,127.35,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,128.62,48.48% of total Billed Charges for Outpatient Setting,238.78,90% of Total Billed charges for Outpatient setting,127.35,399,159.19
Outpatient Medical Services,OUTPATIENT,11755,Biopsy Nail Unit,761,1788.52,399,100% of Aetna Asc Tier Grouping Fee Schedule,858.49,48% of toatl Billed Charges for Outpatient Setting,674.63,100% of BCBS Fee Schedule for Outpatient Setting,674.63,100% of BCBS Fee Schedule for Outpatient Setting,748.84,111% of BCBS Fee Schedule for Outpatient Setting,894.26,50% of total Billed charges for Outpatient setting,1251.96,70% of Total Billed charges for Outpatient setting,867.07,48.48% of total Billed Charges for Outpatient Setting,867.07,48.48% of total Billed Charges for Outpatient Setting,867.07,48.48% of total Billed Charges for Outpatient Setting,1251.96,70% of Total Billed charges for Outpatient setting,1251.96,70% of Total Billed charges for Outpatient setting,858.49,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,867.07,48.48% of total Billed Charges for Outpatient Setting,1609.67,90% of Total Billed charges for Outpatient setting,399,1609.67,1073.11
Outpatient Medical Services,OUTPATIENT,38505,Biopsy Needle Lymph Nodes,761,2128.75,399,100% of Aetna Asc Tier Grouping Fee Schedule,1021.8,48% of toatl Billed Charges for Outpatient Setting,582.79,100% of BCBS Fee Schedule for Outpatient Setting,582.79,100% of BCBS Fee Schedule for Outpatient Setting,646.9,111% of BCBS Fee Schedule for Outpatient Setting,1064.38,50% of total Billed charges for Outpatient setting,1490.13,70% of Total Billed charges for Outpatient setting,1032.02,48.48% of total Billed Charges for Outpatient Setting,1032.02,48.48% of total Billed Charges for Outpatient Setting,1032.02,48.48% of total Billed Charges for Outpatient Setting,1490.13,70% of Total Billed charges for Outpatient setting,1490.13,70% of Total Billed charges for Outpatient setting,1021.8,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,1032.02,48.48% of total Billed Charges for Outpatient Setting,1915.88,90% of Total Billed charges for Outpatient setting,399,1915.88,1277.25
Outpatient Medical Services,OUTPATIENT,11105,Biopsy Skin SQ Tissue Each Additional,761,265.31,399,100% of Aetna Asc Tier Grouping Fee Schedule,127.35,48% of toatl Billed Charges for Outpatient Setting,166.76,100% of BCBS Fee Schedule for Outpatient Setting,166.76,100% of BCBS Fee Schedule for Outpatient Setting,185.1,111% of BCBS Fee Schedule for Outpatient Setting,132.66,50% of total Billed charges for Outpatient setting,185.72,70% of Total Billed charges for Outpatient setting,128.62,48.48% of total Billed Charges for Outpatient Setting,128.62,48.48% of total Billed Charges for Outpatient Setting,128.62,48.48% of total Billed Charges for Outpatient Setting,185.72,70% of Total Billed charges for Outpatient setting,185.72,70% of Total Billed charges for Outpatient setting,127.35,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,128.62,48.48% of total Billed Charges for Outpatient Setting,238.78,90% of Total Billed charges for Outpatient setting,127.35,399,159.19
Outpatient Medical Services,OUTPATIENT,11104,Biopsy Skin SQ Tissue Single,761,1256.65,399,100% of Aetna Asc Tier Grouping Fee Schedule,603.19,48% of toatl Billed Charges for Outpatient Setting,482.21,100% of BCBS Fee Schedule for Outpatient Setting,482.21,100% of BCBS Fee Schedule for Outpatient Setting,535.25,111% of BCBS Fee Schedule for Outpatient Setting,628.33,50% of total Billed charges for Outpatient setting,879.66,70% of Total Billed charges for Outpatient setting,609.22,48.48% of total Billed Charges for Outpatient Setting,609.22,48.48% of total Billed Charges for Outpatient Setting,609.22,48.48% of total Billed Charges for Outpatient Setting,879.66,70% of Total Billed charges for Outpatient setting,879.66,70% of Total Billed charges for Outpatient setting,603.19,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,609.22,48.48% of total Billed Charges for Outpatient Setting,1130.99,90% of Total Billed charges for Outpatient setting,399,1130.99,753.99
Outpatient Medical Services,OUTPATIENT,51798,Bladder Scan/Post Void Residual,761,179.98,107.99,60% of total billed charges for outpatient setting,86.39,48% of toatl Billed Charges for Outpatient Setting,99.81,100% of BCBS Fee Schedule for Outpatient Setting,99.81,100% of BCBS Fee Schedule for Outpatient Setting,110.79,111% of BCBS Fee Schedule for Outpatient Setting,89.99,50% of total Billed charges for Outpatient setting,125.99,70% of Total Billed charges for Outpatient setting,87.25,48.48% of total Billed Charges for Outpatient Setting,87.25,48.48% of total Billed Charges for Outpatient Setting,87.25,48.48% of total Billed Charges for Outpatient Setting,125.99,70% of Total Billed charges for Outpatient setting,125.99,70% of Total Billed charges for Outpatient setting,86.39,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,87.25,48.48% of total Billed Charges for Outpatient Setting,161.98,90% of Total Billed charges for Outpatient setting,86.39,161.98,134.99
Outpatient Medical Services,OUTPATIENT,17250,Chemical Cautery Tissue,761,425.49,399,100% of Aetna Asc Tier Grouping Fee Schedule,204.24,48% of toatl Billed Charges for Outpatient Setting,172.44,100% of BCBS Fee Schedule for Outpatient Setting,172.44,100% of BCBS Fee Schedule for Outpatient Setting,191.41,111% of BCBS Fee Schedule for Outpatient Setting,212.75,50% of total Billed charges for Outpatient setting,297.84,70% of Total Billed charges for Outpatient setting,206.28,48.48% of total Billed Charges for Outpatient Setting,206.28,48.48% of total Billed Charges for Outpatient Setting,206.28,48.48% of total Billed Charges for Outpatient Setting,297.84,70% of Total Billed charges for Outpatient setting,297.84,70% of Total Billed charges for Outpatient setting,204.24,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,206.28,48.48% of total Billed Charges for Outpatient Setting,382.94,90% of Total Billed charges for Outpatient setting,172.44,399,255.29
Outpatient Medical Services,OUTPATIENT,97598,Debridement Wound <20cm,761,699.07,399,100% of Aetna Asc Tier Grouping Fee Schedule,335.55,48% of toatl Billed Charges for Outpatient Setting,138.83,100% of BCBS Fee Schedule for Outpatient Setting,138.83,100% of BCBS Fee Schedule for Outpatient Setting,154.1,111% of BCBS Fee Schedule for Outpatient Setting,349.54,50% of total Billed charges for Outpatient setting,489.35,70% of Total Billed charges for Outpatient setting,338.91,48.48% of total Billed Charges for Outpatient Setting,338.91,48.48% of total Billed Charges for Outpatient Setting,338.91,48.48% of total Billed Charges for Outpatient Setting,489.35,70% of Total Billed charges for Outpatient setting,489.35,70% of Total Billed charges for Outpatient setting,335.55,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,338.91,48.48% of total Billed Charges for Outpatient Setting,629.16,90% of Total Billed charges for Outpatient setting,138.83,629.16,419.44
Outpatient Medical Services,OUTPATIENT,97597,Debridement Wound >20cm,761,724.35,399,100% of Aetna Asc Tier Grouping Fee Schedule,347.69,48% of toatl Billed Charges for Outpatient Setting,111.01,100% of BCBS Fee Schedule for Outpatient Setting,111.01,100% of BCBS Fee Schedule for Outpatient Setting,123.22,111% of BCBS Fee Schedule for Outpatient Setting,362.18,50% of total Billed charges for Outpatient setting,507.05,70% of Total Billed charges for Outpatient setting,351.16,48.48% of total Billed Charges for Outpatient Setting,351.16,48.48% of total Billed Charges for Outpatient Setting,351.16,48.48% of total Billed Charges for Outpatient Setting,507.05,70% of Total Billed charges for Outpatient setting,507.05,70% of Total Billed charges for Outpatient setting,347.69,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,351.16,48.48% of total Billed Charges for Outpatient Setting,651.92,90% of Total Billed charges for Outpatient setting,111.01,651.92,434.61
Outpatient Medical Services,OUTPATIENT,11740,Evac Subungl Hematoma,761,106.25,399,100% of Aetna Asc Tier Grouping Fee Schedule,51,48% of toatl Billed Charges for Outpatient Setting,122.18,100% of BCBS Fee Schedule for Outpatient Setting,122.18,100% of BCBS Fee Schedule for Outpatient Setting,135.62,111% of BCBS Fee Schedule for Outpatient Setting,53.13,50% of total Billed charges for Outpatient setting,74.38,70% of Total Billed charges for Outpatient setting,51.51,48.48% of total Billed Charges for Outpatient Setting,51.51,48.48% of total Billed Charges for Outpatient Setting,51.51,48.48% of total Billed Charges for Outpatient Setting,74.38,70% of Total Billed charges for Outpatient setting,74.38,70% of Total Billed charges for Outpatient setting,51,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,51.51,48.48% of total Billed Charges for Outpatient Setting,95.63,90% of Total Billed charges for Outpatient setting,51,399,79.69
Outpatient Medical Services,OUTPATIENT,11750,Excision Nail Bed,761,1256.25,399,100% of Aetna Asc Tier Grouping Fee Schedule,603,48% of toatl Billed Charges for Outpatient Setting,674.63,100% of BCBS Fee Schedule for Outpatient Setting,674.63,100% of BCBS Fee Schedule for Outpatient Setting,748.84,111% of BCBS Fee Schedule for Outpatient Setting,628.13,50% of total Billed charges for Outpatient setting,879.38,70% of Total Billed charges for Outpatient setting,609.03,48.48% of total Billed Charges for Outpatient Setting,609.03,48.48% of total Billed Charges for Outpatient Setting,609.03,48.48% of total Billed Charges for Outpatient Setting,879.38,70% of Total Billed charges for Outpatient setting,879.38,70% of Total Billed charges for Outpatient setting,603,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,609.03,48.48% of total Billed Charges for Outpatient Setting,1130.63,90% of Total Billed charges for Outpatient setting,399,1130.63,753.75
Outpatient Medical Services,OUTPATIENT,11765,Excision Wedge Nail Fold,761,232.75,399,100% of Aetna Asc Tier Grouping Fee Schedule,111.72,48% of toatl Billed Charges for Outpatient Setting,265.71,100% of BCBS Fee Schedule for Outpatient Setting,265.71,100% of BCBS Fee Schedule for Outpatient Setting,294.94,111% of BCBS Fee Schedule for Outpatient Setting,116.38,50% of total Billed charges for Outpatient setting,162.93,70% of Total Billed charges for Outpatient setting,112.84,48.48% of total Billed Charges for Outpatient Setting,112.84,48.48% of total Billed Charges for Outpatient Setting,112.84,48.48% of total Billed Charges for Outpatient Setting,162.93,70% of Total Billed charges for Outpatient setting,162.93,70% of Total Billed charges for Outpatient setting,111.72,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,112.84,48.48% of total Billed Charges for Outpatient Setting,209.48,90% of Total Billed charges for Outpatient setting,111.72,399,139.65
Outpatient Medical Services,OUTPATIENT,10140,I&D Hematoma,761,540.19,399,100% of Aetna Asc Tier Grouping Fee Schedule,259.29,48% of toatl Billed Charges for Outpatient Setting,2574.32,100% of BCBS Fee Schedule for Outpatient Setting,2574.32,100% of BCBS Fee Schedule for Outpatient Setting,2857.5,111% of BCBS Fee Schedule for Outpatient Setting,270.1,50% of total Billed charges for Outpatient setting,378.13,70% of Total Billed charges for Outpatient setting,261.88,48.48% of total Billed Charges for Outpatient Setting,261.88,48.48% of total Billed Charges for Outpatient Setting,261.88,48.48% of total Billed Charges for Outpatient Setting,378.13,70% of Total Billed charges for Outpatient setting,378.13,70% of Total Billed charges for Outpatient setting,259.29,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,261.88,48.48% of total Billed Charges for Outpatient Setting,486.17,90% of Total Billed charges for Outpatient setting,259.29,2857.5,324.11
Outpatient Medical Services,OUTPATIENT,96360,IV Hydration 31Mins-1Hr INTL,260,208.75,125.25,60% of total billed charges for outpatient setting,100.2,48% of toatl Billed Charges for Outpatient Setting,133.96,100% of BCBS Fee Schedule for Outpatient Setting,133.96,100% of BCBS Fee Schedule for Outpatient Setting,148.7,111% of BCBS Fee Schedule for Outpatient Setting,104.38,50% of total Billed charges for Outpatient setting,146.13,70% of Total Billed charges for Outpatient setting,101.2,48.48% of total Billed Charges for Outpatient Setting,101.2,48.48% of total Billed Charges for Outpatient Setting,101.2,48.48% of total Billed Charges for Outpatient Setting,146.13,70% of Total Billed charges for Outpatient setting,146.13,70% of Total Billed charges for Outpatient setting,100.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,101.2,48.48% of total Billed Charges for Outpatient Setting,187.88,90% of Total Billed charges for Outpatient setting,100.2,187.88,125.25
Outpatient Medical Services,OUTPATIENT,96361,IV Hydration Each Additional Hr,260,45,27,60% of total billed charges for outpatient setting,21.6,48% of toatl Billed Charges for Outpatient Setting,43.04,100% of BCBS Fee Schedule for Outpatient Setting,43.04,100% of BCBS Fee Schedule for Outpatient Setting,47.77,111% of BCBS Fee Schedule for Outpatient Setting,22.5,50% of total Billed charges for Outpatient setting,31.5,70% of Total Billed charges for Outpatient setting,21.82,48.48% of total Billed Charges for Outpatient Setting,21.82,48.48% of total Billed Charges for Outpatient Setting,21.82,48.48% of total Billed Charges for Outpatient Setting,31.5,70% of Total Billed charges for Outpatient setting,31.5,70% of Total Billed charges for Outpatient setting,21.6,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,21.82,48.48% of total Billed Charges for Outpatient Setting,40.5,90% of Total Billed charges for Outpatient setting,21.6,47.77,33.75
Outpatient Medical Services,OUTPATIENT,10160,Puncture Drainage of Abscess,761,408.75,399,100% of Aetna Asc Tier Grouping Fee Schedule,196.2,48% of toatl Billed Charges for Outpatient Setting,204.38,50% of total Billed charges for outpatient setting,204.38,50% of total Billed charges for outpatient setting,204.38,50% of total Billed charges for outpatient setting,204.38,50% of total Billed charges for Outpatient setting,286.13,70% of Total Billed charges for Outpatient setting,198.16,48.48% of total Billed Charges for Outpatient Setting,198.16,48.48% of total Billed Charges for Outpatient Setting,198.16,48.48% of total Billed Charges for Outpatient Setting,286.13,70% of Total Billed charges for Outpatient setting,286.13,70% of Total Billed charges for Outpatient setting,196.2,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,198.16,48.48% of total Billed Charges for Outpatient Setting,367.88,90% of Total Billed charges for Outpatient setting,196.2,399,245.25
Outpatient Medical Services,OUTPATIENT,10120,Removal Foreign Body,761,774.38,399,100% of Aetna Asc Tier Grouping Fee Schedule,371.7,48% of toatl Billed Charges for Outpatient Setting,616.4,100% of BCBS Fee Schedule for Outpatient Setting,616.4,100% of BCBS Fee Schedule for Outpatient Setting,684.2,111% of BCBS Fee Schedule for Outpatient Setting,387.19,50% of total Billed charges for Outpatient setting,542.07,70% of Total Billed charges for Outpatient setting,375.42,48.48% of total Billed Charges for Outpatient Setting,375.42,48.48% of total Billed Charges for Outpatient Setting,375.42,48.48% of total Billed Charges for Outpatient Setting,542.07,70% of Total Billed charges for Outpatient setting,542.07,70% of Total Billed charges for Outpatient setting,371.7,48% of toatl Billed Charges for Outpatient Setting,N/A,Not Applicable.Service not offered,375.42,48.48% of total Billed Charges for Outpatient Setting,696.94,90% of Total Billed charges for Outpatient setting,371.7,696.94,464.63
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal ,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,73721,MRI scan of leg joint,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,SLEEP STUDY,95810,Sleep study,920,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A